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)
V0516 PA-FREQUENCY-INITIAL-30 DAYS/13 TX
CFR(s): 494.80(b)(1)

An initial comprehensive assessment must be conducted on all new patients (that is, all admissions to a dialysis facility), within the latter of 30 calendar days or 13 hemodialysis sessions beginning with the first dialysis session.


This STANDARD is not met as evidenced by:
Based on a review of medical records and staff interview, it was determined that the facility failed to complete a comprehensive interdisciplinary assessment that was conducted by the entire Interdisciplinary Team (IDT) within 30 calendar days of admission or after 13 dialysis treatments for two of two sampled new patients (P#1 and P#2), who were admitted in 2022. This failure had the potential to negatively affect the health and safety of P#1 and P#2. The facility census was 32. A review of medical records revealed the following: - P#1 was admitted to this facility on 5/2/22. There was no documentary evidence that a comprehensive IDT initial assessment was completed. There was only a Social Worker's initial assessment. There was no documentary evidence of an Initial Registered Nurse (RN) Assessment before P#1's initial hemodialysis treatment. - P#2 was admitted on 2/2/22. There was no documentary evidence that a comprehensive IDT initial assessment was completed. There was no documentary evidence of an Initial RN Assessment on P#2 before his initial hemodialysis treatment at this facility. In addition, there was no documentary evidence that a 90-day comprehensive assessment was completed by the entire IDT for P#2. The Chief Executive Officer (CEO)/Owner, stated on 7/12/22 at approximately 11:30 a.m., that he could not find any documentary evidences of P#1's and P#2's initial IDT comprehensive assessment, nor of an Initial RN assessment prior to P#1's and P#2's hemodialysis treatment.