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 852554 (X3) Date Survey Completed 02/28/2024
Name of Provider or Supplier Panola Dialysis Street Address, City, State 5360 Snapfinger Woods Dr, Ste 102, Stonecrest, 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)
V0710 CFC-RESPONSIBILITIES OF THE MEDICAL DIRECTOR
CFR(s): 494.150



This CONDITION is not met as evidenced by:
Based on a review of medical records, staff interviews, and review of the facility's Policies and Procedures (P & P), it was determined that the Medical Director failed to ensure that one of one patient (P#1) who experienced chest pain while at this facility, received care and supervision appropriate to the patient's medical needs. The facility failed to reassess, monitor, and take steps to manage P#1's chest pain for over two hours while she waited for the EMS (Emergency Medical System) to arrive. The facility census was 24. Findings include: Cross Reference V715: Failure of the medical director to ensure that all P & P relative to patient care were adhered to by all staff.