Fresenius Medical Care River City

“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: 52051 Based on observation, a review of the Centers for Disease Control and Prevention (CDC) guidelines, staff and patient interviews, and a review of facility Policies and Procedures (P & P), it was determined that the facility failed to ensure that two of two Registered Nurses (RN AA and RN BB), and one of one Patient Care Technician (PCT BB) observed, consistently performed hand hygiene (handwashing with soap and water or use of an alcohol-based hand sanitizer) upon entering the Patient Treatment Room and after touching contaminated area/equipment. This breach in infection control techniques, such as hand hygiene, had the potential to increase the risk for cross contamination with the potential to expose patients and staff to bloodborne pathogens in the dialysis environment. The facility had 65 in-center hemodialysis (ICHD) patients. Findings include: During observation in the Patient Treatment Room on 9/4/25 from 8:10 a.m. to 9:46 a.m., the following was revealed: - At 8:49 a.m., PCT BB entered the Patient Treatment Room. She put on her gown and face shield, then proceeded to the rolling cart situated in front of Station (S)10 and S11. Without sanitizing her hands first, she grabbed a new pair of gloves and put them on, then touched the dialysis machine at S12. At 8:53 a.m., RN BB removed her face shield by grabbing the front side with her bare hands and hung it by the medication refrigerator adjacent to the nurses’ station. She then sat down in front of the computer at the nurses’ station and started charting (clean task) without sanitizing her hands first. At 9:05 a.m., RN AA entered the Patient Treatment Room. She put on her gown and face shield, then proceeded to the nurses’ station while placing her stethoscope around her neck. This surveyor observed that RN AA did not sanitize her hands at any point before using the computer at the nurses’ station. CDC recommends that healthcare workers clean their hands using an alcohol-based hand sanitizer (or soap and water if their hands are visibly soiled) before entering a treatment area. This practice helps prevent the spread of infection and protects both healthcare workers and their patients. Additionally, CDC emphasized that the outside of goggles or face shield are considered contaminated. If hands become contaminated while removing goggles or a face shield, it is important to promptly wash them or use an alcohol-based hand sanitizer. During an interview with patient (P)#2 at S3 on 9/4/25, at 9:27 a.m., she stated that the staff members typically did not wear their Personal Protective Equipment (PPE) or sanitize their hands consistently and proactively. She also mentioned that seeing them follow these practices on this day (9/4/25) was unusual for her. During an interview with PCT BB on 9/4/25, at 9:10 a.m., she confirmed that she forgot to sanitize her hands after entering the Patient Treatment Room and she acknowledged the importance of consistent hand hygiene practices. In another interview with RN BB on 9/4/25, at 9:19 a.m., she also acknowledged the observation and stated that she forgot to sanitize her hands after removing face shield before proceeding with other tasks. - A review of facility P & P Reference #47664, titled, “Hand Hygiene”, published 11/6/23, stated: Responsibility All staff, patients, patient care givers, including physicians and non-physician practitioners . . . must follow the same requirement for hand hygiene. Hands will be: Decontaminated using alcohol-based hand rub or by washing hands with anti-microbial soap and water . . . When: - Entering and leaving the treatment area. During a telephonic interview with PCT DD on 9/4/25, at 12:38 p.m., she stated that there were significant infection control issues, specifically regarding proper hand hygiene practices among Direct Patient Care (DPC) staff at the facility. During an interview with the Medical Director on 9/4/25, at 1:43 p.m., he stated that he would ensure all staff members receive re-education or retraining on infection control, particularly regarding proper hand hygiene practices.”

