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 852575 (X3) Date Survey Completed 05/25/2022
Name of Provider or Supplier Cc&D Services Street Address, City, State 5040 Snapfinger Woods Dr, Ste 108, Decatur, 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)
V0401 PE-SAFE/FUNCTIONAL/COMFORTABLE ENVIRONMENT
CFR(s): 494.60

The dialysis facility must be designed, constructed, equipped, and maintained to provide dialysis patients, staff, and the public a safe, functional, and comfortable treatment environment.


This STANDARD is not met as evidenced by:
Based on observation and staff interview, it was determined that the facility failed to ensure that there was a safe environment for all 15 of 15 patients (P#1 - P#15) who were undergoing hemodialysis treatment at the time of this observation and that three of three Patient Care Technicians (PCT AA, PCT BB and PCT CC), and one of one Registered Nurse (RN AA), who were present at the time of this observation, as evidenced by the presence of standing water on the floor and a crack on the floor's surface in the patients' treatment room. Failure to keep the floor clean and dry had the potential for slips and fall accidents. The patient census was 34. Findings include: During observation in the patients' treatment room on 5/25/22 between 12:05 p.m. and 1:40 p.m., the following was revealed: - There was a straight crack in the middle of the floor that ran in front of Station (S) 2 through to S12. - There were four wet blue chuck pads that covered a wet area on the floor between the machine at S9 and the wall chase box behind it, and the floor was wet behind the machines at S11 and S12. There were no "Caution Signs" to alert others about the wet floors. P#6 at S26 stated on 5/25/22 at 1:00 p.m., that she had noticed some wet areas on the floor of the treatment room at times. The Facility Administrator stated on 5/25/22 at approximately 2:30 p.m., that the wet floors was due to the plumbing issues in the building and the chase boxes, and not from the dialysis machines. The Biomed Technician (BMT) was not available for an interview and record review.