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 08/18/2022
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)
V0126 IC-HBV-VACCINATE PTS/STAFF
CFR(s): 494.30(a)(1)(i)

Hepatitis B Vaccination Vaccinate all susceptible patients and staff members against hepatitis B.


This STANDARD is not met as evidenced by:
Based on a review of facility records, a review of personnel file, and staff interviews, it was determined that the facility failed to ensure that two of two Registered Nurses (RN DD and RN OO), two of two Patient Care Technicians (PCT CC and PCT FF), and two of two Certified Clinical Hemodialysis Technicians (CCHT VV and CCHT ZZ) had current Hepatitis B status/vaccination. This deficient practice had the potential to negatively affect the health and safety of 33 patients who were under the care of this facility and eight Direct Patient Care Staff (RNs and PCTs/CCHTs) who worked at this facility. Findings include: A review of personnel health file showed the following: - RN DD was hired on 6/1/22. There were no records of Hepatitis B status or vaccination/declination nor any records of being offered Hepatitis B vaccine. - RN OO (Orientee), who was hired on 4/1/22, and new to Hemodialysis, did not have any records of Hepatitis B status or vaccination/declination nor any records of being offered Hepatitis B vaccine. - PCT CC was hired on 5/1/22 (and this was the same PCT CC who did not have personnel records during the July 6 and 7, 2022 complaint investigation survey). There were no records of Hepatitis B status or vaccination/declination nor any records of being offered Hepatitis B vaccine. - PCT FF was hired on 7/8/22. There were no records of Hepatitis B status or vaccination/declination nor any records of being offered Hepatitis B vaccine. - CCHT VV was hired on 7/18/22. There were no records of Hepatitis B status or vaccination/declination nor any records of being offered Hepatitis B vaccine. - CCHT ZZ was hired on 7/8/22. There were no records of Hepatitis B status or vaccination/declination nor any records of being offered Hepatitis B vaccine. - During an interview with the Facility Administrator on 8/17/22 at approximately 2:00 p.m., she stated that she was not able to complete the personnel health records. - During an interview with the Chief Executive Officer (CEO) on 8/17/22 at approximately 2:30 p.m., he stated that the personnel file should have been completed since it was to be worked on from the exit date of the last survey and was to be a priority. - When asked if there were specific facility policies and procedures (P & P) for new hires regarding health status checks, the CEO stated on 8/17/22 at approximately 3:30 p.m., that all employees received Employee handbook which stated general facility welcome and expectations, benefits, etc., but did not address specific requirements to be completed such as orientation and health status tests.