Fmc - Renal Care Center of Marietta Bma

“CFC-GOVERNANCE CFR(s): 494.180 This Condition is not met as evidenced by: 03383 Based on a review of facility records, staff interviews and a a review of minimum state required staffing ratios, it was determined that the Governing Body failed to demonstrate responsibility and accountability for the operations of the facility. This deficient practice had the potential to negatively affect the health and safety of 87 patients who dialyzed at this facility. Findings include: Cross-Reference: V757 - Failure of the Governing Body to ensure that the facility had adequate number of qualified staff to meet the needs of all patients and provide safe patient care; and to be in compliance with the minimum State required staffing ratios of one licensed and qualified nurse for every 12 patients who were receiving dialysis care and one qualified patient care giver for every four patients.”

“GOV-STAFF # & RATIO MEET PT NEEDS CFR(s): 494.180(b)(1) The governing body or designated person responsible must ensure that- (1) An adequate number of qualified personnel are present whenever patients are undergoing dialysis so that the patient/staff ratio is appropriate to the level of dialysis care given and meets the needs of patients; This Standard is not met as evidenced by: 03383 Based on a review of facility records, staff interviews and a a review of minimum state required staffing ratios, it was determined that the Facility Administrator failed to ensure the facility had adequate number of qualified staff to meet the needs of all patients as evidenced by a lack of at least one licensed and qualified nurse (who was not counted as a dialysis care giver in the staff-to-patient ratio of one dialysis care giver to four patients), who was readily available to provide nursing care, take charge and deal with unexpected complications of dialysis, for every 12 patients receiving dialysis care and that each care giver was not assigned more than four patients at any given time. This deficient practice had the potential to cause a delay in monitoring patients for issues such as fluid overload (an excessive amount of fluid in the body), changes in vital signs, or problems with the dialysis equipment. Additionally, insufficient staffing could mean slower responses to alarms, delayed adjustments, or missed complications including but not limited to intradialytic hypotension (sudden drops in blood pressure which can occur when fluid is removed too rapidly), arrhythmias (irregular heartbeat), and other medical issues and emergencies related to hemodialysis. The facility census was 87. Findings include: - A review of the “Patient/Staff Schedule” dated 6/9/25 showed RN AA was scheduled from 5:00 a.m. to 12:00 p.m., RN BB was scheduled from 5:45 a.m. to 16:00 (4:00 p.m.), and RN MM was scheduled to work from 12:00 p.m. to 21:40 (9:40 p.m.). The schedule did not show who was assigned to Pod 1 and Pod 2 on the third shift. - A review of the third shift (from 3:10 p.m. to 9:12 p.m.) “Treatment Sheets” dated 6/9/25 revealed the following: - There were eight patients who dialyzed on the third shift. - The third shift was staffed with one RN (RN MM) and one PCT (PCT HH). - PCT HH cared for four patients (Patient [P] #1 at Station [S] 4, P#2 at S1, P#3 at S7, and P#4 at S8). - RN MM cared for four patients. Three patients had dialysis catheter (P#5 at S14, P#6 at S6, P#7 at S11) and one patient had a fistula access (P#8 at S15). - In addition to performing catheter site care/dressing changes for catheter patients, initiating dialysis treatment, monitoring patients during dialysis, and terminating dialysis treatment for four patients, RN MM also performed pre and post nursing assessments and prepared/administered all medications for eight patients while he was also the charge nurse who was responsible for dealing with unexpected complications of dialysis should any occur. - During an interview on 6/10/25 at 12:30 p.m., Registered Nurse (RN) AA stated she has worked here for two years, that she usually has one patient in the morning and one patient in the afternoon. RN AA stated that she is responsible for machine set-up, patient assessments, obtaining physician orders, initiating and discontinuing dialysis treatment for patients with catheter access. RN AA stated that there were three catheters on the first shift, three catheters on the second shift, and two catheters on third shift on Mondays, Wednesdays, and Fridays; and on Tuesdays, Thursdays, and Saturdays, there was one catheter on the first shift and six catheters on second shift. When staff call out, they request help from other clinics or ask patients to reschedule. However, this happens very seldom because they usually have open chairs. Stated “We are not really short-staffed. The Nurse Manager and the Charge Nurse help. We have one charge nurse who has been off on bereavement leave for weeks. The Nurse Manager has been covering for her while she’s off.” - During an interview on 6/10/25 at 12:59 a.m., Patient Care Tech (PCT) II stated that she has worked at this facility since January 2025 but has 25 years of dialysis experience. PCT II stated she feels overwhelmed at times, with overlapping of patients during shift change and when they switch up patients (change patient stations to accommodate staffing/patient needs). Stated “We end up with patients in our section that are scheduled to go on at the same time”. Stated, this has happened often. It happened yesterday (6/9/25) and it can happen at any time. The facility had very little staff call outs and not often that staff put on more than four patients per shift. - During an interview on 6/10/25 at 1:10 p.m., the Director of Operations stated that they do not have a staffing issue at this facility. “We have a charge nurse and a clinic manager here. Neither of them is on the schedule (assigned to patients). When there are call outs, we will call and find someone to cover with enough notice.””