Davita Palomba Drive Dialysis

“IC-WEAR GLOVES/HAND HYGIENE CFR(s): 494.30(a)(1) Wear disposable gloves when caring for the patient or touching the patient’s equipment at the dialysis station. Staff must remove gloves and wash hands between each patient or station. This Standard is not met as evidenced by: 44675 Based on observations, facility documentation, facility policy and interviews, for three (3) of three (3) patients (Patient #11, #12 and #13), reviewed for hand hygiene, the facility failed to ensure a patient removed gloves and was offered hand hygiene before exiting the treatment floor in accordance with facility policy. The findings include: Observations conducted on 12/17/24 identified the following: a. At 2:35 PM Patient #10 was holding his/her hemodialysis access site with his/her gloved right hand. The patient removed his/her glove at 2:40 PM, gathered his/her items, proceeded to the scale, followed by a staff member, to obtain a post-treatment weight and then exited the clinic without performing or being offered hand hygiene. b. At 2:37 PM Patient #12 had a glove on his/her right hand from holding his/her left ateriovenous fistula (AVF) dialysis access after hemodialysis treatment. Patient #12’s glove was removed by Staff Person #1 and Staff Person #1 did not offer hand hygiene to Patient #12. Patient #12 proceeded to the scale, held the railing, and pushed the weight ticket without the benefit of hand hygiene. c. At 2:54 PM Patient #11 had a glove on his/her left hand from holding his/her right AVF after hemodialysis treatment. Patient #11 removed his/her glove and did not perform hand hygiene. Staff Person #1, present with Patient #11, did not offer hand hygiene to Patient #11 prior to Patient #11 leaving the treatment area. d. At 2:55 PM Patient #14 was holding his/her hemodialysis access site with his/her gloved right hand. The patient removed his/her glove at 3:11 PM, stood up for a blood pressure check, proceeded to the scale to obtain a post-treatment weight, and exited the clinic without performing or being offered hand hygiene. Observations conducted on 12/18/24 identified the following: e. At 9:55 AM Patient #2 was holding his/her hemodialysis access site with his/her gloved right hand. The patient had his/her glove removed by staff at 9:58 AM, proceeded to the scale to obtain a post-treatment weight, put on his/her jacket and gloves, and exited the clinic without performing or being offered hand hygiene. f. At 11:04 AM Patient #13 had a glove on his/her right hand from holding his/her left AVF after hemodialysis treatment. Patient #13 removed his/her glove and did not perform hand hygiene. Staff Person #3, present with Patient #13, did not offer hand hygiene to Patient #13 prior to Patient #13 leaving the treatment area. Interview with the Manager of Clinical Services on 12/18/24 at 2:13 PM identified facility practice was for patients to perform hand hygiene following glove removal. Review of the infection control for dialysis facilities policy directed patients and caregivers will be encouraged to perform hand hygiene after treatment before leaving the treatment area. 47491”

“IC-DISINFECT SURFACES/EQUIP/WRITTEN PROTOCOL CFR(s): 494.30(a)(4)(ii) [The facility must demonstrate that it follows standard infection control precautions by implementing- (4) And maintaining procedures, in accordance with applicable State and local laws and accepted public health procedures, for the-] (ii) Cleaning and disinfection of contaminated surfaces, medical devices, and equipment. This Standard is not met as evidenced by: 44675 Based on observation, clinical record review, interview and review of facility policy, the facility failed to clean and disinfect the hemodialysis stations after hemodialysis treatment per facility policy. The finding included: a. Observation conducted on 12/17/24 at 10:00 AM identified Staff Person #1 was cleaning and disinfecting the hemodialysis station after a patient treatment. Staff Person #1 failed to clean and disinfect the patient television (within patient reach) and place the chair into the reclining position to clean the inside sides of the chair. b. Observation conducted on 12/17/24 at 2:48 PM identified, upon disinfecting Station #7 following a patient’s treatment, the facility failed to disinfect the tubing located on the side of the hemodialysis machine. c. Observation conducted on 12/18/24 at 10:00 AM identified, upon disinfecting Station #6 following a patient’s treatment, the facility failed to disinfect the outside surface of the patient’s chair. d. Observation conducted on 12/18/24 at 10:38 AM identified, upon disinfecting Station #4 following a patient’s treatment, the facility failed to disinfect the outside surface of the patient’s chair. Review of the infection control for dialysis facilities policy directed at the end of each treatment, the dialysis station will be cleaned and disinfected. Surfaces to disinfect include but are not necessarily limited to all surfaces in contact with the patient or their belonging. Non-disposable items are to be disinfected after each patient use. 47491”

