Fresenius Medical Care Apex

“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: 38766 Based on policy review, medical records review, and staff interviews, the facility staff failed to follow the adequacy plan of care by not dialyzing 4 of 9 (Patients #3, #2, #5, and #7) in-center hemodialysis patients at the prescribed Blood Flow Rate (BFR)/Dialysate Flow Rate (DFR). Findings include: A review on 08/14/2025 of the facility’s policy and procedure, “Patient Assessment and Monitoring,” published 05/01/2023, revealed “Purpose ...Responsibility ...Definitions ...Delegation ...Data Collection ...Pre-Treatment ...During Treatment ...Step 1 ...Step 3 [space] Machine Parameters and Extracorporeal Circuit [space] Check machine settings and measurements: 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 is correct and the prescribed flow is being delivered. ...” 1. Review on 09/24/2025 of the medical record for Patient #3 revealed a 79-year-old male was admitted to the facility for in-center hemodialysis (ICHD) treatment on 03/25/2025. A review of the Physician orders revealed Patient #3’s Blood Flow Rate (BFR) was ordered at 400 with a Dialysate Flow Rate (DFR) at 800. A review of the Treatment Flowsheet dated 09/09/2025 revealed that Patient #3’s hemodialysis treatment was initiated at 1210 and ended at 1616. Review of the Flowsheet revealed Patient #3’s BFR/DFR average was 370/500, with no documentation for the decreased BFR/DFR and no documentation of the Registered Nurse notification. Review of the Treatment Flowsheet dated 09/11/2025 revealed that Patient #3’s hemodialysis treatment was initiated at 1230 and ended at 1633. Review of the Flowsheet revealed that Patient #3’s BFR/DFR average was 290/800, with no documentation for the decreased BFR and no documentation of the Registered Nurse notification. Review of the Treatment Flowsheet dated 09/13/2025 revealed Patient #3’s hemodialysis treatment was initiated at 1141 and ended at 1540. Review of the Flowsheet revealed that Patient #3’s BFR/DFR average was 320/500, with no documentation for the decreased BFR/DFR and no documentation of the Registered Nurse notification. Review of the Treatment Flowsheet dated 09/20/2025 revealed Patient #3’s hemodialysis treatment was initiated at 1147 and ended at 1552. Review of the Flowsheet revealed that Patient #3’s BFR/DFR average was 370/500, with no documentation for the decreased BFR/DFR and no documentation of the Registered Nurse notification. An interview on 09/25/2025 at 1125 with the Charge Nurse revealed that the PCTs were expected to notify the nursing staff anytime the patient was unable to obtain the prescribed BFR and increased or decreased the DFR rate. The interview revealed that the nursing staff should have assessed and documented the reason for the decreased BFR/DFR during the patient’s treatment. The interview confirmed that there was no documentation in the treatment record indicating why the BFR/DFR was not achieved. 2. Review on 09/24/2025 of the medical record for Patient #2 revealed a 57-year-old female was admitted to the facility for in-center hemodialysis (ICHD) treatment on 07/17/2025. A review of the Physician orders revealed Patient #2’s Blood Flow Rate (BFR) was ordered at 400 with a Dialysate Flow Rate (DFR) at 1.5 times the BFR. A review of the Treatment Flowsheet dated 09/09/2025 revealed that Patient #2’s hemodialysis treatment was initiated at 0826 and ended at 1215. Review of the Flowsheet revealed Patient #2’s BFR/DFR average was 350/600, with no documentation for the decreased BFR and no documentation of the Registered Nurse notification. A review of the Treatment Flowsheet dated 09/11/2025 revealed that Patient #2’s hemodialysis treatment was initiated at 0813 and ended at 1210. Review of the Flowsheet revealed Patient #2’s BFR/DFR average was 300/500, with no documentation for the decreased BFR/DFR and no documentation of the Registered Nurse notification. An interview on 09/25/2025 at 1125 with the Charge Nurse revealed that the PCTs were expected to notify the nursing staff anytime the patient was unable to obtain the prescribed BFR and increased or decreased the DFR rate. The interview revealed that the nursing staff should have assessed and documented the reason for the decreased BFR/DFR during the patient’s treatment. The interview confirmed that there was no documentation in the treatment record indicating why the BFR/DFR was not achieved. 