Azusa Dialysis Center, LLC

“PR-RESPECT & DIGNITY CFR(s): 494.70(a)(1) The patient has the right to- (1) Respect, dignity, and recognition of his or her individuality and personal needs, and sensitivity to his or her psychological needs and ability to cope with ESRD This Standard is not met as evidenced by: 48367 Based on interviews and record review, the facility failed to ensure that one of one sampled patients (Patient 1) had their rights recognized when Patient 1 was administered saline intravenous fluids (IV) (saline IV is a medical procedure that uses a sterile solution of salt and water delivered through a vein to treat various conditions, such as dehydration, vomiting, or low blood pressure) when Patient 1 ’ s dialysis treatment (a medical procedure that filters and removes waste, excess salt, and water from the blood when the kidneys are unable to do so) had concluded, despite Patient 1 refusing the IV fluids. This failure resulted in Patient 1 ’ s rights not being respected and may have caused psychosocial harm. Findings: During a record review of Patient 1 ’ s “Face sheet” (a concise summary of a patient’s key information, including demographic details, medical history, current medications, allergies, and insurance information) dated unknown, indicated that Patient 1 had chronic regular dialysis treatments with a start date of 10/27/2022. During a review of Patient 1 ’ s “Hemodialysis (HD) Flowsheet (a standardized document, either paper-based or electronic, used by healthcare professionals to record and track all relevant information during a patient’s hemodialysis session),” dated 09/11/25, the “HD flowsheet” indicated the following: -Patient 1 ’ s Pre-treatment blood pressure (the BP force of the blood pushing against the walls of the arteries, measured as two numbers: systolic pressure (when the heart beats) and diastolic pressure (between beats), at 9:47 a.m. was recorded as BP 120/65 with a heart rate (HR) of 128 beats per minute (BPM). -Patient 1 ’ s, BP was recorded as 109/56 and HR of 110 bpm at 12:56 p.m.., with a note indicating that Patient 1 was resting comfortably. -Patient 1 ’ s dialysis treatment ended at 1:20 p.m., Patient 1 ’ s BP was 94/33 and HR 111 bpm. -Patient 1 ’ s post treatment BP was 147/62 and HR of 166 bpm at 1:47 p.m. with a note indicating that there were no signs of “symptomatic hypotension” (low blood pressure that causes noticeable symptoms like dizziness, lightheadedness, blurred vision, nausea, weakness, and fainting.) The note also indicated that Patient 1 refused normal saline per protocol due to low sitting BP and high pulse rate. During an interview on 9/25/2025 at 2:00 p.m. with Registered Nurse (RN) 1, RN 1 stated that he (RN 1) noted Patient 1 ’ s blood pressure after treatment was in the low 90s and that RN 1 stated that he (RN 1) needed to give Patient 1 saline per protocol and that Patient 1 responded “I don ’ t want any saline.” In addition, RN 1 stated that he (RN 1) educated Patient 1 of the risk to go home and that Patient 1 stated “I don ’ t want any (referring to the saline)” RN 1 stated that he (RN 1) was hooking the saline bag and that Patient 1 then clamped the line and stated “NO”. During an interview on 9/26/2025 at 9:30 a.m. with Patient 1 stated that he (Patient 1) has been receiving treatment at the facility for two years. Patient 1 stated that he is aware of his BP and pulse issues regarding dialysis and that the doctor has provided two medications to help with the issue. Patient 1 stated that RN 1 overrode his treatment and still provided the saline after he (Patient 1) refused. Patient 1 also stated that RN 1 provided the saline without a doctor ’ s order. During an interview on 9/25/2025 at 2:30 p.m. with the Director of Nursing (DON) 2, DON 2 stated that the hypotension protocol is about repositioning, giving about 200 mL (a unit of volume measurement in the metric system, equal to one-thousandth of a liter) of oral intakes. DON 2 stated that Patient 1 was requesting no saline. DON 2 could not determine if RN1 contacted the physician to obtain orders. During an interview on 9/25/2025 at 2:45 pm. with the Director of Nursing (DON)1, DON 1 stated that saline should not have been given if the patient refuses, despite our advice to the patient. DON 1 stated that RN 1 should not have given the normal saline and that we should always respect the patients ’ wishes. During a review of the P&P titled “Patient Rights and Responsibilities” updated 12/2022, the P&P indicated: 11. Refuse or discontinue treatment and be told what effect this may have on your health. During a review of the facility ’ s policy and procedure (P&P) titled, “Hypotension After dialysis”, reviewed 2/2019, the P&P indicated that: Return patient to sitting, lying, or Trendelenburg position as needed. Gradually return to sitting or standing position. Ill. Give oral fluids up to 500cc as needed. Sodium containing beverages are preferred (one Boullion cube in one cup hot water= 250cc of saline). If no relief in one hour, obtain order for IV fluids.”