Davita Desert Mountain Dialysis Center

“GOV-INVOL DISCHARGE PROCESS REQUIREMENTS CFR(s): 494.180(f)(4) The medical director ensures that no patient is discharged or transferred from the facility unless - (4) The facility has reassessed the patient and determined that the patient’s behavior is disruptive and abusive to the extent that the delivery of care to the patient or the ability of the facility to operate effectively is seriously impaired, in which case the medical director ensures that the patient’s interdisciplinary team- (i) Documents the reassessments, ongoing problems(s), and efforts made to resolve the problem(s), and enters this documentation into the patient’s medical record; (ii) Provides the patient and the local ESRD Network with a 30-day notice of the planned discharge; (iii) Obtains a written physician’s order that must be signed by both the medical director and the patient’s attending physician concurring with the patient’s discharge or transfer from the facility; (iv) Contacts another facility, attempts to place the patient there, and documents that effort; and (v) Notifies the State survey agency of the involuntary transfer or discharge. (5) In the case of immediate severe threats to the health and safety of others, the facility may utilize an abbreviated involuntary discharge procedure. This Standard is not met as evidenced by: 45999 Based on document review and interview, it was determined that the facility failed to ensure the local ESRD was notified of an involuntary discharge 30 days prior, which poses a potential risk to impact the patient’s access to care. Findings include: The facility policy titled “Patient Behavior Agreements, 30 Day Discharge, Involuntary Discharge or Involuntary Transfer” requires: “...If a patient’s behavior in the dialysis facility is threatening, either verbally or physically, the treatment that day will be terminated and the patient will be asked to leave the facility. The facility will immediately notify the Medical Director, the patient’s physician, the Regional Operations Director (ROD), the ESRD Network, and the Risk Manager...The patient’s physician and facility Medical Director must be notified of the pending involuntary transfer or discharge and provide a signed order. This notification and order will be documented in the patient’s medical record....” The facility provided the patient a letter of notice for immediate involuntary discharge on [02/16/2024]. Included in the letter was documentation that the patient terminated their care from the nephrologist and would have to find another nephrologist or facility to continue their care. The medical record contained a discharge order signed by the Medical Director dated [03/16/2024]. The medical record did not contain any record of the local ESRD Network being notified until after the 30-day notice and the patient had been discharged. Employee #1 confirmed on 05/29/24 that the facility did not make the local ESRD Network aware of the involuntary discharge 30 days prior to the discharge from the facility as required by policy.”

“IC-CDC MMWR 2001 CFR(s): 494.30(a) The facility must demonstrate that it follows standard infection control precautions by implementing- (1)(i) The recommendations (with the exception of screening for hepatitis C), found in “Recommendations for Preventing Transmission of Infections Among Chronic Hemodialysis Patients,” developed by the Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report, volume 50, number RR05, April 27, 2001, pages 18 to 28. The Director of the Federal Register approves this incorporation by reference in accordance with 5 U.S.C. 552(a) and 1 CFR Part 51. This publication is available for inspection at the CMS Information Resource Center, 7500 Security Boulevard, Central Building, Baltimore, MD or at the National Archives and Records Administration (NARA). Copies may be obtained at the CMS Information Resource Center. For information on the availability of this material at NARA, call 202-741-6030, or go to: http://www.archives.gov/federal_register/code_of_regulations/ibr_locations.html. The recommendation found under section header “HBV-Infected Patients”, found on pages 27 and 28 of RR05 (“Recommendations for Preventing Transmission of Infections Among Chronic Hemodialysis Patients”), concerning isolation rooms, must be complied with by February 9, 2009. This Standard is not met as evidenced by: 50568 Based on a review of policy/procedure, observation, and staff interview, it was determined by the Department, that the facility failed to ensure staff appropriately cleansed (1) of (2) patients vascular access prior to cannulation with fistula needles. Failure to practice safe aseptic techniques when cleansing and disinfecting a patient’s vascular access increases the risk of vascular access and bloodstream infection. The facility policy titled “Assessment and Cannulation for AV Fistula/Graft and Patient Self Cannulation” requires “...cleanse the site by applying skin antiseptic using a circular motion, moving from the center out and allow to dry. (for contact and dry time refer to the table...) ...Iodine... 30-second contact time...Hypochlorite (ExSeptPlus)... 60-second contact time .... Both with a 2-minute dry time...”. Observation on May 29, 2024, revealed Employee #8 accessing patient #17 fistula site. Employee #8 scrubbed the arterial site for 35 seconds with ExSeptPlus, employee #8 laid an ExseptPlus-soaked gauze over the venous site. Employee #8 then wiped the piece of gauze over the venous cannulation site, waited over two minutes, and proceeded to cannulate the access. Employee #1 confirmed on May 29, 2024, during an interview that staff did not follow the facility’s policies and procedures.”

