| 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) |
| V0750 | CFC-GOVERNANCE CFR(s): 494.180 This CONDITION is not met as evidenced by: Based on observations, staff interviews, a review of the manufacturer's directions for use (DFU) and facility policy and procedures (P & P), it was determined that the Governing Body who is responsible for the governance and operation of the facility, failed to ensure that policies, procedures and regulations relative to the health care and safety of patients, and to the general operation of the facility were adhered to. This failure had the potential to negatively affect the health and safety of all 13 patients who were under the care of this facility. Findings include: Cross Reference V 117 - Failure of the Governing Body 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. Cross Reference V 196 - Failure of the Governing Body to ensure the Direct Patient Care Staff (Registered Nurses and Patient Care Technicians) follow the manufacturer's DFU to accurately determine the level of Total Chlorine in the water used for dialysis. Cross Reference V 638 - Failure of the Governing Body to monitor its performance, take actions that result in performance improvements, and track performance to ensure that improvements are sustained over time. |