Fmc Guayama

“Roles Under a Waiver Declared by Secretary CFR(s): §403.748(b)(8), §416.54(b)(6), §418.113(b)(6)(C)(iv), §441.184(b)(8), §460.84(b)(9), §482.15(b)(8), §483.73(b)(8), §483.475(b)(8), §485.542(b)(7), §485.625(b)(8), §485.920(b)(7), §494.62(b)(7). [(b) Policies and procedures. The [facilities] must develop and implement emergency preparedness policies and procedures, based on the emergency plan set forth in paragraph (a) of this section, risk assessment at paragraph (a)(1) of this section, and the communication plan at paragraph (c) of this section. The policies and procedures must be reviewed and updated at least every 2 years [annually for LTC facilities]. At a minimum, the policies and procedures must address the following:] (8) [(6), (6)(C)(iv), (7), or (9)] The role of the [facility] under a waiver declared by the Secretary, in accordance with section 1135 of the Act, in the provision of care and treatment at an alternate care site identified by emergency management officials. *[For RNHCIs at §403.748(b):] Policies and procedures. (8) The role of the RNHCI under a waiver declared by the Secretary, in accordance with section 1135 of Act, in the provision of care at an alternative care site identified by emergency management officials. This Standard is not met as evidenced by: 47384 Based upon an Emergency Preparedness Program (EPP) survey performed on 02/13/24 at 8:30 AM through 4:00 PM, to evaluate emergency preparedness requirements for recertification, it was determined that the facility failed to develop and maintain policies and procedures related with the role of the facility under a waiver declared by the Secretary in accordance with section 1135 of the Act in the provision of care and treatment. Finding includes: During the review of the facilities Emergency Preparedness Program with the Clinical Manager (employee # 1) on 02/13/2024 it was noted that the EP failed to include policies and procedures which outline the facility’s role in the provision of care and treatment under section 1135 waivers during a declared public health emergency in alternate care sites as required under §494.62(b)(7).”

“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: 47384 Based on an unannounced recertification CORE survey and observational tour of the patient treatment area during the first shift, on 02/13/2024 from 8:30 AM till 4:00 PM it was determined that the facility failed to provide and monitor a sanitary environment to minimize the transmission of infectious agents within and between the unit. Findings include: 1. Upon entry to the dialysis unit a rack used for hanging gowns when exiting the unit was observed containing several isolation gowns with their straps touching the floor. 2. Paramedic personel was observed entering the facility waiting area wearing gloves and isolation gown, when called to transport patient to treatment area the personnel entered with the gowns and upon request performed a poor hand washing technique.”

“IC-WEAR GLOVES/HAND HYGIENE CFR(s): 494.30(a)(1) Wear disposable gloves when caring for the patient or touching the patient’s equipment at the dialysis station. Staff must remove gloves and wash hands between each patient or station. This Standard is not met as evidenced by: 47632 Based on ESRD Core survey, observation of the disconnection process on 02/13/2024 at 9:55 AM, it was determined that the facility failed to follow standard infection control practice to clean and disinfect the screen before placing it at patients station 2 out of 2 (Station # 2 and #12). Findings include: 1. During the disconnection process of the first shift on 02/13/2024 at 9:55 AM the following was found: a. On 02/13/2024 at 10:09 AM, it was observed that the registered nurse (RN #8) does not clean the screen between patients to prevent transmission of dangerous pathogens. b. On 02/13/2024 at 10:45AM, it was observed that the registered nurse (RN #9) does not clean the screen between patients to prevent transmission of dangerous pathogens.”

“IC-HBV-ISOLATION-MACHINES/EQUIP/SUPPLIES CFR(s): 494.30(a)(1)(i) Isolation of HBV+ Patients To isolate HBsAg positive patients, ... dedicate machines, equipment, instruments, supplies, and medications that will not be used by HBV susceptible patients. This Standard is not met as evidenced by: 47384 Based on an unannounced recertification CORE survey and observational tour of the patient treatment area with RTOM (employee #7) during the first shift, on 02/13/2024 from 8:30 AM till 4:00 PM, it was determined that the facility failed to separate dedicated supplies and equipment for isolation rooms. Findings include: 1. Isolation assigned mop was observed inside bucket in front of the treatment chair. The isolation room has an equipment area which has a rack to hang the mop and it was not being used. 2. Two dialysis machines were found inside the isolation room, machine #11 was observed with a work order tag. 3. Equipment such as trash can, chair, dialysis machine was not identified as equipment of isolation room to prevent the movement of the equipment to unit.”