“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: 44675 Based on a review of clinical records, interview, and policy review for three (3) of five (5) hemodialysis patients reviewed for blood pressures (Patients #2 and #7), the facility failed to ensure an ambulating patient had a standing blood pressure and pulse pre and post hemodialysis treatment, and failed to notify the physician of post treatment blood pressures that exceeded written parameters for the patient in accordance with facility policy. The findings include the following: 1. Patient #2 was admitted to the clinic with diagnoses that included ESRD. Review of the physician’s orders directed hemodialysis three (3) times weekly for three (3) hours with a left upper arteriovenous fistula (AVF) and an estimated dry weight (EDW) of 106.0 kilograms (kg). The annual stable care plan dated 3/7/24 identified Patient #2’s current fluid/blood pressure goal was to meet and maintain a post-weight in relation to the ordered target weight and blood pressure within range. Review of Patient #2’s hemodialysis flowsheets identified on 11/29/24, 12/2/24, 12/4/24, 12/6/24, 12/9/24, 12/11/24 and 12/13/24 Patient #7 ambulated independently and did not have a pre-treatment standing blood pressure and/or the reason why a standing blood pressure was not obtained documented. 2. Patient #7 was admitted to the clinic with diagnoses that included ESRD. Review of the physician’s orders directed hemodialysis three (3) times weekly for three (3) hours with a central venous catheter (CVC) and an estimated dry weight (EDW) of 64.0 kg. The annual stable care plan dated 8/28/24 identified Patient #7’s current fluid/blood pressure goal was to meet and maintain a post-weight in relation to the ordered target weight and blood pressure within range. Review of Patient #7’s hemodialysis flowsheets identified on 11/19/24, 11/21/24, 11/23/24, 11/25/24, 11/27/24, 11/30/24, 12/7/24, 12/10/24, 12/12/24 and 12/14/24 Patient #2 ambulated independently and did not have a pre-treatment standing blood pressure and/or the reason why a standing blood pressure was not obtained documented. 47491 3. Patient #1 was admitted to the facility with diagnoses that included end stage renal disease. Patient #1’s physician order included hemodialysis treatment three (3) times weekly for three (3) hours and forty-five (45) minutes with an upper left arm arteriovenous fistula (AVF). Review of Patient #1’s hemodialysis flowsheet identified post treatment blood pressures of 199/86 while sitting and 206/85 while standing. Further review of the 12/16/24 flowsheet identified a maximum post treatment systolic blood pressure parameter of 170, a maximum post treatment diastolic blood pressure parameter of 110, and failed to indicate a nursing assessment addressing the elevated post treatment blood pressures was performed or that the physician was notified. Interview with the Medical Director on 12/18/24 at 12:10 PM identified Patient #1 had paroxysmal hypertension (episodic and volatile high blood pressure) which factored into the post treatment blood pressure parameters established for the patient, however he/she would expect the nurse to assess the patient and contact him/her regarding the elevated post treatment blood pressures so the patient could receive further medical care, if needed (for example, an adjustment to the patient’s blood pressure medication or possibly be sent to the emergency room). Review of the Pre-Intra-Post Treatment Data Collection, Monitoring and Nursing Assessment policy directed that abnormal findings or findings outside of any patient specific physician ordered parameters will be reported to the licensed nurse immediately (refer to “abnormal findings” section in this policy).The policy further directed a standing blood pressure measurement is required pre and post treatment and if the patient is not able to stand, to document the reason in the patient electronic record or flow sheet).”

“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: 44675 Based on a review of clinical records, interview, and policy review for one (1) of four (4) hemodialysis patients reviewed for treatments (Patient #8), the facility failed to perform weekly serum potassium lab draws for a patient who utilized a 1.0 potassium bath and for two (2) of three (3) patients (Patient #11 and #13), reviewed for treatment initiation, the facility failed to ensure pre-treatment heparin was administered in accordance with facility policy. The findings included: 1. Patient #8 had diagnoses which included end stage renal disease. Review of the physician’s October 2024 treatment order directed hemodialysis three (3) times weekly for four (4) hours, a 1.0 potassium/2.5 calcium bath, a blood flow rate of 400 and dialysate flow rate of 800, while utilizing an arteriovenous graft (AVG) in the upper left arm. Review of Patient #8’s October 2024 lab results identified potassium labs were not drawn 10/11/24 and 10/18/24. Review of Patient #8’s treatment attendance identified he/she received treatment on 10/7/24, 10/9/24, 10/11/24, 10/14/24, 10/16/24, 10/17/24, 10/18/24, 10/22/24, and 10/23/14. Interview with the Manager of Clinical Services on 12/18/24 at 2:10 PM identified weekly potassium lab draws were the standard of practice for patients who utilized a 1.0 potassium bath for treatment to determine if continued use of the 1.0 potassium bath was needed. Review of the Use of Low Potassium Dialysate policy directed patients with orders for less than 2.0 potassium dialysate to have follow-up pre-dialysis serum potassium levels checked weekly. 2a. Observation conducted on 12/17/24 at 10:30 AM identified Staff Person #2 performing cannulation of Patient #11’s hemodialysis access. At 10:35 AM Patient #11’s loading dose of heparin was administered into the patient’s venous line. At 10:36 AM treatment was initiated without the benefit of waiting three (3) to five (5) minutes per facility policy. b. Observation conducted on 12/18/24 at 10:40 AM identified Staff Person #2 performing cannulation of Patient #13’s hemodialysis access. At 10:43 AM Patient #13’s loading dose of heparin was administered into the venous line into the patient. At 10:45 AM treatment was initiated without the benefit of waiting three (3) to five (5) minutes per facility policy. Review of the treatment initiation policy directed to wait a minimum of three (3) to five (5) minutes following administration of heparin loading dose prior to actual initiation of treatment. It identified the rationale was that the three (3) to five (5) minute wait period assures sufficient time for heparin anticoagulation activity to occur prior to treatment initiation. 47491”