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)
V0113 IC-WEAR GLOVES/HAND HYGIENE
CFR(s): 494.30(a)(1)

Wear disposable gloves when caring for the patient or touching the patient's equipment at the dialysis station. Staff must remove gloves and wash hands between each patient or station.


This STANDARD is not met as evidenced by:
Based on observation, a review of policy and procedure, and staff interview, it was determined that the Infection Control Committee failed to ensure that and one of two Certified Clinical Hemodialysis Technician (CCHT BB) observed, performed hand hygiene (wash hands or use an alcohol-based hand sanitizer), after removal of contaminated gloves. This breach in infection control had the potential to cause the spread of infections, or bloodborne pathogens in the dialysis environment through cross contamination. The facility In-center Hemodialysis census was 42. Findings include: During observation in the patient treatment room on 4/12/23 between 9:30 a.m. and 11:00 a.m., the following was revealed: - CCHT BB was observed answering a machine alarm at Station 11. She removed her gloves and documented on the computer (clean) and then placed another pair of gloves on without sanitizing or washing her hands. A review of Policy titled, "Infection Control " dated 1/6/16 stated the following: - Hands are always washed after gloves are removed and between patient contact. According to CDC recommendations, even with glove use, hand hygiene is necessary after glove removal because hands can become contaminated through small defects in gloves and from the outer surface of gloves during glove removal ... During an interview on 4/12/23 at approximately 10:30 a.m., the Clinic Manager stated that CCHT BB should have performed appropriate hand hygiene.