Fresenius Kidney Care of Clark County

“IC-CLEAN/DIRTY;MED PREP AREA;NO COMMON CARTS CFR(s): 494.30(a)(1)(i) Clean areas should be clearly designated for the preparation, handling and storage of medications and unused supplies and equipment. Clean areas should be clearly separated from contaminated areas where used supplies and equipment are handled. Do not handle and store medications or clean supplies in the same or an adjacent area to that where used equipment or blood samples are handled. When multiple dose medication vials are used (including vials containing diluents), prepare individual patient doses in a clean (centralized) area away from dialysis stations and deliver separately to each patient. Do not carry multiple dose medication vials from station to station. Do not use common medication carts to deliver medications to patients. If trays are used to deliver medications to individual patients, they must be cleaned between patients. This Standard is not met as evidenced by: 44230 Based on observation and interview the facility failed to maintain a clean area for the storage of medications for 1 of 1 facility reviewed. Findings Include: During an observation on 06/09/2025 at 11:05 AM, the refrigerator that housed injectable medications for patient use had a mold-like substance on the top shelf. Mircera (an injectable medication used to treat anemia) was housed on the top shelf. RN 2 wiped down the shelf using a 1:100 bleach solution and the mold-like substance was removed. During an interview on 06/09/2025 at 11:05 AM, RN 2 indicated that the dark spotty substance located in the medication refrigerator had been there since she started working at the facility. She was unsure what the substance was. During an interview on 06/09/2025 at 12:00 PM, the Administrator indicated she was unsure what the substance was in the medication refrigerator and speculated it was from a spill with dust accumulation.”

“POC-VA MONITOR/PREVENT FAILURE/STENOSIS CFR(s): 494.90(a)(5) The patient’s vascular access must be monitored to prevent access failure, including monitoring of arteriovenous grafts and fistulae for symptoms of stenosis. This Standard is not met as evidenced by: 51751 Based on observation, record review, and interview, the facility failed to assess the AVF (surgically created connection between an artery and a vein) site prior to cannulation (inserting 2 needles into AVF) during 1 of 3 AVF initiations observed. (Patient #6) Findings Include: According to the “Access Assessment and Cannulation” policy (05/05/2025, version 5) follow the steps to assess the vascular access: Look for skin discoloration, redness, bruising, lesions; Listen with a stethoscope the entire length of the access for changes in bruit; and Feel for the thrill. During an observation on 06/11/2025 at 10:50 AM, PCT 2 initiated Patient #6’s AVF treatment. PCT 2 failed to assess the AVF site by auscultation (listening) prior to cannulation. During an interview on 06/11/2025 at 11:17 AM, PCT 2 indicated she couldn’t recall if she auscultated Patient #6’s AVF prior to cannulation but she should have looked, listened, and felt the access site. During an interview on 06/11/2025 at 12:43 PM, RN 2 indicated that the AVF access site should be assessed by the look, listen, and feel method prior to cannulation. During an interview on 06/11/2025 at 12:57 PM, PCT 3 indicated that staff should look, listen, and feel the AVF access site prior to cannulation.”

“MD RESP-ENSURE ALL ADHERE TO P&P CFR(s): 494.150(c)(2)(i) The medical director must- (2) Ensure that- (i) All policies and procedures relative to patient admissions, patient care, infection control, and safety are adhered to by all individuals who treat patients in the facility, including attending physicians and nonphysician providers; This Standard is not met as evidenced by: 51751 Based on observation, record review, and interview, the medical director failed to ensure policy and procedure was followed to maintain aseptic techniques during AVF canulation for 2 of 3 AVF initiations observed. (Patient #1, 7) Findings Include: 1. According to the “Access Assessment and Cannulation” policy (05/05/2025, version 5), using an alcohol pad with gentle friction, clean the access site beginning in the center and continuing outward 2 inches in a concentric circle for 30 seconds and allow to dry before use cannulation. 2. During an observation on 06/09/2025 at 10:46 AM, PCT 4 initiated Patient #1’s AVF treatment. PCT 4 disinfected the AVF access site for 7 seconds using an alcohol prep pad. PCT 4 failed to disinfect the access site for 30 seconds prior to cannulation. 3. During an observation on 06/09/2025 at 10:58 AM, PCT 3 initiated Patient #7’s AVF treatment. PCT 3 disinfected the AVF access site for 20 seconds using an alcohol prep pad. PCT 3 failed to disinfect the access site for 30 seconds prior to cannulation. 4. During an interview on 06/09/2025 at 1:40 PM, PCT 4 indicated the AVF access site should be disinfected for a total of 30 seconds using an alcohol pad. 5. During an interview on 06/11/2025 at 12:43 PM, RN 2 indicated that the AVF access site is disinfected with an alcohol pad for 30 seconds. 6. During an interview on 06/11/2025 at 12:57 PM, PCT 3 indicated that AVF access site should be disinfected for at least 30 second using an alcohol pad.”