“IC-ASEPTIC TECHNIQUES FOR IV MEDS CFR(s): 494.30(b)(2) [The facility must-] (2) Ensure that clinical staff demonstrate compliance with current aseptic techniques when dispensing and administering intravenous medications from vials and ampules; and This Standard is not met as evidenced by: 47632 Based on ESRD Core survey, interview and policy and procedure with the Charge Nurse (employee #3) on 02/13/2024 at 9:40 AM, it was determined that the facility failed to ensure expired medications are not available for use and multiple-use medications are properly labeled by the nursing staff. Findings include: 1. During observation in the medication room on 02/13/2024 at 9:40 AM with the Charge Nurse (employee #3) the following was found: a. On 2/13/2024 at 9:43 AM a pain relief bottle of 500 tablets was found open with no date and signature of the staff who opened the bottle. b. On 02/13/2024 at 9:47 AM a 5-unit bottle of tuberculin (Tubersol) was found open since 09/12/2023. According to policy 05/04/2021 Version: 3, Page 1. Check manufacturer expiration and date vial opened. Manufacturer’s instructions when opening the tuberculin vial, it should be discarded after 30 days.”

“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: 47384 Based on an unannounced recertification CORE survey and observational tour of the patient treatment area with RTOM (employee #7) during the first shift, on 02/13/2024 from 8:30 AM till 4:00 PM, it was determined that the facility failed to ensure that medical surgical equipment and items needed to performed an emergency disconnection from hemodialysis machine circuits were not available for 10 out of 28 hemodialysis stations where patients are receiving treatment on the first shift on 02/13/2024 ( Station #3, #7, #8, #12, #16, #20, #23, #25, #27 and #28). Findings include: 1.Ten hemodialysis treatment stations did not have attached to the chair the disconnection kit. 2, The facility failed to maintain emergency disconnection kit on every chair were a patient is receiving hemodialysis treatment.”

“PE-BUILDING-CONSTRUCT/MAINTAIN FOR SAFETY CFR(s): 494.60(a) The building in which dialysis services are furnished must be constructed and maintained to ensure the safety of the patients, the staff and the public. This Standard is not met as evidenced by: 47384 Based on an unannounced recertification CORE survey and observational tour of the patient treatment area with RTOM (employee #7) during the first shift, on 02/13/2024 from 8:30 AM till 4:00 PM, it was determined that the facility failed to ensure that the building in which dialysis services are furnished must be constructed and maintained to ensure the safety of the patients, the staff and the public. Findings include: 1. Disposal sink is observed with caulking around the downspout, this hinders the complete flow of liquid causing accumulation of liquid in the area. 2. Excessive dust particles were observed on the majority of the countertops behind treatment chairs. 3. Signs of moisture and raised paint were observed in the lower part of the column near the emergency exit. 4. 2 of 52 light fixtures were observed without acrylic cover. 5. 30 of 52 light fixtures were observed with many dead flying insects on the acrylic cover. 6. Black stains indicative of mold or moisture were found on the cover of the eyewash station. 7. Unit emergency door was observed missing part of the plastic isolation strip on the top part of the door, this permitting entrance of external air and particles. 8. Automatic door closing device on the emergency exit door was observed broken. 9. Exhaust grill on unit bathroom (next to waiting room entrance) was observed with excessive dust. 10. Couter footrest behind station #25 was observed with the Formica peeling off and signs of damage due to contact with water.”

“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 ESRD Core survey, interview and review of policy and procedure on 02/13/2024 at 8:00 AM through 12:00 PM, it was determined that the facility failed to ensure that patients vascular access is uncovered to be seen by a member of staff during dialysis treatment for 5 out of 30 Stations (Station #11, #21, #22, #23 and #24). Findings include: 1. During the observation in stations rooms on 02/13/2024 at 8:00 AM through 12:00 PM the following was found: a. On 02/13/2024 at 8:18 AM the patient located in station #11, it was observed the vascular access covered with sheet. b. On 02/13/2024 at 8:20 AM the patient located in station #21, it was observed the vascular access covered with sheet. c. On 02/13/2024 at 8:21 AM the patient located in station #22, it was observed the vascular access covered with sheet. d. On 02/13/2024 at 8:22 AM the patient located in station #23, was observed the vascular access covered with sheet. e. On 02/13/2024 at 8:23 AM the patient located in station #24, it was observed the vascular access covered with sheet. 2. The facility failed to ensure vascular access site should be seen by a staff member during all dialysis treatment. Allowing patients to cover access provides an opportunity for accidents of needle dislodgement or line disconnection and could result in bleeding or death in minutes.”

