Fmc-Moreno Valley

“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: 44505 Based on observation, interview, and record review, the facility failed to ensure medications were actually given before they were documented as administered. This failure had the potential to disregard the patient’s awareness of their care compromising the patient’s psychological well-being, and interfere with their ability to cope with their treatment. Findings: A review of Patient 1’s “Admission Record,” indicated Patient 1 was admitted to the facility on June 11, 2024, with diagnoses which included ESRD (the kidneys lost nearly all of their function, no longer filter waste, balance fluids) and legally blind. A review of Patient 1’s “History and Physical” dated March 2, 2024, indicated Patient 1, “ ...alert, appropriate, normal speech, no deficits...” On April 3, 2025, at 7:45 a.m., during an interview with Patient 1, he stated he had not yet received his Vitamin D medication that morning. Patient 1 stated, “I can usually taste the medicine when they give it.” Patient 1 stated, he had requested his Vitamin D medication to be given earlier so he could relax and sleep, and the Administrator and Social Worker were aware of his request. On April 3, 2025, at 7:47 a.m., during a concurrent interview and review of Patient 1’s medical record with Registered Nurse 1 (RN 1), she stated that Patient 1’s medications, Hectorol (Vitamin D hormone) 1 micrograms (a unit of weight) IV ( IV - medications given directly into the bloodstream)- and Sensipar 30 mg PO (by mouth) were documented as administered at 4:58 a.m. by RN 2. On April 3, 2025, at 7:55 a.m., during an interview with RN 2, she stated she signed for the administration of Patient 1’s Hectorol and Sensipar at 4:58 a.m., but had not administered the medications at that time. RN 2 stated, she did not administer the medication earlier, as Patient 1 had requested. She further stated, this practice could lead in the patient not receiving the medication at all or receiving it at an incorrect time. During a record review of the facility’s “P&P” titled “Medication Preparation and Administration” published on February 6, 2023, the “P&P” indicated, “ ...to ensure proper documentation of medication and administration ...medication administration must be documented in the patient’s medical record ...medications must not be signed off prior to administration....””

“IC-GOWNS, SHIELDS/MASKS-NO STAFF EAT/DRINK CFR(s): 494.30(a)(1)(i) Staff members should wear gowns, face shields, eye wear, or masks to protect themselves and prevent soiling of clothing when performing procedures during which spurting or spattering of blood might occur (e.g., during initiation and termination of dialysis, cleaning of dialyzers, and centrifugation of blood). Staff members should not eat, drink, or smoke in the dialysis treatment area or in the laboratory. This Standard is not met as evidenced by: 44505 Based on observation, interview, and record review, the facility failed to ensure two (2) transportation drivers used impervious protective gowns (a gown which does not allow fluid penetration) while in the dialysis (use of a machine to remove waste, toxins, and excess fluid from the blood) treatment area. This failure had the potential to contribute to the transmission of disease among staff, visitors, and the 24 in-center hemodialysis (a type of dialysis) patients. Findings: During an observation of the treatment area on January 9, 2025, at 11:35 a.m., two transportation drivers were observed entering the treatment area with a patient on a gurney (a device used to move a patient who can’t walk or needs to lie flat). The staff who opened the door did not offer the transportation drivers a gown to wear. Both drivers were wearing only gloves and mask as they wheeled the gurney across the treatment floor and transferred the patient into her assigned chair. During a concurrent observation and interview with the Registered Nurse (RN) 1, on January 9, 2025, at 11:40 AM, RN 1 stated, the drivers who brought in the patient on the gurney were expected to wear the appropriate personal protective equipment (items facility and family members wear to protect themselves from possible blood- borne contaminants such as gown and gloves). RN 1 stated, the transportation drivers should have worn a gown when entering the treatment floor, for infection control. During a review of the facility’s policy and procedure (P&P) titled, “Visitor Policy,” dated February 6, 2023, the P&P indicated, “...Visitors in the Patient Care Area...This policy applies to patient family members and significant others, contracted care providers, individuals identified in the plan of care, volunteers, and other visitors as approved by the Clinical Manager or designee...Visitors have a responsibility to abide by [NAME of the facility] policies and procedures... Personal protective equipment (PPE) will be provided, and visitors must abide by all requirements for personal protective equipment...””

