Fmcna - Enid Dialysis Ctr

“CFC-INFECTION CONTROL CFR(s): 494.30 This Condition is not met as evidenced by: 34689 Based on observation, interview, and record review, the facility failed to ensure that infection control practices and techniques were followed and maintained to prevent risk to patient health and safety, as evidenced by: Findings included: 1. The facility failed to ensure that two of two facility areas (home therapy program area and in-center treatment area) provided and monitored a sanitary environment to minimize the transmission of infectious agents within and between the units or other public areas. Cross refer to V tag: V 111. 2. The facility failed to ensure that staff clearly designated areas, citing one of one facility area (in-center treatment areas) for the storage of clean unused supplies and used equipment, in that “clean” unused supplies were stored on dirty storage containers or areas. This practice had the potential for harm to all patients and personnel in the facility with possible cross contamination of clean and contaminated supplies and/or equipment. Cross refer to V tag: V 117. 3. The facility failed to ensure staff, citing one of one staff (Personnel #6) changed transducer protector when wetted. This practice placed patients at risk for cross contamination and venous chamber clotting and blood loss. Cross refer to V tag: V 120. 4. The facility failed to ensure that biohazard and infection control practices were monitored and implemented, citing two of two patients (Patients #19 and #23) in that, facility staff did not follow infection control practices and/or activities within the unit. This practice placed all patients and staff in the facility at risk for potential harm for infection and/or cross contamination. Cross refer to V tag: V 142. 5. The facility failed to ensure that appropriate infection control measures to prevent intravascular catheter related infections were practiced and followed, citing two of two facility staff (Registered Nurse (RN) (personnel #4) and Patient Care Technician (PCT) (personnel #5). This practice placed all patients at the facility at risk for infection. Cross refer to V tag: V 147.”

“CFC-PATIENT ASSESSMENT CFR(s): 494.80 This Condition is not met as evidenced by: 34689 Based on observation, record review and interview, the Interdisciplinary Team (IDT) failed to assess patients according to changes in condition and/or individual patient needs, as evidenced by: Findings included: 1. The facility failed to evaluate the appropriateness of the dialysis prescription, citing four of four dialysis patients (Patients #5, #6, #7, and #8) who did not have physician’s orders for the provision of care. Cross refer to V tag: V 503. 2. The Interdisciplinary Team (IDT) failed to conduct at least monthly, a reassessment for unstable patients, citing two of two patients (Patients #6 and #7) who was made unstable by the IDT, did not have a reassessment of patient status to check for the presence or absence of bed bugs conducted by the IDT. Cross refer to V tag: V 520. 3. The facility failed to ensure all patients and their caregivers have the knowledge and skills for home hemodialysis (HHD), citing one of one patient (patient #8) in that patient #8’s clinical record showed no documented evidence of verification of competency and training for HHD. Cross refer to V tag: V 586.”

“CFC-RESPONSIBILITIES OF THE MEDICAL DIRECTOR CFR(s): 494.150 This Condition is not met as evidenced by: 34689 Based on record review and interview, the medical director failed to ensure that all policies and procedures relative to patient care, infection control, and safety were adhered to by all individuals who treat patient in the facility, as evidenced by: Findings included: 1. The facility failed to ensure that infection control practices and techniques were followed and maintained to prevent risk to patient health and safety. Cross refer to V tag: V 110. 2. The Interdisciplinary Team (IDT) failed to assess patients according to changes in condition and/or individual patient needs. Cross refer to V tag: V 500.”