“IC-SINKS AVAILABLE CFR(s): 494.30(a)(1)(i) A sufficient number of sinks with warm water and soap should be available to facilitate hand washing. This Standard is not met as evidenced by: 52051 Based on observation, staff and patient interviews, and a review of facility Policy and Procedures (P & P), it was determined that the facility failed to ensure that three of three clean sinks (handwashing sinks), in one of one Patient Treatment Room, had running warm water to encourage patients and staff to wash their hands. This deficient practice had the potential to discourage fourteen of fourteen patients at Station (S)1, S2, S3, S4, S5, S6, S9, S10, S11, S12, S13, S14, S15, and S16, and five of five Direct Patient Care (DPC) Staff (Registered Nurses - RN AA and RN BB, and Patient Care Technicians - PCT AA, PCT BB, and PCT CC), who were present during this observation, to wash their hands to prevent cross contamination. The facility had 65 in-center hemodialysis (ICHD) patients under their care. Findings include: During observation in the Patient Treatment Room on 9/4/25 from 8:10 a.m. to 9:46 a.m., the following was revealed: - There were a total of three handwashing sinks which were designated as “clean sinks”. - Sink #1 is located on the right side, approximately 10 to 14 feet from the entrance of the Patient Treatment Room, which was accessed from the main lobby. - Sink #2 was located at the nurses’ station, directly across from another exit door that led to the facility’s back hallway. - Sink #3 was located in the medication preparation area. - None of the three sinks mentioned above had running hot water after the surveyor tested them for three minutes. During an interview with PCT AA on 9/4/25, at 8:16 a.m., he stated that it took some time for the running water to warm up. He verbalized, “Water starts to warm up in about five minutes.” PCT AA also stated that the Biomedical Technician (BMT) had been notified about this issue, but PCT AA didn’t remember when the BMT was notified and this issue had not been resolved. During an interview with the Charge Nurse, RN AA, on 9/4/25, at 8:18 a.m., she confirmed that the water in all the clean sinks mentioned above took a while to warm up. RN AA also mentioned that staff members let the water run for some time in the morning before use. During an interview with patient (P)#1 at S16 on 9/4/25, at 8:20 a.m., he mentioned that he had noticed a lack of running hot water whenever he tried to use the sink to wash his hands. He stated that he had been experiencing this issue for about a month. On 9/4/25, at 9:45 a.m., the Director of Operations was informed of this observation and she stated that she would coordinate with the Area Technical Operations Manager. In a follow-up interview on 9/4/25, at 10:50 a.m., the Director of Operations stated that after discussing the issue with the Area Technical Operations Manager, she was informed that there appeared to be a problem with the Water Recirculation Pump. A review of facility P & P Reference #47664, titled, “Hand Hygiene”, published 11/6/23, stated: Sink Policy A sufficient number of sinks with soap and plumbed with both hot and cold water shall be available to facilitate hand washing. During a discussion with the Area Technical Operations Manager on 9/4/25, at 11:07 a.m., he acknowledged this observation and explained that the facility’s Water Recirculation Pump, which had been installed only eight to nine months ago, seemed not to be warming up when he checked it on this date (9/4/25). He stated, “Something’s wrong with it”. During a telephonic interview with PCT DD on 9/4/25, at 12:38 p.m., she stated that there had been no running hot water in the facility, specifically in the Patient Treatment Room, from May 2025 to June 2025, while at the facility.”

“IC-HANDLING INFECTIOUS WASTE CFR(s): 494.30(a)(4)(i) [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- (i) Handling, storage and disposal of potentially infectious waste; This Standard is not met as evidenced by: 52051 Based on observation, staff interviews, a review of Occupational Safety and Health Administration (OSHA) Bloodborne Standard, and a review of facility Policies and Procedures (P & P), it was determined that the Infection Control Committee failed to ensure that five of five Direct Patient Care (DPC) Staff (Registered Nurses- RN AA and RN BB, and Patient Care Technicians - PCT AA, PCT BB, and PCT CC), who were present during this observation, properly disposed of waste contaminated with blood found in one of two “non-hazard” waste bins which was left uncovered, in one of one Patient Treatment Room. This failure could potentially expose both patients and staff to infectious materials. This deficient practice had the potential to negatively affect the health and safety of all DPC Staff and 65 in-center hemodialysis (ICHD) patients who were under the care of this facility. During observation in the Patient Treatment Room on 9/4/25 from 8:10 a.m. to 9:46 a.m., the following was revealed: - There was a total of two large black bins lined with red bags, labeled “Biohazard Waste” (contaminated with potentially infectious agents or other materials, such as blood, body fluids, and human cell lines). - There were two large gray bins lined with black bags, labeled “Non-Hazard Waste” (any waste that causes no harm to human or environmental health, such as materials that do not contain blood or body fluids). These gray bins were uncovered. Inside one of the two large gray bins