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 852604 (X3) Date Survey Completed 02/17/2025
Name of Provider or Supplier Bellemeade Dialysis Street Address, City, State 3240 S Cobb Drive Se Suite 800, Smyrna, 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)
V0686 PQ-CHARGE NURSE-12 MO NURSING+3 MO DIALYSIS
CFR(s): 494.140(b)(3)(i)-(ii)

The charge nurse responsible for each shift must- (i) Be a registered nurse, a licensed practical nurse, or vocational nurse who meets the practice requirements in the State in which he or she is employed; (ii) Have at least 12 months experience in providing nursing care, including 3 months of experience in providing nursing care to patients on maintenance dialysis;


This STANDARD is not met as evidenced by:
Based on a review of records, staff interviews, and a review of facility Policy and Procedures (P&P) it was determined that the facility failed to ensure that one of one Registered Nurse (RN) (RN AA), had at least three months of specialized experience in providing care to dialysis patients, prior to being scheduled in the position of the nurse in charge of 36 in center patients. This deficient practice had the potential to negatively affect the health and safety of 36 in-center hemodialysis patients who dialyzed at this facility. Findings include: - A review of the personnel records revealed that RN AA was hired on 11/18/24 as a "Registered Nurse ICHD (In-center Hemodialysis) Experienced". On 1/15/25 RN AA passed her Clinical Final Exam that assessed the knowledge and skills in providing dialysis care, covering topics like patient assessment, treatment procedures, complications, and post-treatment care. - A review of RN AA's "Professional Resume" lacked documentary evidence that RN AA had Chronic or Acute hemodialysis experience. -A review of the "Patient and Teammate Schedule" from January 2025 through February 2025 showed the following: RN AA was scheduled on 2/7/25, 2/10/25 and 2/15/25 as the only RN in the treatment room who oversaw 12 patients per three shifts and worked alongside with three Patient Care Technicians (PCT's). Shortly after orientation, RN AA was deemed to be working as the facility charge nurse because she was the sole scheduled nurse on those dates. During an interview on 2/17/25 at 11: 59 a.m., RN AA stated she recently just finished her training with a preceptor mid-January 2025. RN AA stated that she took some personal time off after completing orientation and did not return to the facility until early February 2025. RN AA stated since she's been back and out of training, she has been the only scheduled RN overseeing all patient's hemodialysis treatment. RN AA also stated as still being new and learning how to operate the treatment room and hemodialysis machines, some days can be perplexed without a second licensed for assistance. During an interview with the Facility Administrator on 2/17/25 at 5:15 p.m., she stated that she was unaware that RN AA needed three months of experience outside of orientation training, to provide care independently to be scheduled as the charge nurse and oversee all patient care. - A review of the facility's Policy: 8-02-01 titled, "Teammate Qualifications Licensure and Adequate Teammate Staffing" with latest revision date of October 2017 stated: 12. Charge Nurse Standards: The charge nurse responsible for each shift will: o Be a registered nurse, a licensed practical nurse/vocational nurse who meets the practice requirements in the State in which he or she is employed; Have at least 12 months of experience in nursing care, including 3 months of experience in providing nursing care to patients on maintenance dialysis; and If such nurse is a licensed practical nurse or licensed vocational nurse, he/she must work under the supervision of a registered nurse in accordance with state nursing practice act provisions.