“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: 34689 Based on observation, record review, and interview, the facility failed to ensure that two of two facility areas (home therapy program area and in-center treatment area) provided and monitored a sanitary environment to minimize the transmission of infectious agents within and between the units or other public areas. Finding included: During a tour of the facility on 04/03/2024 between 11:35 AM - 12:30 PM, the surveyor and the home program manager (Personnel #10) observed the following: 1. Home Therapy Program area: Room 3: - At 11:35 AM, there was a water filter canister cylinder connected to the wall by the sink stored on the chair with whitish crusted stain approximately the sized of a softball. The wall was dirty with several blackened smudges and streaks. The floor was covered with scratches and grayish/blackish smudges. The red sharps container on the floor with quarter sized reddish brownish stain on top. On 04/03/2024 at 11:40 AM, the Home Program Manager (Personnel #10) confirmed the above findings. 2. In - Center hemodialysis treatment area: - At 12:30 PM, the surveyor and the facility manager (Personnel #3) observed two dirty and two clean sinks with cabinets under the sink that were dirty covered with whitish/grayish crusted sticky stains and the cabinet side where the water pipes were had sticky brownish/blackened greasy substances . There were four - six plastic jugs of used and unused Naturalyte acid dialysate stored in the cabinet under the dirty sinks of the treatment area. On 04/03/2024 at 12:32 PM, the facility manager confirmed the above findings. When asked what the whitish/grayish crusted sticky stains were, she stated Bicarb. A review of the facility’s General Cleanliness and Infection Control Guidelines Policy dated 02/07/2022, included, “All areas must be kept clean and organized...facility staff are accountable for cleaning rooms/areas not assigned to contracted cleaning staff.””

“IC-CLEAN/DIRTY;MED PREP AREA;NO COMMON CARTS CFR(s): 494.30(a)(1)(i) Clean areas should be clearly designated for the preparation, handling and storage of medications and unused supplies and equipment. Clean areas should be clearly separated from contaminated areas where used supplies and equipment are handled. Do not handle and store medications or clean supplies in the same or an adjacent area to that where used equipment or blood samples are handled. When multiple dose medication vials are used (including vials containing diluents), prepare individual patient doses in a clean (centralized) area away from dialysis stations and deliver separately to each patient. Do not carry multiple dose medication vials from station to station. Do not use common medication carts to deliver medications to patients. If trays are used to deliver medications to individual patients, they must be cleaned between patients. This Standard is not met as evidenced by: 34689 Based on observation, record review, and interview, the facility failed to ensure that staff clearly designated areas, citing one of one facility area (in-center treatment areas) for the storage of clean unused supplies and used equipment, in that “clean” unused supplies were stored on dirty storage containers or areas. This practice had the potential for harm to all patients and personnel in the facility with possible cross contamination of clean and contaminated supplies and/or equipment. During a tour of the facility on 04/03/2024 between 11:30 AM - 12:30 PM, the surveyor was accompanied by the facility manager (Personnel #3) and observed the following: In-center hemodialysis treatment area: ~ At 11:45 AM, there were two IV pumps stored in the hallway of the in - center treatment area with cart with several drink cups and glasses of staff drinks. The two IV pumps were not labeled whether they were clean ready for use or dirty. When the facility manager (Personnel #3) was asked if the IV pumps were clean, ready for use or dirty, she stated that those IV pumps were clean and ready for use. On 04/03/2024 at 11:46 AM, the facility manager (Personnel #3) confirmed the above findings. - At 12:30 PM, the surveyor and the facility manager (Personnel #3) observed two dirty and two clean sinks with cabinets under the sink that were dirty covered with whitish/grayish crusted sticky stains and the cabinet side where the water pipes were had sticky brownish/blackened greasy substances . There were four - six plastic jugs of used and unused Naturalyte acid dialysate stored in the cabinet under the dirty sinks of the treatment area. On 04/03/2024 at 12:32 PM, the facility manager (Personnel #3) confirmed the above findings. During a tour of the in-center treatment area on 04/04/2024 at 8:06 AM, the surveyor observed a plastic gray cart that stored approximately 14 - 16 clean bleach plastic containers. The gray cart was dirty covered with whitish crusted crystallized sediments. When Personnel #3 was asked what the bleach containers were used for, she stated for dialysis machine bleaching. On 04/04/2024 at 8:07 AM, Personnel #3 confirmed the above findings. A review of the facility’s General Cleanliness and Infection Control Guidelines Policy dated 02/07/2022, included, “All areas must be kept clean and organized...facility staff are accountable for cleaning rooms/areas not assigned to contracted cleaning staff.””

