Davita Metrowest Dialysis

“POC-MANAGE VOLUME STATUS CFR(s): 494.90(a)(1) The plan of care must address, but not be limited to, the following: (1) Dose of dialysis. The interdisciplinary team must provide the necessary care and services to manage the patient’s volume status; This Standard is not met as evidenced by: 39943 Based on record review and interview, failed to follow physician prescribed treatment orders for blood flow rate (BFR), dialysis flow rate (DFR), estimated dry weight (EDW), monitor patients during treatment and implement corrective actions when EDW goals were not achieved for 3 of 10 patients (#3, #9, #5). Findings: A review of the American Association of Kidney Patients (aakp.org) revealed that dry weight means the amount of body mass (weight) without extra fluid (water). If your body has too much fluid, it can lead to health risks such as high blood pressure, swelling, and other complications. 1.Patient #3 was admitted to the facility on 6/09/20. The initial diagnosis for dialysis was Type 2 diabetes. Physician order dated 11/19/25 noted BFR 400 ml/min (milliliters per minute) and DFR 600 ml/min., an EDW of 65.5 kilograms (kg). The patient’s EDW prior to new order on 11/19/25 was 67 kg. Review of the treatment records revealed on 10/20/25 patient #3’s post treatment weight (wt) was 71.7 kg and the EDW treatment goal was 67.5 kg. His DFR was documented between 600-620 throughout the treatment. The facilty could not any documented evidence as to why the physician orders were not followed nor was their any evidence had the staff had notified the physician or nurse. Further treatment record review revealed the following documented discrepancies with regards to the treatment orders: -10/22/25 his EDW was 67kg and his post treatment weight was 72.3 kg. -10/24/25 his treatment record indicated his BFR 350 during his entire treatment with no documented reason or notification to nurse. EDW 67 kg. post treatment wt. 73 kg. -10/27/25 treatment record read BFR 350 with no documented reason or notification to the nurse. EDW 67 kg post treatment wt. 71.6 kg. -10/29/25 treatment record indicated the DFR was documented to be 720 for 30 minutes with no documented reason or notification to the nurse. EST 67kg, post treatment wt. 75.1 kg. -10/31/25 the treatment record read EDW 67kg. post treatment wt. 74.2 kg. -11/03/25 the treatment record indicated the DFR ran 590-620 during the treatment with no reason given and no documentation of notification to the nurse. The EDW was 67kg. post treatment wt. 73.7 kg. The facility could not provide any documented evidence patient #3 was offered extra treatments or extended treatment time to remove the excess fluid so his prescribed estimated dry weight goal of 67 kg could be archived. 2. Patient #9 was admitted to the facility for dialysis on 8/2/23. The initial diagnosis for dialysis was hypertension and diabetes. Physician order dated 9/30/25 noted a BFR 400 ml/min and a DFR 600 ml/min. Review of the patient’s treatment records on 11/01/15, patient #9’s BFR was documented to be running at 260-350 and her DFR was 620-830 during her treatment. There was not any documentation that nurses or physicians were notified. On 11/04/25, the treatment record noted her DFR was increased to 610-620 with no documented reason and no notification to nurse or physician. On 11/11/25 and 11/13/25, the treatment record read her BFR was 350 for the full time of her dialysis treatments. No documentation that the nurse or physician were notified. On 11/19/25 at 3:15 PM Patient Care Technician (PCT) A stated if the patients’ treatment had to be changed in any way the nurse would be notified. He stated the nurse would then notify the physician. He said when the patient does not reach his EDW, they should be offered a longer dialysis time or an extra day, and the physician should be notified. On 11/20/25 at 5:25 PM the Administrator acknowledged the procedure for dialysis treatments was not followed as per the policy for the above patients. Review of the ICHD (In Center Hemo Dialysis) Management Protocol RV. 2.0 originated 3/21/17, revised 10/18/24 read If post weight is above total weight 2 treatments in 5 days, or 2 treatments since total weight was adjusted whichever is most recent- No change to total weight: increase treatment time by 15 minutes. If not able to increase treatment time, consult with the physician /NPP about treatment frequency. A review of facility policy “Pre-Intra-Post Treatment Data Collection, Monitoring and Nursing Assessment” dated September 2007 and revised April 2024 read, “If the dialysis prescription is not being met (including dialysis flow rate or change to /inability to obtain prescribed flood flow rate) the reason will be documented and the licensed nurse informed.” 