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)
V0402 PE-BUILDING-CONSTRUCT/MAINTAIN FOR SAFETY
CFR(s): 494.60(a)

The building in which dialysis services are furnished must be constructed and maintained to ensure the safety of the patients, the staff and the public.


This STANDARD is not met as evidenced by:
Based on observation and staff interviews, it was determined that the facility failed to maintain the integrity of the building to ensure the safety of the 13 patients who dialyzed at this facility. This failure could hinder effective cleaning and disinfection of the surfaces, thus had the potential for microbial growth. This deficient practice was observed in one of one Dialysate Preparation Room and front lobby. Findings include: During observation in the Dialysate Preparation Room on 6/21/23 at 12:40 p.m., with Patient Care Technician (PCT AA), the following was revealed: - The cement floor around the drain area between the Primary Carbon Tank and Water Softener Tank, were chipped exposing a porous surface that was conducive to microbial growth. - The Fluorescent ceiling light at the entrance of the Dialysate Preparation Room was not working. - There were two ceiling tiles that were covered with water stains at the lobby's ceiling. - The Biomedical Technician (BMT) was notified and acknowledged the above observations on 6/22/23 at 1:50 p.m.