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 852560 (X3) Date Survey Completed 04/01/2021
Name of Provider or Supplier Poplar Dialysis Street Address, City, State 2301 Newnan Crossing Blvd, Ste 180, Newnan, 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)
V0715 MD RESP-ENSURE ALL ADHERE TO P&P
CFR(s): 494.150(c)(2)(i)

The medical director must- (2) Ensure that- (i) All policies and procedures relative to patient admissions, patient care, infection control, and safety are adhered to by all individuals who treat patients in the facility, including attending physicians and nonphysician providers;


This STANDARD is not met as evidenced by:
Based on observation, a review of facility policy and procedure (P&P), and staff interview, it was determined that the Medical Director failed to ensure that the facility provided a safe environment (a room where airflow can be controlled per P&P) for one of one home peritoneal dialysis (PD) patient (P#1), who was receiving PD training at the facility. This environmental concern was observed in one of one PD room (PD room #1) observed, where P#1's training occured. Findings were: During a tour of the facility on 4/1/21 at 11:00 a.m., the following was observed: - The PD room did not have a system in place to control air flow from the the air vent during PD training and exit site dressing changes. A review of Policy 5-05-01A titled: "Post Operative Care of the PD Exit Site" dated October 2017 stated: Dressing changes are done in an area where airflow can be controlled. Open areas with free air circulation increase the risk of contamination. During a discussion with the Facility Administrator (FA) regarding the above findings on 4/1/21 at approximately 12:30 p.m., the FA agreed, and stated that the problem with the air vent will be fixed as soon as possible.