| 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) |
| V0402 | PE-BUILDING-CONSTRUCT/MAINTAIN FOR SAFETY CFR(s): 494.60(a) The building in which dialysis services are furnished must be constructed and maintained to ensure the safety of the patients, the staff and the public. This STANDARD is not met as evidenced by: Based on observation and staff interview, it was determined that the facility failed to ensure that the Acid holding tank was maintained and cleaned to ensure the safety of the 42 patients who dialyzed at this facility. This deficient practice was observed in one of one Water Treatment Room. Findings were: During a tour of the water treatment room on 4/10/2023 at 11:45 a.m., the following was observed: - The hose attached to the holding tank was covered with crystallized substance. - The area under the holding tank was covered with rust colored stains. During an interview with the Clinic Manager on 4/10/23 at approximately 3:00 p.m., she stated that the crystallized substance and the rust should be cleaned and removed. |