“IC-TRANSDUCER PROTECTORS-NOT WETTED/CHANGED CFR(s): 494.30(a)(1)(i) Use external venous and arterial pressure transducer filters/protectors for each patient treatment to prevent blood contamination of the dialysis machines’ pressure monitors. If the external transducer protector becomes wet, replace immediately and inspect the protector. If fluid is visible on the side of the transducer protector that faces the machine, have qualified personnel open the machine after the treatment is completed and check for contamination. This includes inspection for possible blood contamination of the internal pressure tubing set and pressure sensing port. If contamination has occurred, the machine must be taken out of service and disinfected using either 1:100 dilution of bleach (300-600 mg/L free chlorine) or a commercially available, EPA-registered tuberculocidal germicide before reuse. Change filters/protectors between each patient treatment, and do not reuse them. Internal transducer filters do not need to be changed routinely between patients. This Standard is not met as evidenced by: 34689 Based on observation, record review, and interview, the facility failed to ensure staff, citing one of one staff (Personnel #6) changed transducer protector when wetted. This practice placed patients at risk for cross contamination and venous chamber clotting and blood loss. Findings included: On 04/03/2024 at 12:23 PM, the surveyor observed dialysis machine #11 during Patient #2’s dialysis treatment at dialysis station #8 was alarming and with transducer wet with red blood. Patient Care Technician (PCT) (Personnel #6) went to dialysis station #8 and cleared the dialysis machine alarm and left to go to another dialysis station. At 12:25 PM, called PCT (Personnel #6) and when asked what she found out what was wrong or the reason for the alarm of dialysis machine #11 that she cleared, she stated that the venous pressure was alarming and Patient #2’s access arm was against the side of his body. When PCT (Personnel #6) was asked to look at the dialysis machine #11 again and if there’s anything she had to do. Personnel #6 stated that the transducer is filled with blood and wet and that she needed to change it. The surveyor observed Personnel #6 removed and changed the wet transducer without checking the back of the transducer to check for blood. On 04/03/2024 at 2:00 PM, when the facility Biomed (Personnel #9) was asked if Personnel #6 called to notify him of the wet transducer and if dialysis machine #11 was pulled out of the treatment area, he stated no. When asked what the policy was, he stated, the staff is supposed to pull the dialysis machine and notify the Biomed. On 04/03/2024 at 2:10 PM, Personnel #9 confirmed the above findings. A review of the facility’s Maintenance of Transducer Protectors Procedure Policy dated 11/01/2021, included, “Policy...External transducer protectors must be changed immediately when they become wet with blood or other fluid..wet transducer protectors must be thoroughly examined to determine if any blood or other fluid contamination is visible...note: only technical services staff may replace a contaminated internal transducer, disinfect the machine and identify it as appropriate to be returned into service...””

“IC-O-SIGHT-MONITOR ACTIVITY/IMPLEMENT P&P CFR(s): 494.30(b)(1) The facility must- (1) Monitor and implement biohazard and infection control policies and activities within the dialysis unit; This Standard is not met as evidenced by: 34689 Based on observation, record review, and interview, the facility failed to ensure that biohazard and infection control practices were monitored and implemented, citing two of two patients (Patients #19 and #23) in that, facility staff did not follow infection control practices and/or activities within the unit. This practice placed all patients and staff in the facility at risk for potential harm for infection and/or cross contamination. Findings included: On 04/04/2024, the surveyor observed the following: 1. At 8:07 AM, there was an empty used 10 milliliters (ml) syringe on top of the chairside table of Patient #13’s chairside table. On 04/04/2024 at 8:08 AM, the Patient Care Technician (PCT) (Personnel #23) confirmed the findings above. When asked what the syringe was used for, she stated that she did not know. 2. At 8:13 AM, PCT (Personnel #19) cleansed and cannulated Patient #12’s right upper arm arteriovenous fistula (AVF) without using a tourniquet. At 8:17 AM, Personnel #19 attached a vacutainer and collected blood specimen and placed the used vacutainer and Heparin syringe on top of the chairside table mixed with clean supplies. On 04/04/2024 at 8:18 AM, personnel #19 confirmed the above findings. A review of the facility’s General Cleanliness and Infection Control Guidelines Policy dated 02/07/2022, included, “Contaminated needless/sharps...during use, sharps containers shall be...easily accessible and located as close as is feasible to the immediate area where sharps are used...contaminated sharps shall be discarded immediately...other regulated waste...regulated waste shall be placed in a container that is accordance with...bloodborne standard...is closeable, leak proof...closed prior to removal to prevent spillage or protrusion of contents during handling, storage, transport...””