was a paper towel with a drop of fresh blood about the size of a quarter. At the time of this observation, this gray bin was almost three-quarters full and did not have a lid or cover. During an interview with PCT CC on 9/4/25, at 9:07 a.m., she stated that any items containing blood should be disposed of in the black bin lined with a red “Biohazard” plastic bag. In a subsequent interview with PCT BB on 9/4/25, at 9:10 a.m., she clarified that staff were not supposed to throw anything containing blood into the gray bin. She emphasized that all staff members were aware of this policy. OSHA Bloodborne Standard emphasizes the importance of treating blood and materials contaminated with blood as biohazardous waste rather than regular trash in order to protect public health and the environment. It is essential to place biohazardous waste in specially marked red bags or in closable, leak-proof containers that are labeled with a biohazard symbol. Additionally, improper handling and disposal of blood waste can lead to exposure and the transmission of infectious agents. This surveyor notified the Director of Operations on 9/4/25, at 10:31 a.m., and she stated that staff were not supposed to throw anything into the large gray bin containing blood. - A review of facility P & P Reference #47685, titled, “General Cleanliness and Infection Control Guidelines”, published 9/2/25, stated: Other Regulated Waste - Regulated medical waste shall be placed in a container that is accordance with OSHA bloodborne standard ... and is closeable, leak proof and labeled and/or color coded. - Regulated waste shall be placed in containers which are: *Closeable *Labeled or color-coded”

“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: 52051 Based on observation, staff interviews, and a review of facility Policies and Procedures (P & P), it was determined that the facility failed to ensure that the building in which dialysis services were provided was sanitary and maintained to ensure the safety of all patients and staff. Failure to maintain the integrity of all surfaces could hinder effective cleaning and disinfection of the surfaces, thus providing a potential for microbial growth. These environmental concerns were observed in one of one Patient Treatment Room and one of one Dialysate Preparation Room. The facility had 65 in-center hemodialysis (ICHD) patients. Findings include: 1. In the Patient Treatment Room: During observation on 9/4/25 from 8:10 a.m. to 9:46 a.m., the following was revealed: - A gray container, resembling a cooler, was located under the laboratory sink labeled “dirty sink.” This container measured approximately 2.5 Feet in length and 1.5 Feet in height. The lid of this container was partially obscured by brownish and rust-colored substances, along with dried, flaky white residues. Next to this was a detached piece of white plywood, placed sideways, which appeared to be a shelf that had been removed from somewhere. The plywood measured approximately 2 Feet in length and 1.5 Feet in width, and showing significant water damage. - Two of two gray rolling carts for clean/sterile dialysis supplies (like dialyzers, gloves, gauze, and saline bags), were partially covered with a noticeable layer of dust and a mixture of brownish and gray grainy substances. - There was a puddle of water behind Machine #10, extending behind the dialysis chair located at Station (S)13. The wet area measured approximately 4 feet in length and 2 feet in width. During an interview with Registered Nurse (RN BB) on 9/4/25, at 9:22 a.m., she acknowledged that the rolling supply carts were dirty and stated that she had begun cleaning them. During an interview with Patient Care Technician (PCT AA) on 9/4/25, at 9:28 a.m., he stated that he just found out about the puddle of water behind the dialysis machine at S13, since he just came back to the Patient Treatment Room from his break, and added that he will try to figure out why there was a puddle there. During an interview with PCT CC on 9/4/25, at 9:37 a.m., she acknowledged that the gray container under the laboratory sink, was dirty, but was probably empty. 2. In the Dialysate Preparation Room: During a tour with the Director of Operations on 9/4/25 between 10:05 a.m. and 10:13 a.m., the following was revealed: - The wall and floor drain behind the Reverse Osmosis (RO) System (a system that removes chemical and microbiological contaminants from the water supply for dialysis) was heavily soiled with dark brown and blackish dirt buildup. This indicated that it had not been cleaned for a significant period of time. - The Director of Operations acknowledged this observation during the tour on 9/4/25 at 10:36 a.m., and added that she would coordinate with the Area Technical Operations Manager regarding this matter. During an interview with the Area Technical Operations Manager on 9/4/25 at 11:07 a.m., he acknowledged this observation and stated that the dirt buildup on the floor drain behind the RO System was likely due to its location, which made cleaning challenging. A review of facility P & P Reference #47685, titled, “General Cleanliness and Infection Control Guidelines”, published 9/2/25, stated: - All areas must be kept clean and organized, including but not limited to treatment areas, water/supply rooms, offices and restrooms. - Facility staff are accountable for cleaning rooms/areas not assigned to contracted cleaning staff. Such cleaning should be done regularly using a schedule developed by the facility.”