“PA-FREQUENCY-INITIAL-30 DAYS/13 TX CFR(s): 494.80(b)(1) An initial comprehensive assessment must be conducted on all new patients (that is, all admissions to a dialysis facility), within the latter of 30 calendar days or 13 hemodialysis sessions beginning with the first dialysis session. This Standard is not met as evidenced by: 20423 Based on an ESRD Core recertification survey, fifteen (15) records reviewed (R.R), it was determined that the facility failed to ensure that the initial comprehensive assessment is conducted for all new patients within 30 calendar days or 13 hemodialysis sessions beginning with the first dialysis session for 2 out of 15 records reviewed (R.R #1 and #15). Findings include: 1. RR #1 is a 58-year-old female patient admitted to the facility on 12/14/2023 with diagnosis of End Stage Renal Disease (ESRD). On 02/14/2024 at 1:50 PM, the medical record was reviewed and provides evidence of the last 7 dialysis treatments. However, it was found that the physician performs and completes the comprehensive Interdisciplinary assessment on 01/18/2024, 35 days after the first dialysis session. 2. R.R #15 is a 66-year-old female admitted on 08/31/2017 with a diagnosis of End Stage Renal Disease (ESRD), Diabetes Mellitus Type II (DM II). On 02/14/2024 at 1:25 PM the medical record was reviewed and provides evidence of the last 7 dialysis treatment. However, no evidence was found that the physician performs and completes the Comprehensive Interdisciplinary assessment for the date of 09/21/2023. RN #6 assisted the surveyor to review the medical record and did not find the physician comprehensive re-assessment.”

“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: 20423 Based on an unannounced a ESRD Core Recertification survey, fifteen (15) records reviewed (RR), review of policies and procedures (P&Ps) with the access manager Registered Nurse (RN) employee #6, it was determinate that the facility failed to follow established procedures after identifying patients’ high blood pressure (BP) or low blood pressure (BP) during dialysis treatment for 9 out of 15 records reviewed (RR #1, #2, #7, #8, #9, #10, #12, #14, and #15). Findings include: During flowsheet review performed on 02/13/2024 at 8:00 AM to 3:30 PM the following was found: 1. RR #1 is a 58-year-old female patient admitted to the facility on 12/14/2023 with diagnosis of End Stage Renal Disease (ESRD). During the record review performed on 02/14/2024 at 1:50 PM, it was found that patient has hemodialysis treatment three a week for four hours, Blood Flow Rate (BFR) of 350, Dialysis Flow Rate (DFR) of Manual 500, Dialyzer with 160 NRe Optiflux and patient Dry Weight (EDW) 85 kilogram (kg). a. On 01/23/2024 at 20:31 revealed that the BP was 166/130 (millimeter mercury) mm/Hg. No evidence was found of the nurse intervention or documentation performed by personnel of patient’s assessment when identify high blood pressure. b. On 01/25/2024 the post dialysis assessment revealed that patient Blood Pressure (B/P) in stand position cannot be assessed, the RN documented that patient ambulate without assistance. Interview with the access manager nurse employee #6 state that patient ambulate without assistance. c. On 01/27/2024 the pre dialysis assessment revealed that patient Blood Pressure (B/P) in stand position cannot be assessed, the RN did not document if patient came to the unit walking or not. Interview with the access manager nurse employee #6 state that patient ambulate without assistance. d. On 02/06/2024 at 19:31 it was revealed that the BP was 183/103 mm/Hg. No evidence was found of the intervention or documentation performed by personnel of patient’s assessment when identify high blood pressure. 