3. Review on 09/24/2025 of the medical record for Patient #5 revealed a 59-year-old male was admitted to the facility for in-center hemodialysis (ICHD) treatment on 10/26/2023. A review of the Physician orders revealed Patient #5’s Blood Flow Rate (BFR) was ordered at 415 with a Dialysate Flow Rate (DFR) at 800. A review of the Treatment Flowsheet dated 09/15/2025 revealed that Patient #5’s hemodialysis treatment was initiated at 0810 and ended at 1314. Review of the Flowsheet revealed Patient #5’s BFR/DFR average was 250/790, with no documentation for the decreased BFR and no documentation of the Registered Nurse notification. A review of the Treatment Flowsheet dated 09/17/2025 revealed that Patient #5’s hemodialysis treatment was initiated at 0750 and ended at 1245. Review of the Flowsheet revealed Patient #5’s BFR/DFR average was 400/790, with no documentation for the decreased BFR and no documentation of the Registered Nurse notification. An interview on 09/25/2025 at 1125 with the Charge Nurse revealed that the PCTs were expected to notify the nursing staff anytime the patient was unable to obtain the prescribed BFR and increased or decreased the DFR rate. The interview revealed that the nursing staff should have assessed and documented the reason for the decreased BFR/DFR during the patient’s treatment. The interview confirmed that there was no documentation in the treatment record indicating why the BFR/DFR was not achieved. 4. Review on 09/24/2025 of the medical record for Patient #7 revealed a 60-year-old female was admitted to the facility for in-center hemodialysis (ICHD) treatment on 12/05/2025. A review of the Physician orders revealed Patient #7’s Blood Flow Rate (BFR) was ordered at 350 with a Dialysate Flow Rate (DFR) at 800. A review of the Treatment Flowsheet dated 09/13/2025 revealed that Patient #7’s hemodialysis treatment was initiated at 0710 and ended at 1010. Review of the Flowsheet revealed Patient #7’s BFR/DFR average was 330/500, with no documentation for the decreased BFR and no documentation of the Registered Nurse notification. An interview on 09/25/2025 at 1125 with the Charge Nurse revealed that the PCTs were expected to notify the nursing staff anytime the patient was unable to obtain the prescribed BFR and increased or decreased the DFR rate. The interview revealed that the nursing staff should have assessed and documented the reason for the decreased BFR/DFR during the patient’s treatment. The interview confirmed that there was no documentation in the treatment record indicating why the BFR/DFR was not achieved.”

“POC-VASCULAR ACCESS-MONITOR/REFERRALS CFR(s): 494.90(a)(5) The interdisciplinary team must provide vascular access monitoring and appropriate, timely referrals to achieve and sustain vascular access. The hemodialysis patient must be evaluated for the appropriate vascular access type, taking into consideration co-morbid conditions, other risk factors, and whether the patient is a potential candidate for arteriovenous fistula placement. This Standard is not met as evidenced by: 38766 Based on policy and procedure review, observations, and staff interviews, the facility failed to ensure that staff performed skin antisepsis policy before cannulation during 1 of 2 Arterio-venous fistula/graft (AVF/AVG) cannulation procedures (Station #5, PCT #1). Findings include: Review on 09/23/2025 of the facility policy “Access Assessment and Cannulation,” Published: 05/05/2025, revealed “... Assessment of Vascular Access ... Skin Disinfection Step 2 Perform skin antisepsis on one site at a time, allowing them to dry and then cannulate. Do not touch cannulation sites after skin disinfection. Note: This method minimizes the risk of contaminating the second site while cannulating the first site. ...” Observation on 09/23/2025 at 1135 in the patient treatment area revealed PCT #1 entered Station #5 and was prepared to access the patient’s AVF/AVG. Observation revealed PCT #1 done cleaned gloves and applied antiseptic (70% isopropyl alcohol pad) to each access site over the skin in an up and down motion for about 10-15 seconds on both sites at one time. The observation revealed that PCT #1 palpated the sites with a gloved finger before cannulation. The observation revealed the PCT failed to clean each access site one at a time for 30 seconds and touched the cannulation sites after skin disinfection per facility policy. An interview on 09/23/2025 at 1150 with PCT #1 revealed that PCT #1 verbalized the appropriate process for cleaning and the cannulation of access sites. The interview revealed that PCT #1 did not look at the available treatment floor clocks to ensure that the sites were cleaned for 30 seconds. The interview revealed PCT #1 failed to clean/disinfect each of the access sites for 30 seconds one at a time, prior to cannulation and securing the needles. The interview revealed PCT #1 failed to follow the facility policy. An interview on 09/25/2025 at 1125 with the Charge Nurse revealed that the staff were expected to disinfect each access site for 30 seconds when using alcohol pads and should not have touched the sites after disinfection. The interview confirmed that the PCT did not follow the policy. An interview on 09/25/2025 at 1125 with the Charge Nurse revealed that the staff were expected to disinfect each access site for 30 seconds when using alcohol pads and should not have touched the sites after disinfection. The interview confirmed that the PCT did not follow the policy.”