Department of Health & Human Services

Centers for Medicare & Medicaid Services
Form Approved

OMB No. 0938-0391

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.