“IC-STAFF EDUCATION-CATHETERS/CATHETER CARE CFR(s): 494.30(a)(2) Recommendations for Placement of Intravascular Catheters in Adults and Children I. Health care worker education and training A. Educate health-care workers regarding the ... appropriate infection control measures to prevent intravascular catheter-related infections. B. Assess knowledge of and adherence to guidelines periodically for all persons who manage intravascular catheters. II. Surveillance A. Monitor the catheter sites visually of individual patients. If patients have tenderness at the insertion site, fever without obvious source, or other manifestations suggesting local or BSI [blood stream infection], the dressing should be removed to allow thorough examination of the site. Central Venous Catheters, Including PICCs, Hemodialysis, and Pulmonary Artery Catheters in Adult and Pediatric Patients. VI. Catheter and catheter-site care B. Antibiotic lock solutions: Do not routinely use antibiotic lock solutions to prevent CRBSI [catheter related blood stream infections]. This Standard is not met as evidenced by: 34689 Based on observation, record review, and interview, the facility failed to ensure that appropriate infection control measures to prevent intravascular catheter related infections were practiced and followed, citing two of two facility staff (Registered Nurse (RN) (personnel #4) and Patient Care Technician (PCT) (personnel #5). This practice placed all patients at the facility at risk for infection. Findings included: 1. On 04/03/2024 at 12:00 PM, the surveyor observed the Patient Care Technician (PCT) (Personnel #5) provide care to patient #1. Personnel #5 and Patient #1 have their face mask below their nostrils. 2. At 12:04 PM, Registered Nurse (RN) (Personnel #4) cleansed both of the the Central Venous Catheter (CVC) ports with alcohol pre pad, removed the used red cap, connected a 10 milliliters (ml) syringe to the port, and aspirated approximately 8 - 10 ml of blood, removed the 10 ml syringe with blood and placed the syringe on top of the chairside table mixed with clean supplies such as alcohol prep pads, syringes, and Normal Saline (NS) syringes. Personnel #4 repeated the same process when removing the blue port cap, placed a 10 ml syringe filled with blood on top of the chairside table mixed with clean supplies, and connected a vacutainer to the blue port, collected blood specimen, placed blood specimen tubes and used vacutainer on top of the chairside table mixed with clean supplies. Personnel #4 connected the dialysis bloodlines to each CVC port and started Patient #1’s dialysis treatment. Personnel #4 picked up the two 10 ml syringes with blood, uncapped, used vacutainer, and walked behind Personnel #5 to discard the syringes and vacutainer located in the opposite side of the dialysis machine. On 04/03/2024 at 12:15 PM, Personnel #4 confirmed the above findings. A review of the facility’s Initiation of Treatment Using a Central Venous Catheter (CVC) and Optiflux Single Use Ebeam Dialyzer Policy dated 07/06/2021, included, “...Preparing the catheter: disinfection of the catheter connections...Procedure #9. Put mask on the patient...threads and end of the luer lock (hub) must be scrubbed...any time caps are removed, or bloodlines are disconnected...discard the blood-filled syringe from the arterial limb into the sharps container...” A rview of the facility’s Central Venous Catheter Dressing Change Policy dated 05/02/2022, included, “Removal of dressing and Inspection of site...Note: The patient and ...staff must wear a mask for all procedures that require accessing the catheter to help prevent contamination...” A review of the facility’s General Cleanliness and Infection Control Guidelines Policy dated 02/07/2022, included, “Contaminated needless/sharps...during use, sharps containers shall be...easily accessible and located as close as is feasible to the immediate area where sharps are used...contaminated sharps shall be discarded immediately...other regulated waste...regulated waste shall be placed in a container that is accordance with...bloodborne standard...is closeable, leak proof...closed prior to removal to prevent spillage or protrusion of contents during handling, storage, transport...””

