| Statement of Deficiencies | (X1) Provider/Supplier/CLIA Identification Number 852553 | (X3) Date Survey Completed 06/13/2019 |
| Name of Provider or Supplier Flint River Dialysis | Street Address, City, State 700 Gordon Avenue, Bainbridge, 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) |
| V0403 | PE-EQUIPMENT MAINTENANCE-MANUFACTURER'S DFU CFR(s): 494.60(b) The dialysis facility must implement and maintain a program to ensure that all equipment (including emergency equipment, dialysis machines and equipment, and the water treatment system) are maintained and operated in accordance with the manufacturer's recommendations. This STANDARD is not met as evidenced by: Based on record review and staff interview, it was determined that the facility failed to ensure that three of three Phoenix Meters [device used to measure pH (acidity) and conductivity (ability of the dialysate to conduct electricity)] were calibrated. This deficient practice had the potential to negatively affect the health and safety of all 60 in-center hemodialysis patients who dialyze at the facility. Findings include: A review of Phoenix Meter Calibration Logs from April 2019 to May 2019 revealed that during the month of May 2019, three of three Phoenix Meters had no documentation of the Phoenix Meter's serial number (used for identification and inventory) recorded in the Calibration Log. Therefore, there was no specific identification of which Phoenix Meter was calibrated, logged, used, or out of service. During an interview with Biomedical Technician AA on 6/12/19 at 11:00 a.m., he stated that all three Phoenix Meters needed to be identified with serial number and recorded in the Calibration Log for proper identification. |