“IC-IF TO STATION=DISP/DEDICATE OR DISINFECT CFR(s): 494.30(a)(1)(i) Items taken into the dialysis station should either be disposed of, dedicated for use only on a single patient, or cleaned and disinfected before being taken to a common clean area or used on another patient. -- Nondisposable items that cannot be cleaned and disinfected (e.g., adhesive tape, cloth covered blood pressure cuffs) should be dedicated for use only on a single patient. -- Unused medications (including multiple dose vials containing diluents) or supplies (syringes, alcohol swabs, etc.) taken to the patient’s station should be used only for that patient and should not be returned to a common clean area or used on other patients. This Standard is not met as evidenced by: 44505 Based on observation, interview, and record review, the facility failed to implement standard infection control precautions when an electronic thermometer used to check patients arriving at the facility was disinfected after use before being placed with other unused thermometers. This failure had the potential to cause cross-contamination and could possibly lead to the spread of infection. Findings: On January 9, 2025, at 11:35 a.m., during an observation, Patient Care Technician (PCT 1) removed an electronic thermometer from a container and took the temperature of a patient arriving at the facility. PCT 1 was observed returning the used thermometer to the container with other unused thermometers without disinfecting it. The thermometer used on the patient was observed to be covered with white tape. On January 9, 2025, at 11:40 a.m., during a concurrent observation and interview with Registered Nurse (RN) 1, RN 1 stated that the thermometer should be disinfected after each use, for infection control. RN 1 stated the thermometer should not be covered with white tape as this prevents proper disinfection. RN 1 stated the thermometer should not have tape on it as it is for infection control. On January 9, 2025, at 2:20 p.m., during an interview with PCT 2, PCT 2 stated, the thermometer covered with white tape could not be properly cleaned. PCT 2 stated, the thermometer should have been removed from use. A review of the facility policy titled, “General Cleanliness and Infection Control Guidelines”, dated November 4, 2024, indicated, “ ...The purpose of this policy is to provide guidance for FKC staff on preventing the spread of infectious disease and maintaining a clean, safe, and aesthetically pleasant environment for patients, staff, and visitors ...””

“IC-ASEPTIC TECHNIQUES FOR IV MEDS CFR(s): 494.30(b)(2) [The facility must-] (2) Ensure that clinical staff demonstrate compliance with current aseptic techniques when dispensing and administering intravenous medications from vials and ampules; and This Standard is not met as evidenced by: 44505 Based on observation, interview, and record review, the facility failed to ensure accurate medication storage and administration procedures when: 1. Two pre-drawn intravenous medications (medications given directly into the bloodstream) were left unattended and unsecured on the countertop near the nurse’s station. This failure had the potential for risk of medication tampering by unauthorized individuals entering the treatment area and placed patients at risk of cross contamination (bacteria and other microorganism transferred from one object to another with harmful effect). 2. One medication tablet was left unattended on Patient 21’s chair side table. This failure had the potential for risk of medication diversion and inappropriate use, potentially causing harm to Patient 21 or others. Findings: 1. During an observation on January 9, 2025, at 12:01 PM, two labeled syringes of Heparin medication were left unattended and unsecured on the countertop near the nurse’s station, which was not a designated preparation area. During a concurrent observation and interview on January 9, 2025, at 12:10 PM, with Registered Nurse (RN) 3, RN 3 stated that the facility process requires pre-drawn medications to be secured in a locked drawer of cabinet before use. RN 3 further stated, pre-drawn medications should not be left on the countertop due to infection control concerns and the risk of medication errors. it is their process to secure pre-drawn medications in a locked drawer or cabinet before using it. she further stated that the pre-drawn medications shouldn’t be left out on the countertop due to infection control or medication error. During a review of the facility’s policy and procedure (“P&P”) titled “Medication Preparation and Administration” published on February 6, 2023, the “P&P” indicated, “Pre-drawing Medications ... These pre-drawn medications shall be labeled and must be kept under the preparer’s control or in a locked designated medication storage area or refrigerated, if necessary, until delivery to the appropriate patient for administration ...” 2. During an observation and interview on January 2, 2025, at 12:05 PM, Patient 21 was observed undergoing hemodialysis (used to remove waste, toxins, excess fluids, and electrolytes). One medication tablet (pill) was observed sitting in a medicine cup on the chair-side table. When asked about the pill in a cup, Patient 21 stated, “The nurse left it for me, it’s my Sensipar (a medication used to lower calcium and phosphorus in the blood), I will take it later” During an interview with the LVN 3, on January 9, 2025, at 12:10 PM, when asked about the medication left on Patient 21’s chair-side table, LVN 3 stated the medication should not be left on the side table and that the patient needs to take it immediately once administered. During an interview with the Clinical Manager (CM) on January 9, 225, at 4:35 PM, the CM stated, medication should not be left on the patient’s chair-side table. The CM stated, the patient must either take the medication immediately upon administration or have it given at a later time, with proper documentation. A record review of the facility’s “P&P” titled “Medication Preparation and Administration” published on February 6, 2023, the “P&P” indicated, “Pre-drawing Medications ... These pre-drawn medications shall be labeled and must be kept under the preparer’s control or in a locked designated medication storage area or refrigerated, if necessary, until delivery to the appropriate patient for administration ...””

