Fmc Arecibo

“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: 47632 Based on observations made in the treatment area on 06/17/2025, it was determined that the facility failed to monitor the environment to ensure its sanitation and reduce the potential transmission of infectious agents within and between units, due to the lack of adherence to “standard precautions”. Findings include: 1. During the observations made in the medication room area on 06/17/2025, the following were found: a. At 9:03 AM, a 16-gm pot of Liquiacel was observed, opened without a date or sign by the staff. b. At 9:16 AM, an expired 21 G Vacutainer (exp. 04/30/2025) was observed in the allergy kit. It was replaced immediately. 2. During the observations made in the laboratory area on 06/17/2025, the following were found: a. At 9:24 AM, three 50 ml syringes that expired on 03/31/2025. b. At 9:35 AM, four anaerobic cultures were found to have expired on 06/16/2025 inside the Spectra culture boxes. c. At 9:37 AM, underneath the dirty sink, the cabinet was found to be open, with a container, moisture, and corroded hinges. This was corrected by the Biomedical Technician (employee #6). d. At 9:41 AM, a container of Residual Chlorine Lot 2407321021 was found without a sign or date from the staff. e. At 10:10 AM, 22 crop swaps expired on 06/14/2025 were found. 3. During the observations made in the unit area on 06/17/2025, the following were found: a. At 9:57 AM, three packages of 100 pieces of Dialysis Transducer Protectors expired on 10/31/2024. b. At 10:24 AM, biohazard bins were observed touching the treatment chairs at stations: #5, #8, #16, #17, #20, #22, #24, #24, and #25. c. a. At 10:49 AM, acrylic covers for fluorescent lights with insects were observed at the following stations: #2, #23, #25, and #27. 4. During the observations made in the waiting room on 06/17/2025, the following were found: Charge Nurse (employee #1) provided the facility policy Version :6 last update on 11/06/2023, Personal Protective Equipment on 06/17/2025 at 11:22 AM. The policy states on page 2 that all personal protective equipment must be removed before leaving the treatment area. a. At 1:20 PM, the nurses (employees #3 and #8) were observed leaving the units for the waiting room wearing their gowns. b. At 1:27 PM, acrylic covers for fluorescent lights with insects were observed in the waiting room.”

“IC-IF TO STATION=DISP/DEDICATE OR DISINFECT CFR(s): 494.30(a)(1)(i) Items taken into the dialysis station should either be disposed of, dedicated for use only on a single patient, or cleaned and disinfected before being taken to a common clean area or used on another patient. -- Nondisposable items that cannot be cleaned and disinfected (e.g., adhesive tape, cloth covered blood pressure cuffs) should be dedicated for use only on a single patient. -- Unused medications (including multiple dose vials containing diluents) or supplies (syringes, alcohol swabs, etc.) taken to the patient’s station should be used only for that patient and should not be returned to a common clean area or used on other patients. This Standard is not met as evidenced by: 47632 Based on an observation made in the treatment area on 06/17/2025 at 8:32 AM, it is determined that the facility failed to maintain the dialysis station clean and disinfected of items placed on top or side of the treatment chair on 10 out of 10 observations at stations #7, #9, #10, #12, #15, #18, #19, #20, #24 and #28. Findings include: During observation of the treatment area, station #7, #9, #10, #12, #15, #18, #19, #20, #24 and #28, patients were observed having personal belongings either hanging from or on top of the folding table of the treatment chairs.”

“PE-SAFE/FUNCTIONAL/COMFORTABLE ENVIRONMENT CFR(s): 494.60 The dialysis facility must be designed, constructed, equipped, and maintained to provide dialysis patients, staff, and the public a safe, functional, and comfortable treatment environment. This Standard is not met as evidenced by: 47632 Based on the observational tour of the facility treatment area on 06/17/2025, it was determined that the facility failed to maintain the building in which dialysis services are furnished to ensure the safety of the patients, the staff and the public. Findings include: 1. During the observations made in the treatment area on 06/17/2025 at 8:00 AM through 2:00 PM, the following were found: a. At 10:49 AM, acrylic covers for fluorescent lights with insects were observed at the following stations: #2, #23, #25, and #27. b. At 1:27 PM, acrylic covers for fluorescent lights with insects were observed in the waiting room. c. At 1:19 PM, a scented product was found placed on the extractor grill in front of the waiting room bathroom. d. At 1:28 PM, the extractor fan was observed to be detached from the first bathroom in the waiting room. e. At 1:32 PM, the advertising lights in the waiting room bathrooms were observed to be detached. f. At 1:43 PM, it was observed that the sandpaper on the floor of the weighing scale was coming unstuck. 51629 2. Observations made on 6/17/2025 at 10:00 AM at the water and treatment room: a. Cracked floor tiles at the entrance. 3. Observations made on 6/17/2025 at 10:30 AM at the main storage area: a. Detachment of plaster on the ceiling at one end of the area, near entrance b. Rusty and exposed rod on the roof at one end of the area, near entrance. c. Holes in the roof, made for the installation of new pipes. d. Disused pipes on the roof. e. Peeling paint on ceiling and walls. f. Disorganized material for patient equipment use, mixed with facility maintenance material, including chemicals and Christmas decorations in the back of the warehouse.”