“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: 34689 Based on observation, record review and interview, the facility failed to evaluate the appropriateness of the dialysis prescription, citing four of four dialysis patients (Patients #5, #6, #7, and #8) who did not have physician’s orders for the provision of care. Findings included: 1. Patient #5: A review of Patient #5’s treatment sheet dated 03/18/2024, included, “...Hemodialysis orders: Estimated Dry Weight (EDW): 88.60 kilogram (kg)...pre-dialysis vitals...pre weight 96.70 kg...Blood Pressure (BP) sit 226/146 BP stand 237/156...Pulse 107 irregular (IR)...1:50 PM BP 215/167...treatment initiated without problem...2:02 PM BP 214/148...2:37 PM BP 205/142...2:24 PM Nursing evaluation...general...alert, lethargic, oriented...physical exam: flat affect, lethargic...notes: pre assessment - entered ambulatory (amb), complaint of (c/o) nausea/vomiting/Headache/weakness (n/v/HA), drowsy, lungs diminished, generalized edema...pre weight (wt) 8.1 kg greater than (>) edw...Registeed Nurse (RN) (Personnel #22)...2:54 PM BP 205/142...RN notified...patient (pt) states lower back pain, treatment (tx) ended early pt requested ambulance...Patient Care Technician (PCT) (Personnel #25)...3:30 PM...discharged...via life EMS...6:26 PM...2:54 PM pt requested treatment end and to send him to the emergency department (ED) for abdominal (abd) pain...Personnel #22...” A review of Patient #5’s clinical record showed no documented evidence facility staff called patient #5’s physician (Personnel #7) to notify of patient’s pre weight 8.1 kg over edw, lethargy, deminished lung sounds, elevated blood pressure readings, and/or patients’ condition status pre and intra dialytic status, and/or to get order for the provision or care. A review of the facility’s Standing Orders - Interdialytic Treatment and Complication dated 07/28/2021, included, “...Dry Weight...charge nurse may challenge 0.5 kilogram (kg) or 1.0 kg lower, Notify Provider for changes exceeding these limits...Hypertension...if Systolic Blood Pressure (SBP) is greater than 180 or Diastolic Blood Pressure (DBP) is greater than 100...” On 04/05/2024 at 1:30 PM, the facility manager (Personnel #3) confirmed the above findings. When the charge nurse 2 (personnel #1) and facility manager (Personnel #3) were asked if there were patients dialyzing and using the isolation room, they stated two patients use the isolation room for bed bug protocol. 2. Patient #6: A review of patient #6’s clinical record showed no documented evidence of orders to put patient in isolation, no notification to patient #6’s physician regarding bed bug infestation, and to follow the facility’s bed bug protocol. A review of the treatment sheets dated 01/02/2024 - 01/13/2024 showed no documented evidence of facility staff’s assessment if patient #6 still has any bed bugs, if patient is dialyzed in the isolation room, and if facility staff maintained precautions and followed the bed bug protocol. A review of the psychosocial progress note dated 01/11/2023, included, “ ...contacted adult protective services (APS) and made an APS report for ...lack of compliance with her infestation ...” On 04/04/2024 at 4:50 PM, the surveyor observed patient #6 dialyzing in the isolation room with a caregiver in the room. On 04/05/2024 at 11:00 AM, the facility manager (Personnel #3) confirmed the above findings. When asked when patient #6 was placed on isolation and made unstable for bed bug infestation, she stated we are not sure when we found the bed bugs. 3. Patient #7: A review of patient #7’s clinical record showed no documented evidence of orders to put patient in isolation, no notification to patient #7’s physician regarding bed bug infestation, and to follow the facility’s bed bug protocol. A review of the treatment sheets dated 12/19/2023 and 12/23/2023, 03/26/2023 - 03/30/2024, showed no documented evidence of facility staff’s assessment if patient #7 still has any bed bugs, if patient is dialyzed in the isolation room, and if facility staff maintained precautions and followed the bed bug protocol. A review of the psychosocial progress note by the social worker (Personnel #16) dated 12/21/2023, included, “ ...contacted via telephone to address concerns about bed bugs...” On 04/05/2024 at 11:20 AM, the facility manager (Personnel #3) confirmed the above findings. 