Davita Kissimmee Home Training Pd

“IC-CLEAN/DIRTY;MED PREP AREA;NO COMMON CARTS CFR(s): 494.30(a)(1)(i) Clean areas should be clearly designated for the preparation, handling and storage of medications and unused supplies and equipment. Clean areas should be clearly separated from contaminated areas where used supplies and equipment are handled. Do not handle and store medications or clean supplies in the same or an adjacent area to that where used equipment or blood samples are handled. When multiple dose medication vials are used (including vials containing diluents), prepare individual patient doses in a clean (centralized) area away from dialysis stations and deliver separately to each patient. Do not carry multiple dose medication vials from station to station. Do not use common medication carts to deliver medications to patients. If trays are used to deliver medications to individual patients, they must be cleaned between patients. This Standard is not met as evidenced by: 13640 Based on observation, interview and a review of facility documentation, the facility failed to ensure that equipment used in preparing patient lab work in the form of a centrifuge was stored in a clean area. Findings: During an observation of the lab area of the facility on 8/29/24 at approximately 11:30 AM, the area beneath a sink was observed. A centrifuge was found stored beneath the sink. During an interview with the Regional Home Manager at this time she stated the centrifuge was designated for the isolation part of the lab and was reserved for use in processing any lab work for hepatitis B patients (of which there were none on the census). The placement of items associated with patient care are at an increased risk of exposure to microbes beneath a sink as there is a possibility of moisture leaking from above. A review of facility policy Infection Control for Dialysis Facilities revealed the following: “Clean areas should be clearly separated from contaminated areas where used supplies and equipment are handled. . . . Clean supplies or equipment will not be placed adjacent to a sink unless a splash guard is in place.” During an interview with the Administrator on 8/30/24 at 12:20 PM, she confirmed the policy was not followed.”

“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: 13640 Based on observation and interview, the facility failed to provide a safe treatment environment free of expired medications. Findings: During an observation in the medication storage area in training room #9 on 8/29/24 at approximately 12:02 PM, one previously opened multi-dose vial of Heparin Sodium Injection USP, 30,000 units / 30 ML (milliliters) was discovered. The vial did not have a date on its label of when the vial had first been used and was without a date of when it had been opened. It was not possible to determine whether or not the expiration date had passed. A review of facility’s Medication Policy noted it required: “Each vial is labeled with the initials of the person opening the vial and the expiration date.” During an interview of the Administrator on 8/30/24 at approximately 2:31 PM, she confirmed the policy had not been followed.”

“H-FAC RECEIVE/REVIEW PT RECORDS Q 2 MONTHS CFR(s): 494.100(b)(2),(3) The dialysis facility must - (2) Retrieve and review complete self-monitoring data and other information from self-care patients or their designated caregiver(s) at least every 2 months; and (3) Maintain this information in the patient ’ s medical record. This Standard is not met as evidenced by: 13252 Based on record review and interview the facility failed to identify inconsistencies on the patient treatment flow sheets, address these concerns with the patient, and ensure patient adherence to treatment plan for 1 of 2 home hemodialysis patients of a total sample of 10 patients (#4). Findings: Patient #4 admitted to the facility on 7/26/24 and elected a modality of home hemodialysis, where he treats himself. The physician orders noted the patient to treat himself four times a week with a treatment time each day of 3 hours and 30 minutes. Ten of patient #4’s treatment flow sheets, from 7/18/24 to 8/14/24, were reviewed. Patient’s dialysis access is an arteriovenous fistula that has to be monitored for bruit & thrill, pre and post treatment. In 10 of 10 treatment flow sheets reviewed, the patient noted an absence of bruit and thrill. This could be an indication the patient’s fistula is not functioning efficiently or is clotted. Further review revealed the patient was shortening his treatments and not following the physician’s prescribed treatment time of 3 hours and 30 minutes. The patient also noted that his treatment solution had chlorine levels of greater than 0.1 ppm (parts per million). On 8/30/24 at 2:24 PM, Patient #4’s treatment flow sheets were discussed with the facility administrator (FA). She provided the Registered Nurse’s (RN) treatment review for treatments from 7/26/24 to 8/15/24. The RN failed to identify the treatment irregularities and noted, “...treatments and medications have been completed as expected...” The FA stated the nurse would review the treatment flow sheets again and that patient may need re-education on the home hemodialysis process. 13640”

“MR-MAINTAIN HOME PT RECORDS CFR(s): 494.170(b)(3) (3) The dialysis facility must complete, maintain, and monitor home care patients’ records, including the records of patients who receive supplies and equipment from a durable medical equipment supplier. This Standard is not met as evidenced by: 13640 Based on interview and record review, the facility failed to ensure that home care records for peritoneal dialysis patients were monitored with respect to blood pressure discrepancies in one of ten sampled patients. (#1) Findings: A review of patient #1’s “Clara Treatment Summary Reports”, which are submitted electronically from patients at their home after a peritoneal dialysis session, revealed there was no patient input for pre-treatment blood pressure on the following dates: 8/5/24; 8/7/24; 8/8/24; and 8/11/24. A review of nursing documentation for patient #1’s monthly visit to the facility did not reveal any evidence of inquiries or education concerning the recording of pre-treatment blood pressures in the “Clara Treatment Summary Reports”. During an interview with the Administrator on 8/30/24 at 3:00 PM, she confirmed the findings.”