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)
V0501 PA-IDT MEMBERS/RESPONSIBILITIES
CFR(s): 494.80

The facility's interdisciplinary team consists of, at a minimum, the patient or the patient's designee (if the patient chooses), a registered nurse, a physician treating the patient for ESRD, a social worker, and a dietitian. The interdisciplinary team is responsible for providing each patient with an individualized and comprehensive assessment of his or her needs. The comprehensive assessment must be used to develop the patient's treatment plan and expectations for care.


This STANDARD is not met as evidenced by:
Based on facility record review and staff interview, it was determined that the facility failed to ensure that three of five (P#1, P#2, and P#3) sampled patients, had a current comprehensive Interdisciplinary Team (IDT) assessment that was used to develop the patient's treatment plan and expectations for care. This deficient practice had the potential to negatively affect the health and safety of three patients sampled and the other 29 patients who were under the care of this facility. Findings include: A review of the medical records of P#1 - P#3, revealed the following: - P#1 was admitted to this facility on 5/2/22. There was no documentary evidence that an Initial comprehensive assessment was completed by the entire IDT. - P#2 was admitted to this facility on 2/2/22. There was no documentary evidence that an Initial and 90-day comprehensive assessment completed by the entire IDT. - P#3 was admitted to this facility on 12/20/21. There was no documentary evidence that an Initial and 90-day comprehensive assessment was completed by the entire IDT. During an interview on 7/12/22 at approximately 11:15 a.m., the Chief Executive Officer (CEO)/Owner stated he could not find any of the missing documents.