4. Patient #8: A review of NxStage Medical System One Hemodialysis Record dated 03/09/2024, included, “...home visit/respite care...Blood Pressure (BP) sitting 207/112, BP 219/121, BP 196/115, pulse 116, post treatment...patient (pt) has chills at start of treatment (tx)...tx end...early vomiting...Personnel #24, Registered Nurse (RN)...” A review of Patient #8’s Home Hemodialysis Standing Orders - Enid dated 11/13/23, included, “...Notify MD if...A. Systolic Blood Pressure (SBP) is equal to or greater than 180 and/or Diastolic Blood Pressure (DBP) is greater than 95...Nausea with/out vomiting...Physician’s Signature: Personnel #7...Personnel #17 (RN) 11/13/23...” A review of Patient #8’s clinical records showed no documented evidence of physician’s orders for respite care, and no notification of patient #8’s condition status of high blood pressure, patient #8’s chills at the start of treatment, and treatment ended early due to patient’s vomiting, on 03/09/2024. On 04/04/2024 at 5:00 PM, home therapy area team lead (Personnel #13) confirmed the above findings. A review of the facility’s Bed Bugs Control Policy dated 04/20/2017, included, “...when a patient is identified with having bed bugs...notify the patient’s attending physician regarding patients has been identified having bed bugs ...notify physician for appropriate treatment...””

“PA-FREQUENCY REASSESSMENT-UNSTABLE Q MO CFR(s): 494.80(d)(2) In accordance with the standards specified in paragraphs (a)(1) through (a)(13) of this section, a comprehensive reassessment of each patient and a revision of the plan of care must be conducted- At least monthly for unstable patients including, but not limited to, patients with the following: (i) Extended or frequent hospitalizations; (ii) Marked deterioration in health status; (iii) Significant change in psychosocial needs; or (iv) Concurrent poor nutritional status, unmanaged anemia and inadequate dialysis. This Standard is not met as evidenced by: 34689 Based on record review and interview, the Interdisciplinary Team (IDT) failed to conduct at least monthly, a reassessment for unstable patients, citing two of two patients (Patients #6 and #7) who was made unstable by the IDT, did not have a reassessment of patient status to check for the presence or absence of bed bugs conducted by the IDT. Findings included: When the charge nurse 2 (personnel #1) and facility manager (Personnel #3) were asked if there were patients dialyzing and using the isolation room, they stated two patients use the isolation room for bed bug protocol. 1. Patient #6: A review of patient #6’s clinical record showed no documented evidence of orders to put patient in isolation, no notification to patient #6’s physician regarding bed bug infestation, and to follow the facility’s bed bug protocol. A review of the treatment sheets dated 01/02/2024 - 01/13/2024 showed no documented evidence of facility staff’s assessment if patient #6 still has any bed bugs, if patient is dialyzed in the isolation room, and if facility staff maintained precautions and followed the bed bug protocol. A review of the plan of care (POC) dated 12/23/2023 and 03/27/2024 included, “last patient status unstable ...reason for meeting unstable...other: pest infestation for caregiver who is required to assist patient during treatments ...” A review of the psychosocial progress note dated 01/11/2023, included, “...contacted adult protective services (APS) and made an APS report for...lack of compliance with her infestation...” On 04/04/2024 at 4:50 PM, the surveyor observed patient #6 dialyzing in the isolation room with a caregiver in the room. On 04/05/2024 at 11:00 AM, the facility manager (Personnel #3) confirmed the above findings. When asked when patient #6 was placed on isolation and made unstable for bed bug infestation, she stated we are not sure when we found the bed bugs. 2. Patient #7: A review of patient #7’s clinical record showed no documented evidence of orders to put patient in isolation, no notification to patient #7’s physician regarding bed bug infestation, and to follow the facility’s bed bug protocol. A review of the plan of care (POC) 02/07/2024 and 03/01/2024, “...unstable...” A review of the treatment sheets dated 12/19/2023 and 12/23/2023, 03/26/2023 - 03/30/2024, showed no documented evidence of facility staff’s assessment and reassessment if patient #7 still has any bed bugs, if patient is dialyzed in the isolation room, and if facility staff maintained precautions and followed the bed bug protocol. A review of the psychosocial progress note by the social worker (Personnel #16) dated 12/21/2023, included, “...contacted via telephone to address concerns about bed bugs...” On 04/05/2024 at 11:20 AM, the facility manager (Personnel #3) confirmed the above findings. A review of the facility’s Bed Bugs Control Policy dated 04/20/2017, included, “...when a patient is identified with having bed bugs...notify the patient’s attending physician regarding patients has been identified having bed bugs ...notify physician for appropriate treatment...””

