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)
V0695 PQ-PCT CERTIFIED
CFR(s): 494.140(e)(4)

Patient care dialysis technicians must- (4) Be certified under a State certification program or a national commercially available certification program, as follows- (i) For newly employed patient care technicians, within 18 months of being hired as a dialysis patient care technician; or (ii) For patient care technicians employed on October 14, 2008, within 18 months after such date.


This STANDARD is not met as evidenced by:
Based on facility record review and staff and patient interviews, it was revealed that the facility failed to ensure that one of one Patient Care Technician (PCT AA) sampled, who was specifically mentioned in the complaint allegation, and three of three other PCTs (PCT BB, PCT CC, and PCT DD), who were currently employed at this facility, had records of their certification status, nor PCT training. This deficient practice had the potential to negatively impact the health and safety of all 32 patients who were under the care of this facility. Findings include: A review of all certified and licensed personnel records at the facility revealed the following: PCT AA was hired by this facility on 11/20/20. There were no records of PCT AA's certification status. -A review of PCT AA's Time Card or schedule of hours worked from June 3, 2022 through July 11, 2022 revealed that PCT AA continued to work at this facility on 6/3/22, 6/6/22, 6/8/22, and on 6/10/22, with an average of 11.93 hours per work day. - The complainant (C#1), on 7/6/22 at approximately 11:40 a.m., stated that PCT AA told her and several other patients on 5/25/22, when a State Surveyor came to investigate a complaint, PCT AA told them that her name was another PCT's name, (PCT VV) who had left employment since September of 2021. - According to the Chief Executive Officer (CEO/Owner) on 7/6/22 at approximately 1:30 pm., he could not find any of PCT AA's personnel records on file. He stated that both the Facility Administrator (FA #1) and PCT AA left employment at about the same time. - A review of the personnel records of PCT BB, PCT CC, and PCT DD, who were currently working at this facility, also revealed no records of Hemodialysis certification status nor PCT training. The Chief Executive Officer/Owner could not find any documentary evidence of PCT BB, PCT CC, and PCT DD's certification records nor PCT training. The CEO was not able to provide any of the PCTs certification status, nor PCT training as of 7/18/22.