Fresenius Medical Care Farmville

“POC-MANAGE VOLUME STATUS CFR(s): 494.90(a)(1) The plan of care must address, but not be limited to, the following: (1) Dose of dialysis. The interdisciplinary team must provide the necessary care and services to manage the patient’s volume status; This Standard is not met as evidenced by: 38766 Based on facility policy review, medical record reviews, and staff interviews, the facility staff failed to monitor a patient at least every 30-45 minutes during hemodialysis treatments for 4 of 9 sampled in-center hemodialysis records reviewed (Patient #7, #9, #5, and #3). Findings included: A review on 01/29/2025 of the facility policy titled, “Patient Assessment and Monitoring,” published 05/01/2023, revealed, “... During Treatment: Obtain blood pressure and pulse rate every 30 minutes or more as needed but not to exceed 45 minutes per state regulations. Document machine parameters and safety checks every 30 minutes or more often as needed but not to exceed 45 minutes or per state regulations.” 1. Open medical record review on 01/30/2025 for Patient #7 revealed a 40-year-old male admitted to the facility for ICHD treatments on 10/24/2018. A review of the treatment sheet dated 01/21/2025 revealed the treatment started at 0600 and ended at 1139 for 279 minutes. The review of the monitoring documentation dated 01/21/2025 revealed Patient #7’s blood pressure, pulse, and machine parameters were monitored by staff at 0600 and monitored next by staff at 0857 (177 minutes later). The review revealed the facility staff failed to monitor the patient’s blood pressure, pulse, and machine parameters at least every 30-45 minutes during the hemodialysis treatment on 01/21/2025. An interview on 01/30/2025 at 1315 with the Clinical Manager revealed that the policy required patients to be monitored every 30-45 minutes. However, staff were expected to monitor patients every 30 minutes during treatments. The interview revealed the staff monitored vital signs, visualized the access sites, and checked for wet transducers and machine parameters. The interview revealed that the staff should have documented the monitoring in the patient’s treatment record. The interview revealed the staff failed to follow the facility policy. 2. Open medical record review on 01/30/2025 for Patient #9 revealed a 67-year-old female admitted to the facility for ICHD treatments on 05/10/2022. A review of the treatment sheet dated 01/14/2025 revealed the treatment started at 1208 and ended at 1540 for 212 minutes. The review of the monitoring documentation dated 01/14/2025 revealed Patient #9’s blood pressure, pulse, and machine parameters were monitored by staff at 1433 and monitored next by staff at 1526 (53 minutes later). A review of the treatment sheet dated 01/21/2025 revealed the treatment started at 1204 and ended at 1545 for 221 minutes. The review of the monitoring documentation dated 01/21/2025 revealed Patient #9’s blood pressure, pulse, and machine parameters were monitored by staff at 1239 and monitored next by staff at 1405 (86 minutes later) and again at 1503 (58 minutes). A review of the treatment sheet dated 01/24/2025 revealed the treatment started at 1125 and ended at 1455 for 210 minutes. The review of the monitoring documentation dated 01/24/2025 revealed Patient #9’s blood pressure, pulse, and machine parameters were monitored by staff at 1341 and monitored next by staff at 1440 (59 minutes later). The review revealed the facility staff failed to monitor the patient’s blood pressure, pulse, and machine parameters at least every 30-45 minutes during the hemodialysis treatment on 01/14/2025, 01/21/2025, and 01/24/2025. An interview on 01/30/2025 at 1315 with the Clinical Manager revealed that the policy required patients to be monitored every 30-45 minutes. However, staff were expected to monitor patients every 30 minutes during treatments. The interview revealed the staff monitored vital signs, visualized the access sites, and checked for wet transducers and machine parameters. The interview revealed that the staff should have documented the monitoring in the patient’s treatment record. The interview revealed the staff failed to follow the facility policy. 3. Open medical record review on 01/29/2025 for Patient #5 revealed a 63-year-old female admitted to the facility for ICHD treatments on 11/17/2022. A review of the treatment sheet dated 01/14/2025 revealed the treatment started at 0618 and ended at 1018 for 240 minutes. The review of the monitoring documentation dated 01/14/2025 revealed Patient #5’s blood pressure, pulse, and machine parameters were monitored by staff at 0715 and monitored next by staff at 0811 (56 minutes later). A review of the treatment sheet dated 01/24/2025 revealed the treatment started at 1340 and ended at 1707 for 207 minutes. The review of the monitoring documentation dated 01/14/2025 revealed Patient #5’s blood pressure, pulse, and machine parameters were monitored by staff at 1456 and monitored next by staff at 1604 (68 minutes later). The review revealed the facility staff failed to monitor the patient’s blood pressure, pulse, and machine parameters at least every 30-45 minutes during the hemodialysis treatment on 01/14/2025 and 01/24/2025. An interview on 01/30/2025 at 1315 with the Clinical Manager revealed that the policy required patients to be monitored every 30-45 minutes. However, staff were expected to monitor patients every 30 minutes during treatments. The interview revealed the staff monitored vital signs, visualized the access sites, and checked for wet transducers and machine parameters. The interview revealed that the staff should have documented the monitoring in the patient’s treatment record. The interview revealed the staff failed to follow the facility policy. 