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 07/23/2025
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)
V0175 CFC-WATER & DIALYSATE QUALITY
CFR(s): 494.40



This CONDITION is not met as evidenced by:
Based on observation, staff interviews, a review of the manufacturer's Directions for Use (DFU), a review of facility Policies and Procedures (P&P), and a review of the Association for the Advancement of Medical Instrumentation's (AAMI's) "American National Standard for Dialysate for Hemodialysis" (ANSI/AAMI RD52: 2004), it was determined that the facility failed to ensure that there was a safe environment for all in-center hemodialysis (ICHD) patients as evidenced by failure of two of two Patient Care Technicians (PCTs - PCT AA and PCT BB) observed, to correctly verify the hemodialysis (HD) machine's final dialysate conductivity (ability of the dialysate to conduct electricity) and pH (acidity), according to the manufacturer's DFU and facility's P & P. This failure had the potential to negatively affect the health and safety of five of five patients who were receiving hemodialysis treatment at Stations (S) 1, S2, S4, S6, and S7 at the time of observation. Incorrect dialysate composition can lead to a range of complications, from mild symptoms such as nausea and fatigue to more serious conditions like metabolic acidosis (a decrease in blood pH that may cause rapid breathing, confusion, dizziness, shortness of breath, or chest pain). And if conductivity is out of the acceptable range, the effectiveness of the dialysis treatment may be reduced, and impair patient treatment, alter electrolyte and fluid balance, and lead to serious health consequences. The facility census was 10. Findings include: Cross Reference: V 250 - Failure of PCT AA and PCT BB to correctly verify the machine's final dialysate conductivity and pH according to the manufacturer's DFU and facility P & P.