Concerto Michigan LLC

“IC-SANITARY ENVIRONMENT CFR(s): 494.30 The dialysis facility must provide and monitor a sanitary environment to minimize the transmission of infectious agents within and between the unit and any adjacent hospital or other public areas. This Standard is not met as evidenced by: 45246 Based on observation, interview and record review, the facility failed to ensure a sanitary environment for all 6 patients observed receiving dialysis treatment, resulting in the potential for transmission of infections agents for all 20 patients receiving care in the facility. Findings include: During the initial tour of the facility on 7/01/25 from 0930 to approximately 1135 facility treatment room was observed for cleanliness. The mounted above treatment chairs wall art had substantial amounts of dust on them. Back ledges behind treatment stations had light dust on them. Walls had multiple chips and area of paint missing with dry wall exposed. Windows were observed with dark brown sediment on the frames and dust. Multiple debris and dust were observed behind storage cart and along the back wall with windows. A dirty sink cabinet was inspected and found to have a dark grey stain with moldy looking sediment on it approximately 7 inches in diameter on the bottom of it. Charge nurse, Staff F, was asked for how long that stain was known and was not addressed. The nurse stated that she wasn’t sure about the exact time, however she did notify facility leadership as soon as it was discovered. A clean sink cabinet was inspected. A yellow stain was found inside on the bottom of the cabinet approximately 4-5 inches in diameter. Regional Director of Operations, Staff A, confirmed the findings. During an interview with the Regional Manager, Staff B, on 7/01/25 at approximately 1000, she stated that skilled nursing facility (SNF) housekeeping staff was responsible for cleaning the treatment area. Staff B was asked if she was inspecting SNF housekeepers’ work and assuring that they clean according to the facility’s standards. Staff B stated that she will re-educate the staff and will make sure they follow the facility guidelines and policy. Further, Staff B was queried regarding chipped paint and stained sink cabinets. She stated that this was addressed with the SNF administration, however was not fixed yet. Facility policy “Disinfection of treatment area and equipment”, number CRS-700-011, dated 01/2018 and revised 2/2024, was reviewed and revealed: “The treatment area will be maintained in a sanitary condition. Wipe all non-disposable equipment with the appropriate bleach solution including blood pressure cuffs, TV/TV controls, documentation station, and all counters around treatment area.” Facility policy “Infection Control”, number CRS-700-001, dated 5/2017 and revised 01/2024, was reviewed and revealed: 4. Contracted housekeeping providers are responsible for proper use of cleaning supplies and providing housekeeping services. 5. It is the responsibility of the contracted housekeeping provider to ensure all staff providing services are trained on chemical safety, bloodborne pathogens, infection control, and adhere to any applicable state-specific regulations.””

“PE-EQUIPMENT MAINTENANCE-MANUFACTURER’S DFU CFR(s): 494.60(b) The dialysis facility must implement and maintain a program to ensure that all equipment (including emergency equipment, dialysis machines and equipment, and the water treatment system) are maintained and operated in accordance with the manufacturer’s recommendations. This Standard is not met as evidenced by: 45246 Based on observation, interview and record review, the facility failed to ensure that ancillary equipment and patient treatment chairs are appropriately maintained and cleaned for all 20 patients receiving dialysis treatment in the facility resulting in the potential for transmission of infections agents and possible negative outcomes for all patients. Findings include: During the initial tour of the facility, on 7/01/25 from 0930 to approximately 1135, multiple patient treatment chairs were found with torn upholstery and soft underlining exposed. The medication refrigerator was inspected. Thick brown staining was observed on the back wall with dripping stains and brown sediment on the shelf with stored medications. Regional Director of Operations, Staff A, confirmed the findings. Charge nurse, Staff F, was interviewed on 7/01/25 at 0935 and was asked how often the medication refrigerator gets cleaned. She stated it is done monthly. Facility policy “Disinfection of treatment area and equipment”, number CRS-700-011, dated 01/2018 and revised 2/2024, was reviewed and revealed: “The treatment area will be maintained in a sanitary condition. Clean areas should be clearly designated for the preparation, handling, and storage of unused supplies, equipment, and medication. Clean areas should be separated from contaminated area where used supplies and equipment are handled to prevent potential cross-contamination”. “Home Dialysis Services and Coordination Agreement” between facility and SNF was reviewed and revealed: “Furnishings: Dialysis chairs, a wheelchair scale, and a workstation/desk area, and (if applicable and by agreement among the parties) a sufficient number of televisions for the number of stations. i. Should a dialysis chair initially provided by the Facility (SNF) require replacement due to it no longer being in safe and functional working condition (i.e. torn upholstery and/or broken mechanics (e.g., footrests, reclining levers, etc.)), [this facility name] agrees to provide the Facility (SNF) [funds] toward the cost of chair replacement should [this facility name] deem it necessary to provide such replacement. ii. [This facility name] will exercise its discretion with whether it seeks to repair the dialysis chair or pay the above-cited payment to the Facility for the Facility to replace the dialysis chair”.”