Davita Scranton Dialysis

“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: 19122 Based on review of agency policies/procedures and medical records and based on interview with the Administrator (Employee #8), the facility failed to ensure patient assessment were completed in accordance with facility policy/procedure assessed for four (4) of five (5) in-center hemodialysis patients. (Patients #2, #3, #4 and #5) Findings include: On September 18, 2025 at approximately 11:15 AM, review of facility policy 1-03-08, titled “Pre-Intra-Post Treatment Data Collection, Monitoring and Nursing Assessment” revealed the following: Purpose: To obtain and document baseline and ongoing information about the patient before, during and after the dialysis treatment through data collection and nursing assessment... Policy: 1. Patient data will be obtained and documented by the patient care technician (PCT) or a licensed nurse. a. Data collection includes but is not necessarily limited to... ii. Measurement of Blood Pressure (BP) 1. Sitting and standing BP measurement required pre and post treatment (if patient unable to stand, document reason in the patient electronic record or flow sheet)... Intradialytic (During Treamtent) Data Collection/Assessment: 13: All findings...will be documented in the patient’s medical record. Abnormal Findings...Blood Pressure-Intradialytic: -Signs/Symptoms of hypotension may include: -Nausea and vomiting -Restlessness -Rapid, shallow respirations -Excessive yawning -Diaphoretic (excessive sweating )... Patient #2: Review of the medical record between September 16, 2025 at approximately 12:02 PM and September 18, 2025 at approximately 10:02 AM revealed HD medication orders included the administration of 100 ml of NSS as needed every 30 minutes as documented on the “Patient Summary Report”. Review of HD treatment sheet documentation revealed the following: -09/09/2025 at 8:54 AM and 9:30 AM: A 100 ml NSS bolus was administered for symptomatic hypotension. There was no documentation in the medical record which provided evidence the type of hypotensive symptoms the patient experienced had been documented by the registered nurse (RN-Employee #9). Patient #3: Review of the medical record between September 16, 2025 at approximately 12:26 PM and September 18, 2025 at approximately 9:10 AM revealed a pre-treatment standing blood pressure (BP) was obtained on 09/01 and 09/05/2025 but there was no documentation a post-treatment standing BP had been obtained. There was no documentation in the medical record which provided evidence the patient had refused assessment of a post-treatment standing BP on 09/01 and 09/05/2025. Patient #4: Review of the medical record between September 16, 2025 at approximately 12:43 PM and September 18, 2025 at approximately 10:00 AM revealed a post-treatment BP was obtained on 09/03 and 09/15/2025 but there was no documentation a pre-treatment standing BP had been obtained. There was no documentation in the medical record which provided evidence the patient had refused assessment of a pre-treatment standing BP on 09/03 and 09/15/2025. Patient #5: Review of the medical record between September 16, 2025 at approximately 1:05 PM and September 18, 2025 at approximately 10:37 AM revealed a post-treatment BP was obtained on 09/05/2025 but there was no documentation a pre-treatment standing BP had been obtained. There was no documentation in the medical record which provided evidence the patient had refused assessment of a pre-treatment standing BP on 09/05/2025. During interview conducted on September 18, 2025 at approximately 1:16 PM, the Administrator confirmed patient assessment was not completed in accordance with facility policy/procedure for the above identified patients on the above referenced dates.”

“MR-COMPLETE, ACCURATE, ACCESSIBLE CFR(s): 494.170 The dialysis facility must maintain complete, accurate, and accessible records on all patients, including home patients who elect to receive dialysis supplies and equipment from a supplier that is not a provider of ESRD services and all other home dialysis patients whose care is under the supervision of the facility. This Standard is not met as evidenced by: 19122 Based on review of agency policies/procedures and medical records and based on interview with the Administrator (Employee #8), the facility failed to ensure treatment orders were obtained for the administration of normal saline (NSS) above the prescribed dosage for two (2) of three (3) in-center hemodialysis patients for whom supplemental NSS was administered during the hemodialysis (HD) treatment. (Patients #2 and #3) Findings include: On September 18, 2025 at approximately 11:12 AM, review of facility policy 1-09-01, titled “Hypotension” revealed the following under “Procedure”: 3. Administer normal saline bolus of 100 to 200 ml (milliliters) for severe hypotensive episodes. Patient care technicians may give up to 200 ml... On September 18, 2025 at approximately 1:06 PM, review of facility policy 1-06-01, titled “Medications” revealed the following under “Policy”: 10. Prior to the administration of medication, verify...order. Patient #2: Review of the medical record between September 16, 2025 at approximately 12:02 PM and September 18, 2025 at approximately 10:02 AM revealed HD medication orders included the administration of 100 ml of NSS as needed every 30 minutes as documented on the “Patient Summary Report”. Review of HD treatment sheet documentation revealed the following: -09/04/2025 at 8:39 AM: A 200 ml NSS bolus was administered for a blood pressure of 67/48 millimeters of mercury (mm/Hg). There was no documentation in the medical record which provided evidence a medication order had been obtained to administer a 200 ml NSS bolus in a single administration. Patient #3: Review of the medical record between September 16, 2025 at approximately 12:26 PM and September 18, 2025 at approximately 9:10 AM revealed HD medication orders included the administration of 100 ml of NSS as needed as documented on the “Patient Summary Report”. Review of HD treatment sheet documentation revealed the following: -09/01/2025 at 9:10 AM: A 200 ml NSS bolus was administered for a blood pressure of 86/52 mm/Hg and complaints of shortness of breath; and -09/08/2025 at 9:52 AM: A 200 ml NSS bolus was administered for a blood pressure of 77/42 mm/Hg. There was no documentation in the medical record which provided evidence that a medication order had been obtained to administer a 200 ml NSS bolus in a single administration. During interview conducted on September 18, 2025 at approximately 1:16 PM, the Facility Administrator confirmed medication orders had not been obtained to administer a 200 ml NSS bolus in a single administration for the above identified patients.”