2. RR #8 is a 63-year-old male patient admitted to the facility on 06/25/2020 with diagnosis of ESRD. During the record review performed on 02/13/2024 at 1:48 PM, it was found that patient has hemodialysis treatment three a week for four hours, BFR of 350, DFR of Manual 500, Dialyzer with 160 NRe Optiflux and patient EDW 62 kg. a.On 01/31/2024 at 07:03 revealed that the BP was 92/61 mm/Hg, at 07:32 the BP was 100/59 mm/Hg, at 08:02 the BP was 95/49 mm/Hg, at 08:32 the BP was 97/57 mm/Hg, at 09:07 the BP was 103/57 mm/Hg, at 9:35 the BP was 79/40 mm/Hg, at 10:06 the BP was 92/56 mm/Hg. No evidence was found of the intervention or documentation performed by nurse personnel of patient’s assessment when identify low blood pressure. b.On 02/02/2024 at 07:09 revealed that the BP was 94/59 mm/Hg, at 07:32 the BP was 98/60 mm/Hg, at 08:01 the BP was 104/62 mm/Hg, at 08:34 the BP was 103/63 mm/Hg, at 09:07 the BP was 103/68 mm/Hg, at 9:35 the BP was 98/59 mm/Hg, at 10:00 the BP was 80/49 mm/Hg, at 10:00 the BP was 90/46 mm/Hg. No evidence was found of the intervention or documentation performed by nurse personnel of patient’s assessment when identify low blood pressure. c. On 02/05/2024 at 07:05 it was revealed that the BP was 98/69 mm/Hg, at 07:31 the BP was 173/158 mm/Hg, at 08:04 the BP was 96/56 mm/Hg, at 08:30 the BP was 106/66 mm/Hg, at 09:02 the BP was 74/55 mm/Hg, at 9:32 the BP was 100/66 mm/Hg. No evidence was found of the intervention or documentation performed by nurse personnel of patient’s assessment when identify low blood pressure. d. On 02/07/2024 at 09:32 revealed that the BP was 118/62 mm/Hg, the nurse assesses the next patient B/P at 10:30, 58 minutes later, not as physician order every 30 minutes. No evidence was found of the intervention or documentation performed by nurse personnel of patient’s assessment when identify low blood pressure and high blood pressure or the reason for not following physician orders. e. On 02/12/2024 at 06:46 revealed that the BP was 100/75 mm/Hg, at 07:32 the BP was 98/56 mm/Hg, at 09:04 the BP was 63/26 mm/Hg, at 09:17 the BP was 93/55 mm/Hg, at 09:30 the BP was 101/52 mm/Hg, at 09:45 the BP was 107/65 mm/Hg. No evidence was found of the intervention or documentation performed by nurse personnel of patient’s assessment when identify low blood pressure. 3. RR #10 is an 80-year-old male patient admitted to the facility on 03/06/2023 with diagnosis of ESRD. During the record review performed on 02/13/2024 at 3:19 PM, it was found that patient has hemodialysis treatment three a week for 3.5 hours, BFR of 375, DFR of Manual 500, Dialyzer with 160 NRe Optiflux and patient EDW 49 kg. a.On 02/01/2024 at 13:41 revealed that the BP was 94/77 mm/Hg, at 14:34 the BP was 85/70 mm/Hg, at 15:28 the BP was 82/50 mm/Hg. No evidence was found of the intervention or documentation performed by nurse personnel of patient’s assessment when identify low blood pressure. b. On 02/03/2024 at 15:27 it was revealed that the BP was 80/60 mm/Hg. No evidence was found of the intervention or documentation performed by nurse personnel of patient’s assessment when identify low blood pressure. c. On 02/06/2024 at 14:03 it was revealed that the BP was 115/88 mm/Hg, no evidence that the nurse assesses the patient B/P, the treatment finishes at 15:29 and no B/P was assessed as physician order every 30 minutes. d. On 02/08/2024 at 14:00 revealed that the BP was 88/52 mm/Hg, at 14:37 the BP was 82/49 mm/Hg, at 15:02 the BP was 101/52 mm/Hg, at 15:36 the BP was 89/55 mm/Hg, at 15:59 the BP was 90/59 mm/Hg. No evidence was found of the intervention or documentation performed by nurse personnel of patient’s assessment when identify low blood pressure. e. On 02/10/2024 at 12:25 patient started the treatment, no vital sign was documented until 12:35 the B/P was 134/89 mm/Hg, then at 13:00 the nurse registered the patient blood pressure 118/92 mm/Hg, the nurse assesses the next patient B/P at 14:03 63 minutes later not accordance with the physician order. 