| Statement of Deficiencies | (X1) Provider/Supplier/CLIA Identification Number 05P005 | (X3) Date Survey Completed 05/03/2018 |
| Name of Provider or Supplier Donor Network West | Street Address, City, State 12667 Alcosta Blvd, Suite 500, San Ramon, CA | |
| 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) |
| Z0094 | ADMINISTRATION AND GOVERNING BODY CFR(s): 486.324(d) The OPO must have bylaws for each of its board(s) that address potential conflicts of interest, length of terms, and criteria for selecting and removing members. This STANDARD is not met as evidenced by: Based on OPO personnel interviews, and advisory board conflict of interest statements and advisory board bylaws record review on May 3, 2018, the OPO failed to ensure that its bylaws pertaining to potential conflicts of interest had been maintained. Findings included: a. According to the OPO's advisory board bylaws, conflict of interest statements are to completed annually for each advisory board member. b. For 2017, the OPO advisory board member representing an organ donor family member did not complete the OPO's conflict of interest statement. |