| Statement of Deficiencies | (X1) Provider/Supplier/CLIA Identification Number 852582 | (X3) Date Survey Completed 06/24/2025 |
| Name of Provider or Supplier West Clayton Dialysis | Street Address, City, State 100 Promenade Pkwy Suite C, Fayetteville, 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 | An unannounced onsite visit to investigate complaint #GA00255259 was conducted at West Clayton Dialysis from June 24, 2025 through June 24, 2025. One of one allegation (Nursing Services) was substantiated. A deficiency was cited. |