“H-PT/CAREGIVER DEMO COMPREHEND TRAINING CFR(s): 494.100(b)(1) The dialysis facility must - (1) Document in the medical record that the patient, the caregiver, or both received and demonstrated adequate comprehension of the training; This Standard is not met as evidenced by: 34689 Based on record review and interview, the facility failed to ensure all patients and their caregivers have the knowledge and skills for home hemodialysis (HHD), citing one of one patient (patient #8) in that patient #8’s clinical record showed no documented evidence of verification of competency and training for HHD. Findings included: Patient #8: When the home therapy area team lead (Personnel #13) was asked when Patient #8’s last day of training for home hemodialysis was, she stated, the last day of training was 12/21/2023. A review of Patient #8’s clinical records showed no documented evidence that patient #8 and caregiver have verification of competency and training for home hemodialysis. On 04/04/2024 at 5:00 PM, personnel #13 confirmed the above findings.”

“QAPI-MEASURE/ANALYZE/TRACK QUAL INDICATORS CFR(s): 494.110(a)(2) The dialysis facility must measure, analyze, and track quality indicators or other aspects of performance that the facility adopts or develops that reflect processes of care and facility operations. These performance components must influence or relate to the desired outcomes or be the outcomes themselves. This Standard is not met as evidenced by: 34689 Based on record review and interview, the facility failed to continuously monitor its performance improvements for adverse events, citing two of two patients (Patients #4 and #5) in that occurrences were not reported, not analyze and/or track performance to ensure that improvements were sustained over time to promote patient safety and improve care. Findings included: 1. Patient #4: A review of Patient’s #4’s Home Therapies Clinic Visit Intake Form dated 03/06/2024 and 04/03/2024, included, “Comments:...reason: bad cassette...Registered Nurse (RN) (Personnel #17)...” On 04/05/2024 at 9:40 AM, when personnel #17 was asked if Patient #4’s physician (Personnel #7) was notified of the bad cassettes and if an adverse occurrence was reported, she stated, no that she did not know. On 04/05/2024 at 9:50 AM, Personnel #13 confirmed the above findings. 2. Patient #5: A review of Patient #5’s treatment sheet dated 03/18/2024, included, “...Hemodialysis orders: Estimated Dry Weight (EDW): 88.60 kilogram (kg)...pre-dialysis vitals...pre weight 96.70 kg...Blood Pressure (BP) sit 226/146 BP stand 237/156...Pulse 107 irregular (IR)...1:50 PM BP 215/167...treatment initiated without problem...2:02 PM BP 214/148...2:37 PM BP 205/142...2:24 PM Nursing evaluation...general...alert, lethargic, oriented...physical exam: flat affect, lethargic...notes: pre assessment - entered ambulatory (amb), complaint of (c/o) nausea/vomiting/Headache/weakness (n/v/HA), drowsy, lungs diminished, generalized edema...pre weight (wt) 8.1 kg greater than (>) edw...Registered Nurse (RN) (Personnel #22)...2:54 PM BP 205/142...RN notified...patient (pt) states lower back pain, treatment (tx) ended early pt requested ambulance...Patient Care Technician (PCT) (Personnel #25)...3:30 PM...discharged...via life EMS...6:26 PM...2:54 PM pt requested treatment end and to send him to the emergency department (ED) for abdominal (abd) pain...Personnel #22...” On 04/05/2024 at 1:30 PM, the facility manager (Personnel #3) confirmed the above findings. When asked if patient #5’s event occurrence when he was sent to the emergency department was reported as adverse occurrence, she stated no.”