Fresenius Kidney Care Dallas

“CFC-GOVERNANCE CFR(s): 494.180 This Condition is not met as evidenced by: 32734 Based on observation, a review of facility records, staff interviews, and 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 21 in-center hemodialysis patients who were receiving dialysis treatment at this facility. Findings include: Cross-Reference: V 757 - 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: 32734 Based on observation, a review of facility records, staff interviews, and 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 who were receiving dialysis care; and that each care giver was not assigned more than four patients each shift. This deficient practice negatively affected the health and safety of one of one patient (P#3) who experienced a possible air embolism (a potentially life-threatening condition where air enters the bloodstream that can occur during hemodialysis, especially when using CVC [Central Venous Catheter - A flexible tube that was inserted into a vein and was guided/threaded into a large vein above the right side of the heart called the superior vena cava]). P#3’s arterial chamber of the bloodlines became empty, and filled her bloodline with air. Additionally, insufficient staffing 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, access sites, and slower responses to alarms, missed complications including but not limited to intradialytic hypotension (sudden drops in blood pressure [BP] which can occur when fluid is removed too rapidly), arrhythmias (irregular heartbeat), and other medical issues and emergencies related to hemodialysis. The facility had 21 incenter hemodialysis patients. Findings include: During observation in the Patient Treatment Room on 3/5/25 between 10:30 a.m. and 12:30 p.m., the following was revealed: - There was one Registered Nurse (RN AA), and two Patient Care Technicians (PCT AA and PCT BB), who provided direct patient care on 3/5/25. - There were 10 patients who were scheduled to dialyze on the first and 11 patients on second shift. A review of the staff/patients’ assignment sheet dated 3/5/25 showed the following: First shift: - PCT AA was assigned and cared for patients at Station (S) 1, S2, S3, and S4. - PCT BB was assigned and cared for three patients in S6, S7, and S8. S5 was vacant. - RN AA functioned as a dialysis care giver (total care) to three patients in the “Nurse Pod”, S9, S10 and S11, which was the isolation room. In addition, RN AA was also assigned to perform all nursing duties such as conducting pre and post nursing assessments, preparation and administration of all medications, addressing patients’ complaints, physician notification, dealing with unforeseen complications of dialysis/medical issues, and emergency situations that could arise during dialysis treatment for seven patients in S1, S2, S3, S4, S6, S7, and S8, who were assigned to PCT AA and PCT BB. A review of staff/patients’ assignment sheets from February 24, 2025, through March 5, 2025, revealed the following: On 2/24/25: There were 10 patients scheduled on the first shift and 11 patients on second shift. There were two PCTs, and one RN. On 2/26/25: There were 10 patients scheduled on the first shift and 11 patients on second shift. There were two PCTs, and one RN. On 2/28/25: There were 10 patients scheduled on the first shift and 11 patients on second shift. There were two PCTs, and one RN. On 3/3/25: There were 10 patients scheduled on the first shift and 11 patients on second shift. There were two PCTs, and one RN. On 3/5/25: There were 10 patients scheduled on the first shift and 11 patients on second shift. There were two PCTs, and one RN. During an interview on 3/5/25 at approximately 11:10 a.m., RN AA, who was the Charge Nurse (CN) stated that she could handle the treatment floor most of the time, however, there were times when she could not even take a break. Stated “If something happens, like when a patient’s BP drops, I have to handle it, and it gets very busy. Sometimes the Facility Administrator who is an RN, will come out and assist me if it gets too busy”. Also stated she was used to handling a ratio of 1:12 (one nurse to 12 patients) by herself but was harder for the float RNs when they come because they did not know the patients. During an interview on 3/5/25 at approximately 12:00 p.m., the Director of Operations (DO) stated she had to move staff from one facility to another to provide staffing and have hired five new staff who started in March who were currently in training. Stated the Facility Administrator of this facility covered a sister facility as well, but she had a strong CN in each facility. During an interview on 3/5/25 at approximately 12:54 p.m., PCT AA stated that she has been at this facility for three years, and that she usually monitors four patients but provides monitoring for the other PCT’s patients when she goes on break. Stated they work together as a team. It has been the same three people who worked three days a week, and they have developed a routine. An interview with the Facility Administrator on 3/5/25 at 3:15 p.m., revealed that she covered two facilities and was at this facility approximately once a week. A review of “Adverse Occurrences” from February 1, 2025 through March 5, 2025, revealed the following: On 2/24/25, P#3 who had a CVC, experienced a possible air embolism (can cause difficulty breathing, chest pain, and confusion). The arterial chamber of the bloodlines was empty, and the bloodline was filled with air. The bloodlines were clamped to prevent more air from entering the system and P#3 was placed on her left side. P#3 complained of inability to move her left arm and leg and was sent to the hospital via EMS (Emergency Medical Services) for further examination and treatment. During an exit interview with the Facility Administrator and Director of Operations on 3/5/25 at 4:45p.m., the above findings were discussed and acknowledged by both. The Medical Director was on vacation and unavailable for interview.”