“IC-HBV-TEST PTS/STAFF POST LAST DOSE CFR(s): 494.30(a)(1)(i) Hepatitis B Screening: Patients and Staff Test all vaccines [patients and staff] for anti-HBs 1-2 months after last primary vaccine dose. -- If anti-HBs is <10 mIU/mL, consider patient or staff member susceptible, revaccinate with an additional three doses, and retest for anti-HBs. -- If anti-HBs are =10 mIU/mL, consider immune, and retest patients annually. -- Give booster dose of vaccine to patients if anti-HBs declines to <10 mIU/mL and continue to retest patients annually. This Standard is not met as evidenced by: 49430 Based on document review, policy review and staff interview, it was determined that the facility failed to ensure new hires were screened for Hepatitis B within 10 days of hire. This lack of oversight increases the risk for infection transmissions. Finding include: Employee #11, with a hire date of 04/08/2024, had “NEW TM HEP PANL” with a draw date 05/20/2024 and a “Hepatitis B Vaccine Teammate Consent/Declination” form signed and dated by Employee #11 dated 05/29/2024. Facility policy titled “TEAMMATE HEPATITIS B MONITORING AND FOLLOWUP GUIDANCE” requires “New teammates...will be screened for hepatitis B... within 10 days and offered the vaccination as indicated by their results...”. Employee #2 confirmed during an interview on 05/29/2024, Employee #11 did not have the appropriate documentation as required by facility policy.”

“IC-O-SIGHT-MONITOR ACTIVITY/IMPLEMENT P&P CFR(s): 494.30(b)(1) The facility must- (1) Monitor and implement biohazard and infection control policies and activities within the dialysis unit; This Standard is not met as evidenced by: 50568 Based on review of facility policy, observation, and staff interviews, the Department determined that the facility failed to ensure accurate and complete tracking of infectious laboratory samples and results. Failure regarding infectious disease tracking can result in interruptions of patient care, including accurate diagnosis and treatment of infections. Complications that arise from the lack of accurate diagnosis and treatment include deterioration of health status, hospitalization, and death. 1. Facility policy titled, “Infection Control For Dialysis Facilities” states that, “ ... Reporting: The facility Medical Director and the Quality Improvement Committee will be made aware of infection control issues ...” 2. Review of Governing Body minutes dated 03/2024 revealed; “ ... Trainings/In-service meeting held on 2/6/2024 to go over infection control and recent survey findings in the division. Weekly infection control audits will continue ...” 3. Review of Governing Body minutes dated 02/2024 revealed, “ ... Reviewed infection control audits and plan to continue weekly adutis through Febuary or until CMS survey. Team meeting will be held on 2/6 with all RNs and PCTs to inservice on infection control and other repeat findings ...” 4. The last 6 (six) months of infection logs for patients was requested to be produced, beginning 05/2024. The provided documents from the facility titled “ ICHD Monthly Infection Log” included dates ranging from 04/2024 to 12/2023. Documentation that was produced revealed that not all months were completed as indicated by the facility form, with all months lacking in the final result of the laboratory samples collected. Some patients were indicated to have laboratory samples collected for infectious disease, but no results were provided. In an interview conducted on 05/28/2024, Employee #1 stated that infection logs were not being completed, and had been a previous area of concern for the facility. In an interview on 05/30/2024, Employee #2 confirmed the infection control logs were not complete.”

