Statement of Deficiencies

Statement of Deficiencies	(X1) Provider/Supplier/CLIA Identification Number 852575	(X3) Date Survey Completed 08/14/2024
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)

V0543

POC-MANAGE VOLUME STATUS
CFR(s): 494.90(a)(1)

The plan of care must address, but not be limited to, the following: (1) Dose of dialysis. The interdisciplinary team must provide the necessary care and services to manage the patient's volume status;

This STANDARD is not met as evidenced by:
Based on a review of medical records and staff interviews, it was determined that the facility failed to ensure that the Interdisciplinary Team (IDT) updated the patient's plans of care to reflect a change in dry weight for five of five patients (P) (P#1, P#2, P#3, P#4, and P#5) who consistently presented at or below EDW (estimated dry weight) or consistently left below dry weight. Removal of too much fluid or going below the patient's target weight may cause low blood pressure, muscle cramping, and clotting of the vascular access. This deficient practice could negatively affect the health and safety of P#1, P#2, P#3, P#4, P#5, and the other 14 patients who were receiving dialysis treatment at this facility. Findings include: P#1: Pt #1's dialysis prescription: Tx (Treatment) time: 4:30 hours (4 hours and 30 minutes), EDW: 100 kg (kilogram), BFR (Blood Flow Rate): 450, DFR (Dialysate Flow Rate): 800. - On 7/31/24: P#1's EDW was 100 kg. P#1's pre dialysis weight was 101.7 kg. Post weight 97.5 kg. On 8/2/24: - P#1's EDW was 100 kg. P#1's pre dialysis weight was 98.7 kg. Post weight 95 kg. On 8/5/24: - P#1's EDW was 100 kg. P#1's pre dialysis weight was 99.7 kg. Post weight 95.8 kg. On 8/7/24: - P#1's EDW was 100 kg. P#1's pre dialysis weight was 97.2 kg. Post weight 92.9 kg. On 8/9/24: - P#1's EDW was 100 kg. P#1's pre dialysis weight was 96.5 kg. Post weight 91.2 kg. On 8/12/24: - P#1's EDW was 100 kg. P#1's pre dialysis weight was 95.2 kg. Post weight 90.5 kg. P#1 was admitted to the facility on 5/13/24 and did not yet have a care plan developed by the IDT P#2: Pt #2's dialysis prescription: Tx time: 3:30 hours (3 hours and 30 minutes), EDW: 73 kg, BFR: 400, DFR: 800. On 7/22/24: - P#2's EDW was 73 kg. P#2's pre dialysis weight was 73.4 kg. Post weight 72.2 kg. On 7/24/24: - P#2's EDW was 73 kg. P#2's pre dialysis weight was 73.5 kg. Post weight 72 kg. On 7/26/24: - P#2's EDW was 73 kg. P#2's pre dialysis weight was 72 kg. Post weight 71.6 kg. On 7/29/24: - P#2's EDW was 73 kg. P#2's pre dialysis weight was 72.2 kg. Post weight 70.2 kg. On 8/9/24: - P#2's EDW was 73 kg. P#2's pre dialysis weight was 75.5 kg. Post weight 72 kg. On 8/12/24: - P#2's EDW was 73 kg. P#2's pre dialysis weight was 74.8 kg. Post weight 72.7 kg. P#3: Pt #3's dialysis prescription: Tx time: 3:15 hours (3 hours and 15 minutes), EDW: 75 kg, BFR: 400, DFR: 400. On 7/26/24: - P#3's EDW was 75 kg. P#3's pre dialysis weight was 74.6 kg. Post weight 72 kg. On 7/24/24: - P#3's EDW was 75 kg. P#3's pre dialysis weight was 74.6 kg. Post weight 72 kg. On 7/29/24: - P#3's EDW was 73 kg. P#3's pre dialysis weight was 72.7 kg. Post weight 72.5 kg. On 7/31/24: - P#3's EDW was 75 kg. P#3's pre dialysis weight was 72.7 kg. Post weight 72.5 kg. On 8/2/24: - P#3's EDW was 75 kg. P#3's pre dialysis weight was 74.3 kg. Post weight 72.5 kg. On 8/5/24: - P#3's EDW was 75 kg. P#3's pre dialysis weight was 72.2 kg. Post weight 71.4 kg. On 8/7/24: - P#3's EDW was 75 kg. P#3's pre dialysis weight was 72.9 kg. Post weight 71.9 kg. On 8/9/24: - P#3's EDW was 75 kg. P#3's pre dialysis weight was 72.3 kg. Post weight 71.5 kg. On 8/12/24: - P#3's EDW was 75 kg. P#3's pre dialysis weight was 72.8 kg. Post weight 71.6 kg. P#4: Pt #4's dialysis prescription: Tx time: 3:30 hours, EDW: 87 kg, BFR: 400, DFR: 700. On 7/10/24: - P#4's EDW was 87 kg. P#4's pre dialysis weight was 89.1 kg. Post weight 83.1 kg. On 7/12/24: - P#4's EDW was 87 kg. P#4's pre dialysis weight was 87 kg. Post weight 84.6 kg. On 7/15/24: - P#4's EDW was 87 kg. P#4's pre dialysis weight was 90 kg. Post weight 85.3 kg. On 7/19/24: - P#4's EDW was 87 kg. P#4's pre dialysis weight was 89.4 kg. Post weight 84 kg. On 8/7/24: - P#4's EDW was 87 kg. P#4's pre dialysis weight was 89.4 kg. Post weight 86.4 kg. On 8/9/24: - P#4's EDW was 87 kg. P#4's pre dialysis weight was 87.5 kg. Post weight 84.6 kg. P#4's CIPA/POC dated 7/26/24 showed EDW was not updated or adjusted to reflect current dry weigh. P#5: Pt #5's dialysis prescription: Tx time: 3:30 hours, EDW: 65 kg, BFR: 350, DFR: 800. On 7/24/24: - P#5's EDW was 65 kg. P#5's pre dialysis weight was 68.1 kg. Post weight 64.2 kg. On 7/29/24: - P#5's EDW was 65 kg. P#5's pre dialysis weight was 66.8 kg. Post weight 68.4 kg. On 7/31/24: - P#5's EDW was 65 kg. P#5's pre dialysis weight was 64.5 kg. Post weight 62.2 kg. On 8/2/24: - P#5's EDW was 65 kg. P#5's pre dialysis weight was 62.7 kg. Post weight 63 kg. On 8/5/24: - P#5's EDW was 65 kg. P#5's pre dialysis weight was 63.7 kg. Post weight 60.8 kg. During an interview on 8/14/24 at approximately 3:40 p.m., this surveyor informed the Facility Administrator (FA) about the above concerns that no changes were made to reflect current EDW on the patient's care plan or treatment order to reflect that EDW has been reviewed and readjusted by the IDT/physician. The FA confirmed that CIPA/POC was not updated to address the EDW of P#1, P#2, P#3, P#4, and P#5.