“PE-PT CARE ENVIRONMENT-SUFFICIENT SPACE CFR(s): 494.60(c)(1) The space for treating each patient must be sufficient to provide needed care and services, prevent cross-contamination, and to accommodate medical emergency equipment and staff. This Standard is not met as evidenced by: 47632 Based on the observational tour of the facility treatment area on 06/17/2025, it was determined that the facility failed to provide sufficient space needed to prevent cross-contamination, and to accommodate medical emergency equipment and staff, for 1 out of 30 stations (ST) (ST #28). Findings include: 1. During the visit to the unit, it was observed that station #28 does not meet the minimum requirement of 3 feet on the left side of the treatment chair. This could hinder the care of any patient who needs emergency medical assistance.”

“PE-HD PTS IN VIEW DURING TREATMENTS CFR(s): 494.60(c)(4) Patients must be in view of staff during hemodialysis treatment to ensure patient safety, (video surveillance will not meet this requirement). This Standard is not met as evidenced by: 47632 Based on observations made in the treatment area on 06/17/2025, it was determined that the facility failed to ensure that patients receive treatment in a manner that allows staff to have full view of patients access site for the first and second shift. This deficient effect 9 out of 30 stations, patients observed receiving treatment (St. #5, #6, #7, #12, #22, #24, #25, #26, and #28) Findings include: 1. During the observations made in the treatment area on 06/17/2025 at 8:00 AM through 12:00 PM, the following were found: a. On 06/17/2025 at 8:30 AM, patients with vascular accesses covered with sheets were observed at the following stations: #5, #6, #7, #12, #22, #24, #25, #26, and #28.”

“PE-FIRE SAFETY-LIFE SAFETY CODE CFR(s): 494.60(e)(1) (1) Except as provided in paragraph (d)(2) of this section, dialysis facilities that do not provide one or more exits to the outside at grade level from the patient treatment area level must comply with provisions of the Life Safety Code (NFPA 101 and its Tentative Interim Amendments TIA 12-1, TIA 12-2, TIA 12-3, and TIA 12-4) applicable to Ambulatory Health Care Occupancies, regardless of the number of patients served. This Standard is not met as evidenced by: 51629 Based on observations made of the home hemodialysis training area on 06/17/2025 at 9:00 AM and the main storage area on 06/17/2024 at 10:30 AM, it was determined that the facility failed to maintain Life Safety measures that complies with NFPA 101 (Life Safety Code) and NFPA 99 (Health Care Facilities Code) provisions which could affect all patients receiving treatment and staff. Findings include: 1.Fire extinguisher located at the entrance of documents storage boxes area was observed blocked by Christmas ornaments. 2. At the moment of the survey no written evidence that the # (2) fire doors in the facility had been inspected. After further observation, all the fire doors and frames had been painted over the fire rating decal. To assure that fire doors are working properly NFPA 80 (Standard for Fire Doors and Other Opening Protectives) section 5.2.1 mandates that fire doors should be inspected and tested at least once a year. 3.It was observed both types of electrical receptacles (regular and ground fault) in the three Home Hemodialysis / Peritoneal Dialysis training rooms, instead of complete ground fault electrical receptacles.”

“PR-PRIVACY & CONFIDENTIALITY-TREATMENT CFR(s): 494.70(a)(3) The patient has the right to- (3) Privacy and confidentiality in all aspects of treatment; This Standard is not met as evidenced by: 47632 Based on the observation tour in the patient treatment area during the first shift, 06/17/2025, it was determined that the facility failed to ensure privacy on exposing private body part during the disconnection from the hemodialysis machine in the facility. Findings include: 1. During the round provided in the treatment area on 06/17/2025, the following was observed: At 10:33 AM, it was observed that the registered nurse at station # 25 disconnected the graft located on the left thigh without providing privacy to the patient by failing to place the screen. The facility failed to ensure privacy with the screen at the time of disconnection of the patient’s graft during dialysis treatment.”