“PE-SAFE/FUNCTIONAL/COMFORTABLE ENVIRONMENT CFR(s): 494.60 The dialysis facility must be designed, constructed, equipped, and maintained to provide dialysis patients, staff, and the public a safe, functional, and comfortable treatment environment. This Standard is not met as evidenced by: 50568 Based on review of facility policy, observation, and staff interviews, the Department determined that the facility failed to ensure medications, supplies, and equipment had not expired. Failure of staff to follow facility policy regarding equipment and supply expiration dates has the potential risk of using expired supplies and equipment for patients which could lower the efficacy of the equipment or supplies and could expose patients to risk of infection. During a tour on May 28, 2024, the following expired medical supplies were located: 1 (one) Rp-RPC Recirculation connector expired 03/17/2023 1 (one) Genentech Cathflo activase (Alteplase) 2 mg medication vial expired 04/2024 During an interview conducted on 05/28/2024, Employee #1 confirmed the expired supplies had not been discarded in accordance with manufacturer instructions and expiration dates.”

“PE-EQUIPMENT MAINTENANCE-MANUFACTURER’S DFU CFR(s): 494.60(b) The dialysis facility must implement and maintain a program to ensure that all equipment (including emergency equipment, dialysis machines and equipment, and the water treatment system) are maintained and operated in accordance with the manufacturer’s recommendations. This Standard is not met as evidenced by: 45999 Based on document review, observation, and interview, the Department determined that the facility failed to 1. ensure that dialysis station chairs maintained their integrity which allowed sterilization and/or disinfection. Failure to maintain intact vinyl on dialysis chairs poses a risk of infection through cross-contamination as exposed foam and fabric on the chair may harbor potentially infectious material that cannot be cleaned and/or disinfected and 2. Failed to ensure staff cleaned stethoscope after use which has the potential for cross-contamination and increased infection. Findings include: The facility policy titled “Physical Environment” requires: “...The space for treating each patient will be sufficient to provide needed care and services, prevent cross-contamination....” 1. The facility policy titled “Infection Control for Dialysis Facilities” requires: “...Disinfection...Cleaning and/or disinfection of equipment and work surfaces will be performed as soon as possible following exposure to blood or other potentially infectious materials...Prior to routine disinfection, remove all visible blood...For visible blood or gross blood spills, a 1:10 (one to ten) bleach solution must be utilized...After all visible blood is cleaned...use a new disposable towel soaked with 1:10 (one to ten) bleach solution and clean the area a second time...Use an appropriate disinfectant such as 1;100 (one to one hundred) bleach solution for routine disinfection of environmental surfaces....” Observation on May 29, 2024, revealed the following. 1. Dialysis chairs at stations #8, #12, and #15, had multiple tears and cracks in the vinyl covering the arm, and footrest areas of the chairs. Employee #1 confirmed on May 29, 2024, that the observed chairs were in disrepair with torn vinyl that prevented appropriate disinfection between patients. 2. The facility document titled “Infection Control Quick Reference Guide All Modalities” requires: “...Stethoscopes...Hang cleaned stethoscope either at the dialysis station or in a central clean location....” Observation on May 28, 2024, revealed Employee #4 retrieved from around their neck and used their stethoscope to auscultate a patient’s vascular access. Employee #4 used an alcohol prep pad to disinfect the stethoscope bell and replaced the stethoscope around their neck. Observation on May 29, 2024, revealed Employee # 9 took the stethoscope from the pod area and auscultated the patient’s vascular access. Employee #9 then took off the stethoscope and returned it to the pod desk without disinfecting it. Observation on May 29, 2024, revealed Employee #19 took a stethoscope from around their neck and listened to the patient at station #8, after listening to the patient employee #19 cleaned only the bell and returned the stethoscope to their neck. Employee #1 confirmed on May 29, 2024, that the cleaning of the stethoscope was not performed as required by facility policy and procedures.”

