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 852579 (X3) Date Survey Completed 06/07/2023
Name of Provider or Supplier Home Dialysis Services Norcross, Llc Street Address, City, State 3780 Holcomb Bridge Road, Suite E, Norcross, 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)
V0632 QAPI-INDICATOR-ANEMIA MANAGEMENT
CFR(s): 494.110(a)(2)(iv)

The program must include, but not be limited to, the following: (iv) Anemia management.


This STANDARD is not met as evidenced by:
Based on a review of Dialysis Facility Report (DFR) and facility records and staff interview, it was determined that the facility failed to track and trend anemia rates (low red blood cell counts), develop action plans and evaluate the effectiveness of the facility's management of patients with a Hemoglobin (Hgb - protein in red blood cells that carries oxygen) of less than (<) 10 g/dL, for six of six months of Quality Improvement Meeting Minutes reviewed (December 2022 - May 2023). This deficient practice had the potential to negatively affect the health and safety of the six home hemodialysis patients who were receiving home dialysis support services at this facility. Findings were: A review of 2022 DFR (A report prepared by Centers for Medicare and Medicaid Services to provide a comparative summary of treatment patterns and patient outcomes for dialysis patients of this facility, as compared to other facilities in the U.S.) revealed that the average Hgb < 10 g/dL should not exceed 16.8 % for hemodialysis patients. A review of Quality Improvement Meeting reports for six of six months (December 2022 - May 2023) revealed that the facility's average percentage for Hgb < 10 g/dL was 28% for home hemodialysis patients. The Quality Improvement Meeting minutes revealed a lack of documented evidence that anemia management for home hemodialysis patients with a Hgb < 10 g/dL had appropriate action plans, root cause analysis, and follow-up evaluations to ensure improvement. During an interview with the Clinic Manager on 6/7/23 at approximately 1:30 p.m., she stated that the anemia management for patients with Hgb <10 were being reviewed. However, the action plans, root cause analysis and follow-up evaluation needed to be completed for the home hemodialysis patients with Hgb <10.