“IC-CATHETERS:GENERAL CFR(s): 494.30(c)(2) (2) The “Guidelines for the Prevention of Intravascular Catheter-Related Infections” entitled “Recommendations for Placement of Intravascular Catheters in Adults and Children” parts I - IV; and “Central Venous Catheters, Including PICCs, Hemodialysis, and Pulmonary Artery Catheters in Adult and Pediatric Patients,” Morbidity and Mortality Weekly Report, volume 51 number RR-10, pages 16 through 18, August 9, 2002. 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 as 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 This Standard is not met as evidenced by: 44505 Based on observation, interview, and record review, the facility failed to ensure one of three sampled patients (Patient 1) wore a mask properly during the initiation of hemodialysis treatment (a treatment that filters and purifies the blood using a machine). This failure had the potential to place Patient 1 at risk for catheter-related infections. Findings: A review of the Patient Transfer Information Sheet indicated Patient 1 was admitted to the facility on September 17, 2024, with diagnoses that included end stage renal disease (kidney failure) dependent on renal dialysis and a central venous catheter (a thin flexible tube inserted into a large vein for the purpose of hemodialysis) as the access. During an observation on January 9, 2025, at 11:55 a.m. with Registered Nurse (RN) 3, RN 3 was initiating Patient 1’s hemodialysis treatment. Patient 1 was wearing a face mask but her nose was not covered. During an observation and interview on January 9, 2025, at 11:56 a.m. with RN 2, RN 2 stated, Patient 1 was not wearing the face mask properly and it should have covered her nose to prevent infection. During an interview on January 9, 2025, at 3:06 p.m., RN 3 stated, Patient 1 was not wearing her face mask appropriately. RN 2 stated, during the initiation of treatment using a central venous catheter, the patient should wear a face mask covering both the mouth and nose for infection control. A review of the facility policy titled, “Initiation of Treatment Using a Central Venous Catheter”, dated of May 6, 2024, indicated: “ ...Prior to Initiation: Assessment and Machine Parameter ...perform hand hygiene and don full PPE ...put mask on the patient, doff (remove) gloves, perform hand hygiene then dons new gloves ...””

“PA-APPROPRIATENESS OF DIALYSIS RX CFR(s): 494.80(a)(2) The patient’s comprehensive assessment must include, but is not limited to, the following: (2) Evaluation of the appropriateness of the dialysis prescription, This Standard is not met as evidenced by: 44505 Based on interview and record review, the facility failed to follow the prescribed hemodialysis (process of removing waste from the blood with the use of a machine) treatment orders for treatment duration (length of dialysis treatment) during the course of hemodialysis for six out of 12 sampled patients (Patient 31, 32, 38, 22, 26, 36) on dialysis. This failure had the potential to result in inadequate dialysis treatment, reduced efficacy of vascular access, and ineffective removal of toxins from the blood. Findings: During an interview with Registered Nurse (RN) 1 on January 9, 2025, at 12:40 PM, RN 1 stated that on December 31, 2024, the doctor gave a telephone order to reduce the treatment duration for all second and third shift dialysis patients to three hours. A review of the “treatment sheets,” for Patients 22, 26, 31, 32, 36, and 38 on December 31, 2024, indicated that these patients, dialyzed during the first shift (3:15 AM- 8:45 AM), second shift (7:15 AM- 15:10 PM), and third shift (11:30 AM- 19:25 PM) did not receive their full prescribed dialysis treatment duration. A review of Patient 31’s “treatment sheet”, dated on December 31, 2024, indicated Patient 31 was scheduled to dialyze for 5 hours, but only dialyzed a total of 3.50 hours. A review of Patient 32’s “treatment sheet”, dated on December 31, 2024, indicated Patient 32 was scheduled to dialyze for 4 hours, but only dialyzed a total of 2.55 hours. A review of Patient 36’s “treatment sheet”, dated on December 31, 2024, indicated Patient 36 was scheduled to dialyze for 4 hours, but only dialyzed a total of 3.05 hours. A review of Patient 26’s “treatment sheet”, dated on December 31, 2024, indicated Patient 26 was scheduled to dialyze for 4.15 hours, but only dialyzed a total of 3.00 hours. A review of Patient 22’s “treatment sheet”, dated on December 31, 2024, indicated Patient 22 was scheduled to dialyze for 4.15 hours, but only dialyzed a total of 3.02 hours. A review of Patient 38’s “treatment sheet”, dated on December 31, 2024, indicated Patient 38 was scheduled to dialyze for 4 hours, but only dialyzed a total of 3.04 hours. Further review of the “treatment sheets” for Patients 22, 26, 31, 32, 36, and 38 dated December 31, 2024, showed that the reasons for not following the scheduled treatment duration were not documented. During a concurrent interview and record review, with the Clinical Manager (CM) on January 9, 2025, at 4:35 PM, the CM stated nurses should have documented in the treatment sheet the reason the patient did not receive their full scheduled treatment time. A review of the facility’s policy and procedure titled, “Physician Order Documentation,” published on July 3, 2023, indicated, “The purpose of this policy is to provide instruction on physician orders documented by medical staff included in the medical record ...It is the nurses responsibility to ensure that all treatments, medications, labs or any care provided to the patient have an accurately documented physician order ...Nurse practice acts require nurses to carry out treatment care, medication administration, lab tests, procedures, and other treatments, based on physician orders ...All medical orders must be entered in the electronic medical record ...””