Apollo Renal Center Miami LLC

“IC-STAFF EDUCATION-CATHETERS/CATHETER CARE CFR(s): 494.30(a)(2) Recommendations for Placement of Intravascular Catheters in Adults and Children I. Health care worker education and training A. Educate health-care workers regarding the ... appropriate infection control measures to prevent intravascular catheter-related infections. B. Assess knowledge of and adherence to guidelines periodically for all persons who manage intravascular catheters. II. Surveillance A. Monitor the catheter sites visually of individual patients. If patients have tenderness at the insertion site, fever without obvious source, or other manifestations suggesting local or BSI [blood stream infection], the dressing should be removed to allow thorough examination of the site. Central Venous Catheters, Including PICCs, Hemodialysis, and Pulmonary Artery Catheters in Adult and Pediatric Patients. VI. Catheter and catheter-site care B. Antibiotic lock solutions: Do not routinely use antibiotic lock solutions to prevent CRBSI [catheter related blood stream infections]. This Standard is not met as evidenced by: 47207 Based on observation and interviews, the facility failed to provide appropriate infection control practices for 1 out of 13 sampled patients in the isolation dialysis room. Patient #5 Findings include: On 5/28/2025, at approximately 3:10 PM, Patient #5 was brought down from the Nursing Home to the dialysis center for treatment. The patient has a wound on the right foot which has developed (Methicillin-resistant Staphylococcus Aureus) MRSA. The Patient Care Technician (PCT)/ Staff D began the process of accessing the Central Venous Catheter (CVC) port on Patient #5. PCT/ Staff D removed the patient’s jersey from the right arm providing an ample amount of space around the CVC dressing. PCT / Staff D removed the dressing from the site and applied chlorhexidine to the skin in an appropriate manner. PCT/ Staff D did not provide the patient with a mask prior to the process of the dressing removal. The Director of Nursing (DON) was observing the entire process with the surveyor. The surveyor asked why the PCT/ Staff D had not put a mask on the patient. The DON immediately told the PCT/Staff D, in Spanish, to place a mask on the patient, which she did. The DON spoke with the PCT / Staff D, and she reported that the PCT / Staff D was nervous because she was being observed.”

“PE-BUILDING-CONSTRUCT/MAINTAIN FOR SAFETY CFR(s): 494.60(a) The building in which dialysis services are furnished must be constructed and maintained to ensure the safety of the patients, the staff and the public. This Standard is not met as evidenced by: 47207 Based on observations and interviews, the facility has failed to provide appropriate disposal storage of their Biohazardous waste. Findings include: On 5/28/2025 at approximately 2:20 PM, the surveyor went to see the area the Biohazardous Wastes were stored for collection with the Director of Nursing (DON). The area is located outside the dialysis facility on the loading docks. The shed has a had lock on it, the DON opened the lock to reveal the boxes of Biohazardous wastes sealed, however the bottom of the shed had rusted out leaving some of the boxes directly on the cement floor. The DON stated, “I did not notice that before.” On 5/29/2025 at approximately 1:30 PM, the Administrator came in saying “I understand there is an issue with the Biohazardous wastes.” The surveyor took him out to show him the issue. The Administrator acknowledged the findings and stated “We need to fix this”.”

“PA-IDT MEMBERS/RESPONSIBILITIES CFR(s): 494.80 The facility’s interdisciplinary team consists of, at a minimum, the patient or the patient’s designee (if the patient chooses), a registered nurse, a physician treating the patient for ESRD, a social worker, and a dietitian. The interdisciplinary team is responsible for providing each patient with an individualized and comprehensive assessment of his or her needs. The comprehensive assessment must be used to develop the patient’s treatment plan and expectations for care. This Standard is not met as evidenced by: 47207 Based on medical record reviews and interviews, the facility failed to provide a Social Worker (SW) for the Interdisciplinary Team (IDT) for patients from mid July 2024 to late February 2025. This affected 1 out 13 sampled patients. Patient #1 Findings include: Review of Patient #1’s record revealed the patient was admitted on 06/14/24. Further review revealed that an initial nurse’s assessment and Plan of Care (POC) had been completed on 06/14/24 and 07/14/24 respectively, however a 90 days POC had not been completed. In an interview with the SW on 05/29/2025 at approximately 1:30 PM, she reviewed the patient’s record and determined the only follow up Plan of Care (POC) completed was her own which is dated 3/19/2025. The SW stated, “that can’t be right.” In an interview on 05/29/25 at approximately 2:30 PM, the Director of Nursing (DON) stated that the facility had no SW on staff from mid July 2024 until late February 2025, a SW from a sister facility came in to assist. The DON stated that they had tried to hire a social worker during that time without success.”

