Renal Care Group - Newton

“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: 50529 Based on observation, policy review, and interview, the End Stage Renal Disease (ESRD) facility failed to ensure that staff required or encouraged patients to wash their hands or perform hand hygiene after holding their dialysis (a medical treatment that removes waste products and excess fluid from the blood when the kidneys are unable to do so) access site (a surgically created entry point into the bloodstream) after treatment on 1 of 2 observation days. This deficient practice increases the risk of infection that could negatively impact the health and well-being of the 28 patients who receive treatments. Findings Include: Review of a policy titled, “Hand Hygiene,” published on 11/06/23, showed, “ ...Gloves must be provided to patients when performing procedures which risk exposure to blood or body fluids, such as when self-cannulating or holding access sites post treatment to achieve hemostasis. To help ensure the prevention of cross contamination to their family members or other patients, hand hygiene must be performed ...” An observation of Station #7 on 09/10/25 at 8:20 AM showed that Staff H, Patient Care Technician (PCT) and Staff G, Certified Clinical Hemodialysis Technician (CCHT) failed to provide hand sanitizer or remind the patient to wash his/her hands prior to exiting the clinic. An observation of Station #9 on 09/10/25 at 10:21 AM showed that Staff G, CCHT did not offer hand sanitizer or remind the patient to wash his/her hands prior to exiting the clinic. An observation of Station #8 on 09/10/25 at 3:08 PM showed that Staff H, PCT did not offer hand sanitizer or remind the patient to wash his/her hands prior to exiting the clinic. During an interview on 09/10/25 at 7:54 AM with Staff H, Patient Care Technician (PCT), stated that patients are expected to wash hands or be offered hand sanitizer after holding sites post treatment. During an interview on 09/10/25 at 11:43 AM, Staff G, CCHT stated that patients who hold their own sites after treatment are to wash their hands or be provided hand sanitizer before leaving the facility.”

“IC-DISINFECT SURFACES/EQUIP/WRITTEN PROTOCOL CFR(s): 494.30(a)(4)(ii) [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-] (ii) Cleaning and disinfection of contaminated surfaces, medical devices, and equipment. This Standard is not met as evidenced by: 50529 Based on policy review, observation, and interview, the End Stage Renal Disease (ESRD) facility failed to that staff disinfected patient blood pressure cuffs after patient use on 1 of 2 observation days. This deficient practice increases the risk for infection that could negatively impact the health and well-being of the 28 patients who receive treatments at this facility. Findings Include: Review of a policy titled, “Cleaning and Disinfecting the Dialysis Station,” published on 09/02/25, showed, “ ...Equipment in the dialysis station may include (but is not limited to) to following: Dialysis machine/cycler and attachments such as IV pole, BP cuff and hand sanitizer/holder, sharps container mounted to the machine ...The dialysis station could be contaminated with blood and other body fluids during treatment ...” An observation on 09/10/25 at 8:40 AM, showed that Staff G, Certified Clinical Hemodialysis Technician (CCHT), did not disinfect the blood pressure cuff after use and stored it away. During an interview on 09/10/25 at 2:38 PM, Staff G, CCHT, stated that blood pressure cuffs should be wiped after use and before being stored away. During an interview on 09/10/25 at 3:47 PM, Staff A, Facility Administrator (FA), stated that it is the expectation of clinical staff to disinfect blood pressure cuffs after use and before storing away until next use.”

“PA-APPROPRIATENESS OF DIALYSIS RX CFR(s): 494.80(a)(2) The patient’s comprehensive assessment must include, but is not limited to, the following: (2) Evaluation of the appropriateness of the dialysis prescription, This Standard is not met as evidenced by: 50529 Based on policy review, record review, and interview, the End Stage Renal Disease (ESRD) facility failed to ensure that staff notified a licensed nurse for changes to dialysate flow rate (DFR) or blood flow rate (BFR) and that a licensed nurse assessment included a review of the patient treatment to verify the dialysis prescription was provided as ordered for 2 (Patient 1, and 6) of 7 sampled patients. This deficient practice increases the risk of inadequate treatment outcomes that could negatively impact the health and well-being of the 28 patients receiving treatment at this facility. Findings Include: Review of a policy titled, “Patient Assessment and Monitoring,” published 05/01/23, showed, “ ... Check prescribed blood flow is being achieved, or reason is documented in medical record if unable to meet prescribed blood flow. Check dialysate flow rate setting is correct, and the prescribed flow is being delivered ...Document any findings and interventions in the medical record ...” Review of a policy titled, “Nursing Supervision and Delegation,” published 11/06/23, showed, “ ...The registered nurse must evaluate each patient ...to ...Review accuracy and completeness of treatment ...Review patient treatment prescription and equipment parameters to verify correct settings, and if dialysis prescription is being followed ... The staff member who collects information pre, post, and during treatment will document their findings. Any observed changes or abnormal findings ...must be reported to the registered nurse who will assess the patient ...Prior to discharge, the RN must review the treatment record to ...Confirm patient is stable for discharge ...Correct dialysate prescription was delivered ...” Patient 1 Review of Patient 1’s treatment flowsheet records, dated 08/25/25 thru 09/05/25, showed a prescribed BFR of 400 milliliters per minute (mL/min) and DFR of 500 mL/min. On 08/29/25 at 12:36 PM, Staff A, Facility Administrator (FA) initiated treatment with a documented BFR at 350 mL/min. The BFR remained at 350 mL/min until end of treatment at 3:54 PM. Staff A failed to document a rationale for the decrease to the prescribed BFR and failed to document evidence that the prescribed treatment was not provided as ordered. On 09/01/25 at 1:01 PM, Staff H, Patient Care Technician (PCT) initiated treatment with a DFR of 800 mL/min. The DFR remained at 800 mL/min until end of treatment at 4:20 PM. Documentation failed to show evidence that a rationale was provided for the decrease to the prescribed DFR or that an RN was notified of the change to the prescribed DFR. Further review failed to show evidence that an RN reviewed data to ensure the treatment was provided as ordered. Patient 6 Review of Patient 6’s treatment flowsheet records, dated 08/25/25 thru 09/05/25, showed a prescribed DFR of 500 mL/min. On 09/03/25 at 9:06 AM, Staff G, CCHT initiated treatment with a DFR of 800 mL/min. The DFR remained at 800 mL/min until end of treatment at 12:04 PM. Documentation failed to show a rationale for the change to the prescribed DFR or that an RN was notified of the change to the DFR. Further review failed to show evidence that an RN assessed treatment data to ensure the dialysis treatment was provided as ordered During an interview on 09/09/25 at 11:45 AM, Staff A, FA, stated it is the expectation of clinical staff to follow physician’s dialysis orders per facility policy to ensure patients receive adequate dialysis.”