4. RR #14 is a 74-year-old male patient admitted to the facility on 03/21/2019 with diagnosis of ESRD. During the record review performed on 02/14/2024 at 11:52 AM, it was found that patient has hemodialysis treatment three a week for 4 hours, BFR of 400, DFR of Manual 800, Dialyzer with 180 NRe Optiflux and patient EDW 90 kg. a.On 01/30/2024 at 13:41, patient take only 3-hour 54 minute, no evidence was found that the nurse oriented the patient of the need to take the complete 4 hour of treatment, and no evidence was found that patient sign the refuse consent for the 6 minute of treatment losses. b. On 02/03/2024 at 13:03 revealed that the BP was 143/100 mm/Hg, at 14:34 revealed that the BP was 92/58 mm/Hg, at 16:00 revealed that the BP was 97/578 mm/Hg, at 16:15 revealed that the BP was 91/53 mm/Hg. No evidence was found of the intervention or documentation performed by nurse personnel of patient’s assessment when identify high or low blood pressure. c. On 02/10/2024 at 15:08 it was revealed that the BP was 98/56 mm/Hg. No evidence was found of the intervention or documentation performed by nurse personnel of patient’s assessment when identify high or low blood pressure. 5. RR #15 is a 66-year-old female patient admitted to the facility on 08/31/2017 with diagnosis of ESRD. During the record review performed on 02/14/2024 at 1:25 PM, it was found that patient has hemodialysis treatment three a week for 4 hours, BFR of 400, DFR of Manual 500, Dialyzer with 160 NRe Optiflux and patient EDW 60.45 kg. a. On 02/01/2024 at 06:06, revealed that the BP was 190/100 mm/Hg, at 06:13 revealed that the BP was 172/100 mm/Hg. No evidence was found of the intervention or documentation performed by nurse personnel of patient’s assessment when identify high blood pressure. b. On 02/03/2024 at 06:05 revealed that the BP was 195/115 mm/Hg, at 06:06 revealed that the BP was 195/111 mm/Hg, at 06:33 revealed that the BP was 170/100 mm/Hg, at 07:32 revealed that the BP was 174/100 mm/Hg, at 09:31 revealed that the BP was 160/101 mm/Hg. No evidence was found of the intervention or documentation performed by nurse personnel of patient’s assessment when identify high blood pressure. c. On 02/06/2024 at 06:03 revealed that the BP was 225/130 mm/Hg, at 06:05 revealed that the BP was 209/132 mm/Hg, at 06:38 revealed that the BP was 189/110 mm/Hg, at 07:01 revealed that the BP was 168/101 mm/Hg, at 07:31 revealed that the BP was 184/107 mm/Hg. No evidence was found of the intervention or documentation performed by nurse personnel of patient’s assessment when identify high blood pressure. d. On 02/08/2024 at 06:13 revealed that the BP was 192/103 mm/Hg, at 06:14 revealed that the BP was 188/111 mm/Hg, at 06:30 revealed that the BP was 188/112 mm/Hg, at 07:02 revealed that the BP was 181/111 mm/Hg, at 07:35 revealed that the BP was 183/113 mm/Hg, at 08:03 revealed that the BP was 167/101 mm/Hg, at 09:03 revealed that the BP was 159/108 mm/Hg. No evidence was found of the intervention or documentation performed by nurse personnel of patient’s assessment when identify high blood pressure. e. On 02/10/2024 at 06:01 revealed that the BP was 200/110 mm/Hg, at 06:02 revealed that the BP was 200/120, at 06:40 revealed that the BP was 191/114 mm/Hg, at 07:05 revealed that the BP was 183/107 mm/Hg, at 07:31 revealed that the BP was 170/102 mm/Hg, at 08:04 revealed that the BP was 159/104 mm/Hg. No evidence was found of the intervention or documentation performed by nurse personnel of patient’s assessment when identify high blood pressure. f. On 02/13/2024 at 06:12 revealed that the BP was 205/109 mm/Hg, at 06:15 revealed that the BP was 181/106 mm/Hg, at 07:02 revealed that the BP was 176/105 mm/Hg. No evidence was found of the intervention or documentation performed by nurse personnel of patient’s assessment when identify high blood pressure.. 