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 07/12/2022
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)
V0000 An onsite survey to investigate complaints #GA00224547 and #GA00225116, was initiated on July 6, 2022 and concluded on July 12, 2022. The complaint investigation revealed that two of three allegations (Unqualified Personnel and Infection Control) were substantiated; and one of three allegations (Quality of Care/Treatment) was unsubstantiated. However, additional Condition level and standard level deficiencies were identified which resulted from the facility's noncompliance related to the survey. The survey revealed that the facility was not in compliance with 42 CFR Part 494.80 - Patient Assessment, 42 CFR Part 494.90 - Patient Care Plans, 42 CFR Part 494.110 - Quality Assessment and Performance Improvement, 42 CFR Part 494.140 - Personnel Qualifications, 42 CFR Part 494.150 - Responsibilities of the Medical Director, and 42 CFR Part 494.180 - Governance, for End Stage Renal Disease Facilities. The facility census was 32.