“PA-ASSESS B/P, FLUID MANAGEMENT NEEDS CFR(s): 494.80(a)(2) The patient’s comprehensive assessment must include, but is not limited to, the following: Blood pressure, and fluid management needs. This Standard is not met as evidenced by: 45999 Based on a review of facility policy, medical records, and staff interviews, the Department determined that the facility failed to require clinical staff to notify the nurse and provide a documented intervention for 3 out of 4 patients reviewed when the patient’s blood pressure (BP) and/or heart rate (HR) were out of range per the facility policy, which poses the potential risk of cardiovascular compromise and hospitalization. Findings include: Facility policy titled, “Pre-Intra-Post Treatment Data Collection, Monitoring, and Nursing Assessment” revealed: “...Monitoring During Treatment...Report to the nurse: Systolic blood pressure greater than 180 mm/Hg, Diastolic blood pressure greater than 90 mm/Hg...Heart rates less than 60 or greater above 100 beats per minute ...Report to the nurse any significant findings....” “...Treatment Sheets....” revealed: Patient # 9 May 15, 2024, revealed: 05:58 HR 50 06:28 HR 52 06:58 HR 50 07:28 HR 52 07:58 HR 52 08:28 HR 50 08:58 HR 50 09:28 HR 50 09:58 HR 51 May 20, 2024, revealed: 05:46 HR 58 05:58 HR 57 06:28 HR 58 08:28 HR 56 08:58 HR 57 09:28 HR 52 09:48 HR 54 May 22, 2024 10:17 HR 54 10:25 HR 49 10:55 HR 55 11:25 HR 55 11:55 HR 56 12:25 HR 56 13:55 HR 59 May 24, 2024 10:07 HR 57 10:28 HR 50 10:58 HR 49 11:28 HR 50 11:58 HR 49 12:58 HR 50 13:28 HR 51 13:58 HR 59 There was no documentation of the RN being made aware of vital signs out of range. Patient #11 May 10, 2024 06:31 HR 55 07:01 HR 48 07:31 HR 55 08:01 HR 56 08:31 HR 58 09:01 HR 56 09:31 HR 56 09:34 HR 57 May 13, 2024 06:16 HR 56 06:31 HR 52 06:35 HR 33 07:01 HR 49 07:31 HR 54 08:01 HR 54 08:31 HR 55 09:01 HR 55 09:31 HR 55 09:45 HR 55 May 15, 2024 06:13 HR 51 06:31 HR 58 07:01 HR 58 07:02 HR 59 07:31 HR 59 08:01 HR 57 08:31 HR 59 May 17, 2024 06:07 HR 54 06;31 HR 53 06:33 HR 48 06:58 HR 55 07:01 HR 56 07:31 HR 57 08:01 HR 55 08:31 HR 56 09:01 HR 56 09:31 HR 56 09:36 HR 56 May 22, 2024 06:17 HR 59 06:30 HR 53 06:39 HR 56 07:00 HR 53 07:30 HR 55 08:30 HR 55 08:51 HR 54 May 27, 2024 05:58 HR 51 06:01 HR 59 06:31 HR 54 07:01 HR 54 08:01 HR 59 09:01 HR 52 There was no documentation of the RN being made aware of vital signs out of range. Patient #13 May 15, 2024 05:42 HR 57 05:56 HR 56 06:26 HR 55 06:56 HR 52 07:40 HR 55 07:56 HR 55 May 17, 2024 05:40 HR 58 06:10 HR 58 May 20, 2024 05:29 HR 51 05:59 HR 52 06:29 HR 55 06:59 HR 56 07:29 HR 56 08:04 HR 57 08:25 HR 56 May 22, 2024 05:10 HR 59 05:40 HR 58 06:10 HR 59 May 24, 2024 05:16 HR 54 05:46 HR 53 06:16 HR 59 May 27, 2024 05:17 HR 52 05:46 HR 48 06:16 HR 47 06:46 HR 55 07:16 HR 59 07:46 HR 55 07:48 HR 58 07:57 HR 57 08:15 HR 59 There was no documentation of the RN being made aware of vital signs out of range. Employee #1 confirmed during an interview on May 29, 2024, that no documentation of RN notification and/or intervention for out-of-range vitals was provided as required per facility policy.”

