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 852569 (X3) Date Survey Completed 06/23/2023
Name of Provider or Supplier Dialysis Center Of Athens Street Address, City, State 210 Hawthorne Park, Athens, 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)
V0110 CFC-INFECTION CONTROL
CFR(s): 494.30



This CONDITION is not met as evidenced by:
Based on observation, staff interviews, a review of Centers for Disease Control and Prevention (CDC) guidelines, and a review of facility policy and procedures (P&P), it was determined that the facility failed to ensure that the staff practiced infection control techniques to prevent transmission of dangerous pathogens in the hemodialysis unit. This deficient practice had the potential to negatively affect the health and safety of all 13 in-center hemodialysis patients who were receiving dialysis at this facility. Findings include: Cross reference: V 117 - Failure of the facility to ensure Direct Patient Care Staff (Registered Nurse and Patient Care Technicians) did not store or keep blood specimens for labs in the Medication Refrigerator.