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 852586 (X3) Date Survey Completed 07/09/2025
Name of Provider or Supplier Dialysis Care Center Gwinnett, Llc Street Address, City, State 558 Old Norcross Road, Suite 104, Lawrenceville, 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)
V0175 CFC-WATER & DIALYSATE QUALITY
CFR(s): 494.40



This CONDITION is not met as evidenced by:
Based on observation, staff interviews, a review of the manufacturer's Directions for Use (DFU) and a review of the facility's Policy and Procedures (P&P), it was determined that the facility failed to ensure that there was a safe environment for all patients as evidenced by failure of two of three Patient Care Technicians (PCT AA and PCT BB) observed, to correctly verify the machine's final dialysate conductivity (ability of the dialysate to conduct electricity) and pH (acidity), according to the manufacturer's DFU and facility P&P. This failure had the potential to negatively affect the health and safety of 11 of 11 patients who were receiving hemodialysis treatment at Station (S) 1, S2, S3, S4, S5, S6, S7, S8, S9, S11, and S12 at the time of this observation. Complications as minor as nausea and fatigue or as severe as metabolic acidosis (decrease in pH that could cause rapid breathing, confusion, dizziness, shortness of breath, chest pain) could result if dialysate composition is incorrect. And if the conductivity is out of the acceptable range, the effectiveness of the treatment is reduced and the patient's electrolyte balance could be altered. The facility census was 71. Findings include: Cross Reference: V 250 - Failure of the facility to ensure that two of three Patient Care Technicians (PCT AA and PCT BB) observed, correctly verified the machine's dialysate conductivity and pH, according to the manufacturer's DFU and facility P&P.