“PA-FREQUENCY-INITIAL-30 DAYS/13 TX CFR(s): 494.80(b)(1) An initial comprehensive assessment must be conducted on all new patients (that is, all admissions to a dialysis facility), within the latter of 30 calendar days or 13 hemodialysis sessions beginning with the first dialysis session. This Standard is not met as evidenced by: 50568 Based on facility policy review, record review and interviews, the facility failed to conduct a comprehensive initial assessment for a newly admitted patients for the facility The failure to conduct a timely initial assessment for a newly admitted patient significantly increases the risk of hospital admissions, hospital readmissions and death to the dialysis patient population due to a lack of an established baseline of a patient’s health. Finding includes: Policy Titled “Dialysis Services and Patient History and Physical Examination” requires “...A physician preforms a medical history and physical examination on the patient within 30 days before admission or within 48 hours after admission and documents the medical history and physical examination in the patient’s medical record within 48 hours after admission ... “ Review of patients #6, #7, #8 revealed initial history and physicals completed by providers who do not maintain privileges within the facility. No documentation was provided to validate the relationship between the provider who conducted the history and physical and the patient. No authentication for the history and physicals was completed by a provider, or designee, with a relationship to the patient was provided. In an interview on 5/28/2024 employee #2 was not able to verify the identity/privileges of the providers who completed the initial history and physicals, and confirmed no authentication was in place for these documents.”

“PA-FREQUENCY REASSESSMENT-STABLE 1X/YR CFR(s): 494.80(d)(1) In accordance with the standards specified in paragraphs (a)(1) through (a)(13) of this section, a comprehensive reassessment of each patient and a revision of the plan of care must be conducted- (1) At least annually for stable patients; This Standard is not met as evidenced by: 50568 Based on facility policy review, record review and interviews, the facility failed to conduct a comprehensive annual assessment for established patients within the facility. The failure to conduct a timely annual assessment for established patients significantly increases the risk of hospital admissions, hospital readmissions and death to the dialysis patient population due to a lack of an established baseline of a patient’s health. Finding includes: Policy Titled “Dialysis Services and Patient History and Physical Examination” requires “...A physician preforms a medical history and physical examination on the patient within 30 days before admission or within 48 hours after admission and documents the medical history and physical examination in the patient’s medical record within 48 hours after admission ...” 1. Patient # 13 annual history and physical was dated 10/10/2022, no updated history and physical was provided. 2. Patient # 12 annual history and physical was dated 05/01/2023, no updated history and physical was provided. 3. Patient # 11 annual history and physical was dated 04/18/2023, no updated history and physical was provided. 4. Patient # 10 annual history and physical was dated 02/05/2024, but no authentication was conducted by a provider with privileges at this facility. 5. Patient #9 annual history and physical was dated 01/04/2024, but no authentication was conducted by a provider with privileges at this facility. During an interview on 5/28/2024, Employee #2 could not verify the identity/privileges of the providers, or designee, who completed the initial history and physicals, and confirmed no authentication was in place for these documents.”

