Ara Auburn Dialysis Center

“POC-ACHIEVE ADEQUATE CLEARANCE CFR(s): 494.90(a)(1) Achieve and sustain the prescribed dose of dialysis to meet a hemodialysis Kt/V of at least 1.2 and a peritoneal dialysis weekly Kt/V of at least 1.7 or meet an alternative equivalent professionally-accepted clinical practice standard for adequacy of dialysis. This Standard is not met as evidenced by: 44223 Based on observation, interview, and record review, the facility failed to ensure the dialysis treatment order was delivered as prescribed, relative to Blood Flow Rate [BFR]-speed measured in millimeter per minute [ml/min] in which the patient’s blood is pushed through the dialysate and back into the body) and Dialysate Flow Rate (DFR-the measurement of how fast the dialysis solution flows in ml/min to draw toxins from the patient’s blood) for 1 of 4 prescriptions observed; and for 3 of 6 applicable patient’s (#2, #3, and #6) records reviewed, out of a total sample of 9 patients. Findings Include: 1. For Patient #2, the facility failed to ensure the dialysis prescription was delivered as prescribed relative to DFR. Patient #2 was admitted to the facility in April 2022 with a diagnosis of End Stage Renal Disease (ESRD), requiring hemodialysis treatment 3 times a week. During an observation on 2/10/25 at 8:30 A.M., the surveyor observed Patient #2 receiving dialysis treatment and the machine was set at a DFR rate of 500 ml/min, and not the 800 ml/min as prescribed. Review of the physician’s order, dated 2/10/25, indicated the DFR was to be delivered at a rate of 800 ml/min. During an interview on 2/10/25 at 8:35 A.M., Certified Clinical Hemodialysis Technician [CCHT] #4 reviewed the physician’s order and said it should be running at 800 and not 500. She said she was not sure why it wasn’t running at the correct order. 38141 2. For Patient #2, #3, and #6, the dialysis staff failed to ensure the BFR and/or DFR were delivered as prescribed. a. For Patient #2, the dialysis staff failed to ensure the BFR and DFR were delivered as prescribed. Patient #2 was admitted to the facility in April 2022 with diagnoses which included End Stage Renal Disease (ESRD), requiring hemodialysis treatment 3 times a week. Review of the Physician’s order, dated 1/21/25, indicated the BFR was to be delivered at a rate of 400 ml/min, and DFR was to be delivered at the rate of 800 ml/min. Review of the 9 Hemodialysis Flowsheets, dated 1/22/25 through 2/10/25, indicated that the BFR and DFR had not been delivered as prescribed for 6 of 9 Hemodialysis Flowsheets as follows: *1/24/25 - the DFR was delivered at a rate of 500 ml/min, not 800 ml/min as ordered, and there was no documentation to indicate why the physician’s order was not followed. *1/27/25 - the BFR was delivered at a rate of 450 ml/min, not 400 ml/min, and there was no documentation to indicate why the physician’s order was not followed. *1/29/25 - the BFR was delivered at a rate of 450 ml/min, not 400 ml/min as ordered, and there was no documentation to indicate why the physician’s order was not followed. *1/31/25 - the BFR was delivered at a rate of 450 ml/min, not 400 ml/min as ordered, and there was no documentation to indicate why the physician’s order was not followed. *2/5/25 - the BFR was delivered at a rate of 200 ml/min, not 400 ml/min as ordered, and there was no documentation to indicate why the physician’s order was not followed. *2/10/25 - the DFR was delivered at a rate of 500 ml/min, not 800 ml/min as ordered, and there was no documentation to indicate why the physician’s order was not followed. During an interview on 2/10/25 at 3:55 P.M., the Clinic Manager (CM) said staff should run the prescription per the MD order. 10249 b. For Patient #3, the dialysis staff failed to ensure that the DFR were delivered as prescribed. Patient #3 was admitted to the facility in November 2024 with diagnoses which included End Stage Renal Disease (ESRD), requiring requiring hemodialysis treatment 3 times a week. Review of the Physician’s order, dated 11/11/24 and revised on 1/10/25, indicated the BFR was to be delivered at a rate of 350 ml/min, and DFR was to be delivered at the rate of 800 ml/min. Review of the 9 Hemodialysis Flowsheets, dated 1/23/25 through 2/10/25, indicated the DFR had not been delivered as prescribed for 3 of 9 Hemodialysis Flowsheets as follows: *1/24/25 - the DFR was delivered at a rate of 500 ml/min, not 800 ml/min as ordered, and there was no documentation to indicate why the physician’s order was not followed. *2/3/25 - the DFR was delivered at a rate of 500 ml/min, not 800 ml/min as ordered, and there was no documentation to indicate why the physician’s order was not followed. *2/10/25 - the DFR was delivered at a rate of 500 ml/min, not 800 ml/min as ordered, and there was no documentation to indicate why the physician’s order was not followed. During an interview on 2/10/25 at 3:55 P.M., the CM said staff should run the prescription per the MD order. The CM also said she could not find any explanation why the DFR was changed. 27189 c. For Patient #6, the dialysis staff failed to ensure the BFR was delivered as prescribed. Patient #2 was admitted to the facility in March 2022 with diagnoses which included End Stage Renal Disease (ESRD), requiring hemodialysis treatment 3 times a week Review of the Physician orders, dated 1/28/25, indicated the BFR was to be delivered at a rate of 450 ml/min. Review of 9 hemodialysis Treatment Flowsheets, dated 1/21/25 through 2/8/25, indicated the BFR had not been delivered as prescribed on 3 of 9 Treatment Flowsheets as follows: * 1/28/25 - The BFR was delivered at a rate of 400 ml/min, not 450 ml/min as ordered, and there was no documentation to indicate why the physician’s order was not followed. * 2/4/25 - The BFR was delivered at a rate of 400 ml/min, not 450 ml/min as ordered, and there was no documentation to indicate why the physician’s order was not followed. * 2/8/25 - The BFR was delivered at a rate of 400 ml/min, not 450 ml/min as ordered, and there was no documentation to indicate why the physician’s order was not followed. During an interview on 2/11/25 at 2:00 P.M., the CM said staff must follow the physician’s order for the BFR. The CM also said if for some reason the staff cannot deliver the ordered BFR rate, they should document the justification, but did not.”

“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: 37349 Based on observation, interview, and policy review, the facility failed to ensure that 1 of 2 staff members (Certified Clinical Hemodialysis Technician [CCHT] #2 observed, did not use a tourniquet when initiating treatment for 1 of 1 applicable patients (#8) with a Arteriovenous Graft (AVG), out of a total sample of 9 patients. Findings include: Review of the facility policy, titled AVF-AVG Cannulation, Treatment Initiation, and Termination, last revised 6/20/24, included the following: * Tourniquets are not used on grafts because the graft is made of synthetic material that does not expand and contract like blood vessels do. On 2/11/25 at 11:00 A.M., the surveyor observed CCHT #2 initiate dialysis treatment for Patient #8. She assessed the AVG, washed the AVG, applied a tourniquet, disinfected and cannulated the lower access site, then disinfected and cannulated the upper access site. She removed the tourniquet and started the dialysis treatment. Review of the medical record indicated that Patient #8 received dialysis treatment three times per week using an AVG in his/her left upper arm. During an interview on 2/11/25 at 11:15 A.M., CCHT #2 said that a tourniquet is not typically used for patients with a AVG, but she uses one for Patient #8. During an interview on 2/11/25 at 12:20 P.M., the Clinical and Regulatory Manager said that a tourniquet is not typically used for patients with an AVG, and she could find no information in the medical record to support using one for Patient #8.”