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)
V0710 CFC-RESPONSIBILITIES OF THE MEDICAL DIRECTOR
CFR(s): 494.150



This CONDITION is not met as evidenced by:
Based on a review of facility records and staff interviews, it was determined that the Medical Director (MD) failed to demonstrate responsibility for the operations of the facility. This failure had the potential to negatively impact the health and safety of 32 patients who were receiving hemodialysis at this facility. Findings include: Cross Reference the following cited deficiencies: V 681 - Failure of the facility to ensure that the Facility Administrator (FA), was duly licensed to perform skilled nursing care to hemodialysis patients and PCT AA was certified or had documentary evidence of PCT training and skills competencies to perform the duties and responsibilities for safe hemodialysis patient care. V 693 - Failure of the facility to ensure that all PCTs (AA, BB, CC, and DD) were competent to perform their assigned tasks. V 695 - Failure of the facility to ensure that all PCTs (AA, BB, CC, and DD) had a documentary evidence that they were certified under a State certification program or a national commercially available certification program. During an interview with the Medical Director on 7/12/22 at approximately 1:00 p.m., he stated that the facility needed stability of staff and that it was being addressed.