“MD RESP-ENSURE ALL ADHERE TO P&P CFR(s): 494.150(c)(2)(i) The medical director must- (2) Ensure that- (i) All policies and procedures relative to patient admissions, patient care, infection control, and safety are adhered to by all individuals who treat patients in the facility, including attending physicians and nonphysician providers; This Standard is not met as evidenced by: 49430 Based on document review, policy review and staff interview, it was determined that the facility failed to ensure Tuberculosis (TB) screening was completed accurately and/or completely for staff and/or patients. This lack of oversight decreases the indenification of diseaseand increases the risk of disease transmission. Findings include: Employee #11, with a hire date of 04/08/2024, did not have a completed TB skin test. During employee chart review, is was discovered Employee #3’s “Tuberculin Skin Test (TST) PPD Mantoux Record ...Date and Time administrated 08/21/23 at 3:40 pm ...Date and Time Results Read 08/23/2023 at 7:00am.”. The time interval is thirty-eight (38) hours and forty (40) minutes. During employee chart review, is was discovered Employee #5’s “Tuberculin Skin Test (TST) PPD Mantoux Record ...Date and Time administrated 07/11/22 at 13:00 ...Date and Time Results Read 11/09/2022 at 11:50am.”. The time interval is forty-six (46) hours and fifty (50) minutes. During patient chart review, is was discovered patient #12’s “Tuberculin Skin Test (TST) PPD Mantoux Record ...Date and Time administrated 02/04/23 at 10:45 ...Date and Time Results Read 02/07/23 at 11:00am.”. The time interval is seventy-two (72) hours and fifteen (15) minutes. During patient chart review, is was discovered patient #12’s “Tuberculin Skin Test (TST) PPD Mantoux Record ...Date and Time administrated 04/14/23 at 16:13 ...Date and Time Results Read 04/17/23 at 17:00.”. The time interval is seventy-two (72) hours and forty-seven (47) minutes. During patient chart review, is was discovered patient #13’s “Tuberculin Skin Test (TST) PPD Mantoux Record ...Date and Time administrated 04/15/22 at 08:35 ...Date and Time Results Read 04/18/22 at 09:00.”. The time interval is seventy-two (72) hours and twenty-five (25) minutes. During patient chart review, is was discovered patient #13’s “Tuberculin Skin Test (TST) PPD Mantoux Record ...Date and Time administrated 04/08/20 at 08:12 ...Date and Time Results Read 04/10/20 at 07:00.”. The time interval is forty-seven (47) hours and forty-eight (48) minutes. During patient chart review, is was discovered patient #13’s “Tuberculin Skin Test (TST) PPD Mantoux Record ...Date and Time administrated 04/01/24 (No time charted) ...Date and Time Results Read 04/03/24 (No time charted).”. The time interval is seventy-two (72) hours and forty-seven (47) minutes. Directions on the bottom of the testing forms require “Skin test must be checked in 48-72 hours for any induration or raised area ...” Policy titled “Tuberculosis Monitoring and Follow-up” requires “Baseline new hire requirements ... Negative QFT-G or T-SPOT completed within the past three months ...” or “ ...History of BCG ...” or “Baseline TST using a two step Purified Protein Derivative (PPD) Mantoux test ...Baseline TST results must be documented and recorded in millimeters within 10 days of employment ...”. Employee #1 confirmed, during interview on 05/28/2024, that Employee #11 did not have a completed TB skin screening completed within 10 days of hire as required by policy. Employee #1 confirmed, during interview on 05/28/2024, Employee #11 did not have a completed TB skin test and Employee #3, Employee #5, Patient #12 and Patient #13 did not have test results read within the 48-72-hour timeframe as required.”