“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: 47207 Based on observation, record review and interviews, the facility failed to ensure the staff provided the dialysis treatments for 2 out of 13 sampled patients as prescribed. Patient #6 and Patient #4. Findings include: 1) On 05/27/2025 at approximately 9:30 AM, Staff A (Licensed Practical Nurse/ LPN) completed the cannulation of the Arteriovenous fistula (AVF) on Patient #6. Staff A/ LPN started the hemodialysis machine to start the dialysis process and walked away. The surveyor asked the Director of Nursing (DON) to come with him to review the treatment. The display on the screen indicated the Dialysis Flow Rate (DFR) was set at 500. The treatment was then reviewed on the floor nurse’s computer which showed the DFR prescribed for the patient was 700 not 500. Staff A/ LPN immediately changed the DFR setting to 700 saying, “I usually check the treatments during the sessions. The DON stated she would go talk with Staff A/ LPN. The DON came back at approximately 10:00 AM on 05/27/2025 saying the Staff A/ LPN had set the patient up for another staff member and had not looked at the treatment record before starting the dialysis treatment. 2) On 05/28/2025 at approximately 1:30 PM while reviewing Patient #4’s record, it revealed the patient was admitted on 02/13/24. Further record review revealed the following note which was written on 03/07/2025 by Staff C/ Registered Nurse (RN), “Treatment missed. The patient is called several times, but there is no answer. Monitoring continues.” The next entry also from Staff C/ RN read “Hypercalcemia Calcium is at 7.8 a 3 Ca bath is administered per the order of ....Advanced Registered Nurse Practitioner (ARNP)”. The next entry from Staff C/ RN is on 03/10/2025 “Additional treatment is offered for tomorrow due to excess fluid. The patient refuses.” The treatment prescription read as Ca++2.5, this was brought up to the DON. The DON and the surveyor asked Staff C/ RN why the treatment for 03/10/2025 stated Ca++ 2.5 and not Ca ++3.0. Staff C /RN stated she did give Patient #4 the 3 Ca++ on 03/10/2025. Staff C/RN referred to a note that had been placed in the treatment note from 03/07/2025 which stated under Other Ancillary Treatment Data “Adjust dry weight due to cramp as per the order of ....ARNP. 03/7/2025 Calcium is at 7.8 a 3 Ca++ bath is administered per the order of ...ARNP”.” Staff C/ RN was asked if she had followed the order. Staff C/RN stated she has followed the order on 3/10/2025. When the treatment record for 3/10/2025 was provided to her she stated “ I did not change the order, I made a mistake.” There was no documentation of any new dry weight in the nurse’s note nor on the treatment plans, Dry weight remains 90 Kg (Kilograms).”

“PA-F/U REASSESSMENT-WITHIN 3 MO OF INITIAL CFR(s): 494.80(b)(2) A follow up comprehensive reassessment must occur within 3 months after the completion of the initial assessment to provide information to adjust the patient’s plan of care specified in §494.90. This Standard is not met as evidenced by: 47207 Based on medical record review, policy review and interview, it was determined the facility had not provided a 90 day plan of care for 1 out of 13 sampled patients. Patient #1. Findings include: A review of the facility’s Policy Patient Plan of Care: Outpatient and Home Program Last revised November 2016, Effective January 2025 mentions only implementation of the initial care plan stating ...”initial care plan shall begin within the latter of 30 calendar days after admission to the ARC Dialysis or 13 outpatient hemodialysis sessions ...” During a medical record review of Patient #1, it was determined that an initial nurse’s assessment and Plan of Care (POC) had been completed on 06/14/24 and 07/14/24 respectively, however a 90 days POC had not been completed. In an interview with the Social Worker (SW), she reviewed the patient’s record and determined the only follow up POC completed was her own which is dated 3/19/2025. The SW stated “that can’t be right.” In an interview on 05/29/25 at approximately 2:30 PM, the Director of Nursing (DON) stated that the facility had no social worker on staff from mid July 2024 until late February 2025, a SW from a sister facility came in to assist.”