13640 3. A review of the medical record of patient #5 was performed. On 11/6/25 the patient began her hemodialysis treatment at 10:58 AM. It was terminated at 1:59 PM, for a treatment time that was a minute over three hours. During the treatment session, assessments for the following were performed: blood pressure; heart rate; blood flow rate; dialysate flow rate; arterial pressure; venous pressure; ultrafiltration rate; volume removed; temperature of the machine, access visualization; and face visualization. These assessments were documented as being performed at the following times: 10:58 AM (initiation of treatment); 11:15 AM (17 minutes later than the preceding); 1:58 PM (2 hours 43 minutes later than the preceding); and 1:59 PM (termination of treatment - 1 minute later than the immediately preceding). A review of facility policy Pre-Intra-Post Treatment Data Collection, Monitoring and Nursing Assessment revealed the following: “Intradialytic treatment monitoring and data collection which may be performed by the PCT (Patient Care Tech) or licensed nurse includes: . . . Vital signs and treatment monitoring: . . . Non-nocturnal treatments are completed at least every (30) minutes.” Since there was a lack of assessments for a 2 hour and 43 minute time interval, the facility was not in compliance with this policy. During an interview of the Administrator on 11/20/25 at 5:15 PM she confirmed the failure to comply with expectations for treatment sessions.”

“GOV-INVOL DISCHARGE PROCESS REQUIREMENTS CFR(s): 494.180(f)(4) The medical director ensures that no patient is discharged or transferred from the facility unless - (4) The facility has reassessed the patient and determined that the patient’s behavior is disruptive and abusive to the extent that the delivery of care to the patient or the ability of the facility to operate effectively is seriously impaired, in which case the medical director ensures that the patient’s interdisciplinary team- (i) Documents the reassessments, ongoing problems(s), and efforts made to resolve the problem(s), and enters this documentation into the patient’s medical record; (ii) Provides the patient and the local ESRD Network with a 30-day notice of the planned discharge; (iii) Obtains a written physician’s order that must be signed by both the medical director and the patient’s attending physician concurring with the patient’s discharge or transfer from the facility; (iv) Contacts another facility, attempts to place the patient there, and documents that effort; and (v) Notifies the State survey agency of the involuntary transfer or discharge. (5) In the case of immediate severe threats to the health and safety of others, the facility may utilize an abbreviated involuntary discharge procedure. This Standard is not met as evidenced by: 39943 Based on interview, and record review, the facility’s administration failed to ensure patients received a notice of discharge 30 days prior to the actual date of the discharge, for 1 of 3 sampled patients, (#1). Findings: Resident #1 was a hemodialysis patient who was admitted to the facility on 10/11/23 and received treatments on Monday, Wednesday and Friday. She was provided with a 30-day discharge notice on 9/05/24, but the patient was not discharged from the facility within the 30 days of the notification. The patient continued to receive services and treatment 3 times a week until 2/06/25 when the patient was provided with an involuntarily discharge form indicating this would be her last treatment at the facility. A new 30-day discharge notice was not issued to the patient. On 3/26/25 at 3:30 PM, the facility’s Administrator stated she did not issue another 30-day discharge to patient #1 because she had already given the 30-day to the patient. She said she received a letter from her company stating if she did not give the final discharge notice to patient #1, she would be out of compliance. She stated the process was new to her and she thought that since she had already given patient #1 a 30-day discharge notice, she did not have to issue another one. The facility “Non-Payment Discharge Policy (Involuntary OR Voluntary Financial Discharge Policy” dated 3/04/03 read: D. Provide a 30-day written notice to the patient (i.e. the Initial Discharge Notice) of the impending discharge for nonpayment, if a payor source is not obtained. . .”