“MR-COMPLETE, ACCURATE, ACCESSIBLE CFR(s): 494.170 The dialysis facility must maintain complete, accurate, and accessible records on all patients, including home patients who elect to receive dialysis supplies and equipment from a supplier that is not a provider of ESRD services and all other home dialysis patients whose care is under the supervision of the facility. This Standard is not met as evidenced by: 50568 Based on review of medical records and staff interview, it was determined that the facility failed to ensure medical records were complete and accurate. Inaccurate and incomplete monthly progress notes can lead to an interruption in the continuum of patient care, assessment, and treatment. Findings include: Monthly progress notes completed by licensed staff were not accurate, as they contained information that was inaccurate as it relates to a patient’s health status. The monthly progress notes were also incomplete as they were not specific to the status of the patient’s progress. 1. A monthly Social Worker (SW) progress note for patient #11, dated 03/18/2024 reads, “Monthly Progress Note Comment ... ...Pt has 2 missed txs and 0 hospitalizations within the past 30 days ...” Patient was hospitalized 02/13/2024 and discharged 02/22/2024. 2. A monthly Social Worker (SW) progress note for patient #11, dated 04/08/2024 reads, “Monthly Progress Note Comment ...Pt has 1 missed txs, 2 shortened txs, and 0 hospitalizations within the past 30 days ...” Patient was hospitalized 03/24/2024. 3. A monthly Registered Nurse (RN) progress note for patient #11 dated 04/29/2024 reads, “ ...The following documentation reflects the RN care activities and notes with the corresponding patient date from the past 30 days, including the most recent Interdisciplinary Team Plan of Care goals, the progress towards their goals, and planned interventions ...” No individual comment was made for the patient’s progress, as it relates to a comprehensive monthly note. 4. A monthly Registered Nurse (RN) progress note for patient #11 dated 03/29/2024 reads, “ ...The following documentation reflects the RN care activities and notes with the corresponding patient date from the past 30 days, including the most recent Interdisciplinary Team Plan of Care goals, the progress towards their goals, and planned interventions ...” No individual comment was made for the patient’s progress, as it relates to a comprehensive monthly note. 5. A monthly Registered Nurse (RN) progress note for patient #11 dated 03/01/2024 reads, “ ...The following documentation reflects the RN care activities and notes with the corresponding patient date from the past 30 days, including the most recent Interdisciplinary Team Plan of Care goals, the progress towards their goals, and planned interventions ...” No individual comment was made for the patient’s progress, as it relates to a comprehensive monthly note. 6. No documentation was provided for patient #11’s monthly Registered Nurse (RN) note for the month of 02/2024. 7. A monthly Registered Nurse (RN) progress note for patient #10 dated 04/20/2024 reads, “ ...The following documentation reflects the RN care activities and notes with the corresponding patient date from the past 30 days, including the most recent Interdisciplinary Team Plan of Care goals, the progress towards their goals, and planned interventions ...” No individual comment was made for the patient’s progress, as it relates to a comprehensive monthly note. 8. A monthly Registered Nurse (RN) progress note for patient #10 dated 04/20/2024 reads, “ ...The following documentation reflects the RN care activities and notes with the corresponding patient date from the past 30 days, including the most recent Interdisciplinary Team Plan of Care goals, the progress towards their goals, and planned interventions ...No individual comment was made for the patient’s progress, as it relates to a comprehensive monthly note. 9. A monthly Registered Nurse (RN) progress note for patient #10 dated 03/01/2024 reads, “ ...The following documentation reflects the RN care activities and notes with the corresponding patient date from the past 30 days, including the most recent Interdisciplinary Team Plan of Care goals, the progress towards their goals, and planned interventions ...” No individual comment was made for the patient’s progress, as it relates to a comprehensive monthly note. 10. A monthly Registered Nurse (RN) progress note for patient #10 dated 01/30/2024 reads, “ ...The following documentation reflects the RN care activities and notes with the corresponding patient date from the past 30 days, including the most recent Interdisciplinary Team Plan of Care goals, the progress towards their goals, and planned interventions ...” No individual comment was made for the patient’s progress, as it relates to a comprehensive monthly note. 11. No documentation was provided for patient #10’s monthly Registered Nurse (RN) note for the month of 02/2024 During an interview on 5/28/2024, Employee #1 confirmed the dates of the monthly notes provided, with no further documentation to provide.”