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 852578 (X3) Date Survey Completed 04/12/2023
Name of Provider or Supplier Dialysis Care Center Pleasant Hill, Llc Street Address, City, State 1425 Georgia Ave, Suite 101, Macon, 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)
V0000 A Recertification Survey [CORE] was conducted at Dialysis Care Cenrer Pleasant Hill, LLC from April 10, 2023 through April 12, 2023. The survey revealed that the facility was in substantial compliance with 42 CFR Part 494 Conditions for Coverage for End Stage Renal Disease Facilities. However, the following deficiencies resulted from the facility's noncompliance related to the survey: