Liberty Dialysis - Meridian

“COMPLIANCE WITH FED/STATE/LOCAL LAWS CFR(s): 494.20 The facility and its staff must operate and furnish services in compliance with applicable Federal, State, and local laws and regulations pertaining to licensure and any other relevant health and safety requirements. This Standard is not met as evidenced by: 39430 Based on record review, staff interview, and policy review, the facility failed to ensure documented oversight of a Licensed Practical Nurse (LPN) by a Registered Nurse (RN), as required by Idaho state law and scope-of-practice regulations. This deficient practice was identified in 1 of 8 Incenter patients whose record was reviewed (Patient #8) and has the potential to affect all patients receiving dialysis care by LPNs at the facility. Findings included: The Idaho Board of Nursing, per IDAPA 24.34.01.002.15 stated: “licensed practical nurses function in dependent roles. The stability of the patient’s environment, the patients clinical state and the predictability of the outcome determine the degree of direction and supervision that must be provided to the practical nurse.” Additionally, under Idaho Statute 54-1402(3): “”Licensed practical nurse” means a person licensed by the board who practices nursing by: (a) Functioning at the direction of a licensed registered nurse, licensed advanced practice registered nurse, licensed physician, or licensed dentist in a role falling within the nurse’s scope of practice as defined by the board.” Patient #8 was a 81 year old male who received In center hemodialysis 3 times a week. His medical record review included at treatment on 7/01/25. The treatment sheet included that an LPN independently performed patient assessments, administered IV medications through the dialysis machine, and documented treatment responses without evidence of supervision, review, or co-signature by an RN. No RN oversight or care coordination was documented in the medical record. The Facility Administrator was interviewed on 7/15/25 beginning at 9:30 AM and Patient #8’s medical record was reviewed in his presence. He confirmed that the LPN was assigned independently, and that the facility does not maintain documentation of RN oversight in individual treatment records. The facility failed to ensure that an LPN functioned under the direction of an RN and failed to document such oversight as required by Idaho law.”

“PR-RECEIVE SERVICES OUTLINED IN POC CFR(s): 494.70(a)(12) The patient has the right to- (12) Receive the necessary services outlined in the patient plan of care described in §494.90; This Standard is not met as evidenced by: 51906 Based on record review and staff interview, it was determined the facility failed to ensure services were provided in accordance with the POC for 4 of 8 ICHD patients (Patient #6, #7, #11, and #13) whose records were reviewed. Not meeting the prescribed BFR and DFR had the potential for inadequate treatment. Findings include: 1. Patient #13 was a 74 year old female who received ICHD since 8/26/2020. Her incenter treatment sheets were reviewed for 13 treatments between 6/11/25 and 7/11/25. - The treatment sheet for 6/30/25 noted that her BFR was prescribed to be set at 500. At 11:00 AM, the beginning of treatment her BFR was set to 600 and continued at 600 until the end of her treatment at 2:29 PM. - The treatment sheet for 7/09/25 noted that Patient #13’s BFR was prescribed to be set to 500. At 11:01 AM the BFR for Patient #13 is noted to be set at 600 and continues at 600 until the end of treatment at 3:01 PM. - The treatment sheet for 7/11/25 noted that Patient #13’s BFR was prescribed to be set at 500. At 11:00 AM the BFR for Patient #13 was noted to be 600 and continued at 600 until the end of treatment at 2:30 PM. It was unclear why Patient #13’s BFR was not set to the prescribed rate for the above treatments. 2. Patient #6 was a 74 year old male who received ICHD since 06/10/2021. His incenter treatment sheets were reviewed for 13 treatments between 6/11/25 and 7/11/25. - His treatment sheet for 6/20/25 was reviewed. It showed that his DFR was prescribed to be at 600 mL/min. At 11:01AM, the beginning of his treatment, the DFR rate was set to 800mL/min. The DFR rate continued at 800 mL/min until the end of his treatment at 2:37 PM. It is unclear why Patient #6’s prescription was not followed. 3. Patient #7 was a 23 year old female who received ICHD in center since 10/01/2024. Her incenter treatment sheets were reviewed for 13 treatments between 6/12/25 and 7/12/25. - For treatment date 6/17/25 the prescribed DFR was 600mL/min. The 6/17/25 treatment sheet showed that at the beginning of her treatment at 6:53 AM the DFR was set at 500 mL/min and continued at 500 mL/min until the end of treatment at 10:40 AM. - The treatment sheet for 07/08/25 showed that the prescribed rate for the BFR was 350. The treatment was started at 350 at 6:41 AM. The BFR is then changed to 300 at 7:00 AM and remained at 300 until it is changed to 350 at 8:03 AM. It was unclear why Patient #7’s prescription was not followed for the above treatments. 4. Patient #11 was a 70 year old female who received ICHD since 03/19/2020. Her incenter treatment sheets were reviewed for 13 treatments between 6/12/25 and 7/11/25. - Her treatment sheet for 6/19/25 showed that her prescribed BFR was 450. At 5:45 AM, the beginning of his treatment, her BFR is recorded to be set at 400. The BFR continuee at the rate of 400 until the end of treatment at 9:18 AM. It was unclear why Patient #11’s prescription was not followed. The Charge Nurse was interviewed on 7/16/25 beginning at 11:45 AM. The treatment sheets for Patient #6, #7, #11, and #13 were reviewed in her presence. She acknowledged that the BFR and DRF were not set according to the patients prescribed rates as described above. She stated she would expect an explanation on the treatment sheet if there was a reason for the setting to be different. She acknowledged that each incident of the rate being off had no explanation as to why it was not set to the prescribed rate. The facility failed to ensure patients received their treatment as prescribed in their plan of care.”

“MR-COMPLETE, ACCURATE, ACCESSIBLE CFR(s): 494.170 The dialysis facility must maintain complete, accurate, and accessible records on all patients, including home patients who elect to receive dialysis supplies and equipment from a supplier that is not a provider of ESRD services and all other home dialysis patients whose care is under the supervision of the facility. This Standard is not met as evidenced by: 51906 Based on record review and staff interview, it was determined that the facility failed to maintain complete, accurate records. This lack of accurate documentation indicating pertinent patient complaints, signs, and symptoms during treatment directly impacted 3 of 8 ICHD patients (Patient #6, #11, and #13). Not maintaining accurate documentation has the potential to impact all patients dialyzing at the facility. This failure allowed the potential for inadequate and improper treatment being administered to patients. Findings include: 1. Patient #6 was a 74 year old male who received ICHD since 06/10/2021. His incenter treatment sheets were reviewed for 13 treatments between 6/11/25 and 7/11/25. Treatment sheet for 6/25/25 stated that Patient #6’s “UF unmet d/t dizziness and hypotension.” The treatment sheet for 6/25/25 in a section titled, “NEW COMPLAINTS OR OBSERVATIONS WHICH DEVELOPED DURING DIALYSIS:” noted “No new findings.” It is unclear why Patient #6’s complaint of dizziness and hypotension was not noted as a complaint or observation. 2. Patient #11 was a 70 year old female who received ICHD since 03/19/2020. Her incenter treatment sheets were reviewed for 13 treatments between 6/12/25 and 7/11/25. Treatment sheet for 7/03/25 stated “UF off; pt bp low.” The treatment sheet for 7/03/25, in a section titled, “NEW COMPLAINTS OR OBSERVATIONS WHICH DEVELOPED DURING DIALYSIS:” noted “No new findings.” It is unclear why Patient #11’s episode of hypotension was not noted as a complaint or observation. 3. Patient #13 was a 74 year old female who received ICHH since 8/26/2020. Her incenter treatment sheets were reviewed for 13 treatments between 6/11/25 and 7/11/25. The treatment sheet for 06/25/25 stated “pt c/o headache, pt taking 2 tylenol.” The treatment sheet for 6/25/25, in a section titled, “NEW COMPLAINTS OR OBSERVATIONS WHICH DEVELOPED DURING DIALYSIS:” noted “No new findings.” It is unclear why Patient #13’s complaint of headache and administration of Tylenol was not noted. The Charge Nurse was interviewed on 7/16/25 beginning at 11:45 AM. The treatment sheets for Patient #6, #11, and #13 were reviewed in her presence. She acknowledged that she would expect any complaints or observations which developed during dialysis would be noted in a section titled, “NEW COMPLAINTS OR OBSERVATIONS WHICH DEVELOPED DURING DIALYSIS:” and acknowledged they were not noted in the treatment sheets for Patient #6, #11, and #13. The facility failed to maintain complete, accurate records.”