4. Open medical record review on 01/29/2025 for Patient #3 revealed a 40-year-old male admitted to the facility for ICHD treatments on 06/25/2024. A review of the treatment sheet dated 01/17/2025 revealed the treatment started at 0753 and ended at 1154 for 241 minutes. The review of the monitoring documentation dated 01/17/2025 revealed Patient #3’s blood pressure, pulse, and machine parameters were monitored by staff at 0823 and monitored next by staff at 0921 (58 minutes later). The review revealed the facility staff failed to monitor the patient’s blood pressure, pulse, and machine parameters at least every 30-45 minutes during the hemodialysis treatment on 01/17/2025. An interview on 01/30/2025 at 1315 with the Clinical Manager revealed that the policy required patients to be monitored every 30-45 minutes. However, staff were expected to monitor patients every 30 minutes during treatments. The interview revealed the staff monitored vital signs, visualized the access sites, and checked for wet transducers and machine parameters. The interview revealed that the staff should have documented the monitoring in the patient’s treatment record. The interview revealed the staff failed to follow the facility policy.”

“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 facility policy review, medical record reviews, and staff interviews, the facility staff failed to follow the adequacy plan of care by not dialyzing patients at the prescribed blood flow rate for 4 of 9 sampled in-center hemodialysis records reviewed (Patients #1, #2, #3, and #6). Findings include: A review on 01/28/2025 of the facility policy titled “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...Post-Treatment...” 1. Open medical record review on 01/28/2025 for Patient #1 revealed a 58-year-old male admitted to the facility for ICHD treatments on 12/27/2024. A review of the patient’s dialysis prescription orders revealed the patient’s prescribed BFR was 400 mL/min, and DFR was autoflowed at 1.5. A review of the patient’s Post Treatment Dialysis flowsheets from 01/13/2025 through 01/20/2025 revealed the facility staff failed to dialyze the patient at his ordered BFR and/or DFR for implementation of the patient’s adequacy plan as follows: ~Treatment on 01/15/2025 from 1240 to 1643 for 243 minutes had “350” average BFR and ~Treatment on 01/17/2025 from 1220 to 1623 for 243 minutes had an “800” average DFR. The review of the patient treatment sheets revealed the facility staff failed to dialyze the patient at his ordered BFR of “400” in 1 of 4 treatments and DFR of “autoflow 1.5” in 1 of 4 treatments, with no documentation for the decreased BFR/DFR and nurse notification. An interview on 01/30/2025 at 1315 with the Clinical Manager revealed that the BFR/DFR were ordered by the provider, and the staff was expected to follow the provider’s orders. The interview revealed the facility’s patient care technicians should notify the nursing staff anytime they increase/decrease the patient’s BFR and/or DFR. The interview revealed the nursing staff should have assessed and documented the reason for the decrease/increase of the BFR/DFR during the patient’s treatments. 2. Open medical record review on 01/28/2025 for Patient #2 revealed a 36-year-old female admitted to the facility for ICHD treatments on 07/03/2024. A review of the patient’s dialysis prescription orders revealed the patient’s prescribed BFR was 400 mL/min and DFR was 800 mL/min. A review of the patient’s Post Treatment Dialysis flowsheets from 01/13/2025 through 01/24/2025 revealed the facility staff failed to dialyze the patient at her ordered BFR and/or DFR for implementation of the patient’s adequacy plan as follows: ~Treatment on 01/13/2025 from 1134 to 1346 for 132 minutes had a “300” average BFR. The review of the patient treatment sheets revealed the facility staff failed to dialyze the patient at her ordered BFR of “400” in 1 of 6 treatments with no documentation for the decreased BFR and nurse notification. An interview on 01/30/2025 at 1315 with the Clinical Manager revealed that the BFR/DFR were ordered by the provider, and the staff was expected to follow the provider’s orders. The interview revealed the facility’s patient care technicians should notify the nursing staff anytime they increase/decrease the patient’s BFR and/or DFR. The interview revealed the nursing staff should have assessed and documented the reason for the decrease/increase of the BFR/DFR during the patient’s treatments. 