| Statement of Deficiencies | (X1) Provider/Supplier/CLIA Identification Number 852551 | (X3) Date Survey Completed 01/15/2025 |
| Name of Provider or Supplier Duluth Dialysis | Street Address, City, State 3170 Peachtree Ind Blvd, Ste 100, Duluth, GA | |
| For information on the provider's plan to correct this deficiency, please contact the provider or the state survey agency. | ||
| (X4) ID Prefix Tag | Summary Statement of Deficiencies
(Each deficiency should be preceded by full regulatory or LSC identifying information) |
| V0126 | IC-HBV-VACCINATE PTS/STAFF CFR(s): 494.30(a)(1)(i) Hepatitis B Vaccination Vaccinate all susceptible patients and staff members against hepatitis B. This STANDARD is not met as evidenced by: Based on a review of records and staff interview, it was determined that the facility failed to ensure that one of one Medical Director (MD) had current Hepatitis B status/vaccination. This deficient practice had the potential to negatively affect the health and safety of all staff employed and 32 in-center hemodialysis (ICHD) patients and 19 Peritoneal Dialysis (PD) patients who were under the care of this facility. Findings include: A review of personnel files revealed that the MD lacked recent documentation pertaining to hepatitis B testing, vaccination, or declination. The Facility Administrator (FA) was notified of the above findings on 1/15/25 at 10:23 a.m. The FA stated the documents were at the physician's office but as of exit interview on 1/15/25 at 1:15 p.m., the FA did not produce the missing documents. |