“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: 51782 Based on sixteen records reviewed (RR), review of policies and procedures and interview with Clinical Manager (employee #2), it was determined that the facility failed to follow established procedures after identifying patients’ high blood pressure (BP) or low blood pressure (BP) during dialysis treatment for 3 out of 16 records reviewed (RR #6, #7 and #9) Findings include: During the flowsheet review performed on 06/17/2025 and 06/18/2025 at 8:30 AM to 3:30 PM the following were found: 1. RR# 9 is an 80-year-old female admitted to the facility on 09/01/2022 with a diagnostic End Stage Renal Disease (ESRD). During the record review performed on 06/17/2025 at 3:15 PM, the hemodialysis treatment three times a week for three hours and thirty minutes, Dialyzer 160 NRE Optiflux, Blood Flow Rate (BFR) of 400, Dialysis Flow Rate (DFR) of 800 and Patient Dry Weight (EDW) of 56.5 kilograms (kg). a. On 05/07/2025 at 12:00 PM, it was revealed that the Blood Pressure (BP) was 195/83mg/Hg, at 12:30 PM it was revealed that the BP was 194/78 mg/Hg, and at 1:08 PM it was revealed that the BP was 198/80 mg/Hg. No evidence was found of nursing interventions, documentation for hypertension or notification of the physician. 47632 Charge Nurse (employee #1) provided the facility policy Version :4 last update on 05/01/2023, Patient Assessment and monitoring on 06/18/2025 at 1:22 PM. The policy states on page 4 document machine parameters and safety check every 30 minutes or more often as needed but not to exceed 45 minutes. 2. RR #6 is a 74-year-old female admitted to the facility on 09/07/2024 with a diagnostic End Stage Renal Disease. During the record review performed on 06/18/2025 at 10:04 AM, the hemodialysis treatment three times a week for four hours, Dialyzer 180 NRE Optiflux, Blood Flow Rate (BFR) of 300, Dialysis Flow Rate (DFR) of 800 and Patient Dry Weight (EDW) of 53 kilograms (kg). a. On 05/29/2025 at 9:59 AM, it was revealed that the Blood Pressure (BP) was184/89 mg/Hg. b. On 05/31/2025 at 10:37 AM, it was revealed that the BP was 182/80 mg/Hg. c. On 06/03/2025 at 9:30 AM, it was revealed that not BP readings were taken for 58 minutes. 3. RR #7 is a 56-year-old male admitted to the facility on 06/11/2014 with a diagnostic End Stage Renal Disease. During the record review performed on 06/18/2025 at 10:04 AM, the hemodialysis treatment three times a week for four hours, Dialyzer 180 NRE Optiflux, Blood Flow Rate (BFR) of 450, Dialysis Flow Rate (DFR) of 800 and Patient Dry Weight (EDW) of 78 kilograms (kg). a. 06/16/2025 at 10:26 AM, it was revealed that not BP readings were taken for 1 hoors and 6 minutes. No evidence was found of nursing interventions, documentation for hypertension or notification of the physician.”

“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: 47632 Based on review of the treatment flowsheets on 06/17/2025, it was determined that the facility failed to ensure that the medical records contained complete information related to the documentation of blood pressure taken before and after treatment and after hemodialysis treatment for 2 out of 16 records reviwed (RR) (RR#2 and RR #6) Findings include: During the review of the flow sheets on 06/17/2025 to 06/18/2025, the following was found: 1. RR #2 is an 82-year-old male admitted to the facility on 08/31/2016 with a diagnostic End Stage Renal Disease. During the record review performed on 06/17/2025 at 2:31 PM, the hemodialysis treatment three times a week for four hours, Dialyzer 180 NRE Optiflux, Blood Flow Rate (BFR) of 380, Dialysis Flow Rate (DFR) of 800 and Patient Dry Weight (EDW) of 62 kilograms (kg). a. On 06/09/2025 at 6:41 AM, Pre-dialysis treatment revealed that blood pressure (BP) was not taken in a standing position, as the nurse considered that the patient could walk with assistance. The nurse’s evaluation states that the patient arrived walking. 2. RR #6 is a 74-year-old female admitted to the facility on 09/07/2024 with a diagnostic End Stage Renal Disease. During the record review performed on 06/18/2025 at 10:04 AM, the hemodialysis treatment three times a week for four hours, Dialyzer 180 NRE Optiflux, Blood Flow Rate (BFR) of 300, Dialysis Flow Rate (DFR) of 800 and Patient Dry Weight (EDW) of 53 kilograms (kg). a. On 06/18/2025 at 6:47 AM, pre-dialysis treatment revealed that blood pressure (BP) was not taken in the standing position, as the nurse assessed that the patient could walk without assistance.”