3. Open medical record review on 01/29/2025 for Patient #3 revealed a 40-year-old male admitted to the facility for ICHD treatments on 06/25/2024. A review of the patient’s dialysis prescription orders revealed the patient’s prescribed BFR was 450 mL/min and DFR was 800 mL/min. A review of the patient’s Post Treatment Dialysis flowsheets from 01/14/2025 through 01/27/2025 revealed the facility staff failed to dialyze the patient at his ordered BFR and/or DFR for implementation of the patient’s adequacy plan as follows: ~Treatment on 01/14/2025 from 0743 to 1203 for 260 minutes had a “400” average BFR and a “750” average DFR. The review of the patient treatment sheets revealed the facility staff failed to dialyze the patient at his ordered BFR of “450” in 1 of 6 treatments and DFR of “800 mL/min” in 1 of 6 treatments, with no documentation for the decreased BFR/DFR and nurse notification. An interview on 01/30/2025 at 1315 with the Clinical Manager revealed that the BFR/DFR were ordered by the provider, and the staff was expected to follow the provider’s orders. The interview revealed the facility’s patient care technicians should notify the nursing staff anytime they increase/decrease the patient’s BFR and/or DFR. The interview revealed the nursing staff should have assessed and documented the reason for the decrease/increase of the BFR/DFR during the patient’s treatments. 4. Open medical record review on 01/29/2025 for Patient #6 revealed a 56-year-old male admitted to the facility for ICHD treatments on 07/09/2024. A review of the patient’s dialysis prescription orders revealed the patient’s prescribed BFR was 400 mL/min and DFR was 800 mL/min. A review of the patient’s Post Treatment Dialysis flowsheets from 01/14/2025 through 01/24/2025 revealed the facility staff failed to dialyze the patient at his ordered BFR for implementation of the patient’s adequacy plan as follows: ~Treatment on 01/18/2025 from 1159 to 1559 for 240 minutes had a “250” average BFR. The review of the patient treatment sheets revealed the facility staff failed to dialyze the patient at his ordered BFR of “400” in 1 of 6 treatments with no documentation for the decreased BFR and nurse notification. An interview on 01/30/2025 at 1315 with the Clinical Manager revealed that the BFR/DFR were ordered by the provider, and the staff was expected to follow the provider’s orders. The interview revealed the facility’s patient care technicians should notify the nursing staff anytime they increase/decrease the patient’s BFR and/or DFR. The interview revealed the nursing staff should have assessed and documented the reason for the decrease/increase of the BFR/DFR during the patient’s treatments.”

“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: 38766 Based on medical record review and staff interviews, the facility staff failed to promote patient safety by dialyzing a patient without wearing a LifeVest, as ordered by a provider. Findings included: An open medical record review on 01/29/2025 for Patient #7 revealed a 40-year-old male was admitted to the facility for ICHD treatments on 10/24/2018. A review of the patient’s record revealed the patient was hospitalized on 11/12/2024 through 11/22/2024 with a diagnosis of cardiac arrest. The review revealed that the patient had refused the placement of an Automatic Implantable Cardioverter-Defibrillator (AICD - a small device that monitors the heart rhythm and delivers an electrical shock if it detects a life-threatening arrhythmia). The patient got a LifeVest (a wearable defibrillator that monitors the heart and delivers a shock to treat life-threatening arrhythmias). The hospital record revealed that the hospital had consulted with the Nephrologist regarding whether the dialysis center would take the patient with a LifeVest. A review of provider notes on 12/18/2024 revealed, “...I have reinforced the need that he wears the LifeVest to dialysis in order to receive outpatient ICHD...” A review of the patient’s order written on 12/20/2024 revealed “Special Attention: Patient may not dialyze without WEARING Zoll LifeVest. Please contact the Named Provider or Named Nurse Practitioner in any issues arise between staff and patient...” A review of the patient’s Post Treatment Dialysis flowsheets from 01/13/2025 through 01/24/2025 revealed the facility staff failed to follow the provider’s order as follows: ~Treatment on 01/17/2025 from 0653 to 1056 with a nursing comment “pt. (patient) states not feeling well, not wearing the LifeVest...” ~Treatment on 01/20/2025 from 0710 to 1126 with a nursing comment “pt. (patient) did not wear lifeVest during treatment...” The review of the patient treatment sheets revealed the facility staff failed to follow the orders and dialyzed the patient without wearing the LifeVest in 2 of 6 treatments. An interview on 01/30/2025 at 1140 with the Clinical Manager revealed that the patient had had several cardiac events and was supposed to wear a LifeVest during treatment per the Medical Director. The interview revealed that the nurses were to visualize that the patient had the LifeVest before the start of every treatment. Further interviews revealed that the medical director had informed the patient that he had to wear the LifeVest, and that was the condition under which he was accepted to continue being treated while remaining a full code. The interview confirmed that the policy was not followed.”