47632 6. RR # 2 is a 64-year-old male patient admitted 11/03/2023 with End Stage Renal Disease. During the record review performed on 2/14/2004 at 8:00 AM, the hemodialysis treatment three a week for four hours, Dialyzer 160NRe Optiflux, Blood Flow Rate (BFR) of 350, Dialysis Flow Rate (DFR) of 800 and Patient Dry Weight (EDW) 75 kilogram (kg). a. On 01/26/2024 at 6:34 PM it was revealed that the BP was 174/121mg/Hg. No evidence was found of the nurse intervention or documentation performed. b. On 02/02/2024 at 5:03 PM it was revealed that the BP was 60/48mg/Hg. No evidence was found of the nurse intervention or documentation performed. c. On 02/07/2024 at 4:37 PM it was revealed that the BP was 71/63mg/Hg, at 6:04 PM the BP was 86/51mg/Hg, at 6:33 PM the BP was 86/54mg/Hg, at 7:03 PM the BP was 65/55mg/Hg and at 8:11 PM the BP was63/41mg/Hg. No evidence was found of the nurse intervention or documentation performed. d. On 02/09/2024 at 8:43 PM it was revealed that the BP was 80/40mg/HG and at 9:03 PM the BP was 76/56mg/Hg. No evidence was found of the nurse intervention or documentation performed. e.On 02/12/2024 at 6:37 PM it was revealed that the BP was 91/44mg/Hg and at 8:31 PM the BP was 85/57mg/Hg. No evidence was found of the nurse intervention or documentation performed. 7. RR #7 is a 64-year-old female patient admitted 01/019/2021 with End Stage Renal Disease and Diabetes Mellitus. During the record review performed on 2/13/2004 at 1:43 PM, the hemodialysis treatment three a week for four hours, Dialyzer 160NRe Optiflux, Blood Flow Rate (BFR) of 300, Dialysis Flow Rate (DFR) of 500 and Patient Dry Weight (EDW) 52 kilogram (kg). a. On 02/10/2024 at 5:36 PM it was revealed that the BP was 153/113mg/Hg and at 6:37 PM the BP was 100/36mg/Hg. No evidence was found of the nurse intervention or documentation performed. 8. RR #9 is an 84-year-old female patient admitted 10/08/2021 with End Stage Renal Disease. During the record review performed on 2/13/2004 at 2:54 PM, the hemodialysis treatment three a week for four hours, Dialyzer 160NRe Optiflux, Blood Flow Rate (BFR) of 350, Dialysis Flow Rate (DFR) of 500 and Patient Dry Weight (EDW) 37.5 kilogram (kg). a. On 02/02/2024 at 11:14 AM it was revealed that the BP was 198/88mg/Hg, at 11:32 AM the BP was 212/99mg/Hg and at 12:04 PM the BP was 151/107mg/Hg. No evidence was found of the nurse intervention or documentation performed. b. On 02/105/2024 at 11:10 AM it was revealed that the BP was 207/89mg/Hg. No evidence was found of the nurse intervention or documentation performed. c. On 02/09/2024 at 11:41 AM it was revealed that the BP was 204/86mg/Hg. No evidence was found of the nurse intervention or documentation performed. d. On 02/12/2024 at 11:05 AM PM it was revealed that the BP was 191/84mg/Hg, at 11:38 AM the BP was 191/89mg/Hg, at 2:03 PM the BP was 185/82mg/Hg and at 2:07 PM the BP was 202/90mg/Hg. No evidence was found of the nurse intervention or documentation performed. 9. RR #12 is a 37-year-old male patient admitted 08/07/2023 with End Stage Renal Disease. During the record review performed on 2/13/2004 at 10:55 AM, the hemodialysis treatment three a week for four hours, Dialyzer 160NRe Optiflux, Blood Flow Rate (BFR) of 400, Dialysis Flow Rate (DFR) of 800 and Patient Dry Weight (EDW) 56.5 kilogram (kg). a. On 01/17/2024 at 5:15 PM it was revealed that the BP was 164/109mg/Hg, at 6:01PM the BP was 176/111mg/Hg, and at 7:30 PM the BP was 171/103. No evidence was found of the nurse intervention or documentation performed. b. On 01/26/2024 at 6:05 PM it was revealed that the BP was 174/112mg/Hg, at 6:33 PM the BP was 196/119mg/Hg, at 7:04 PM the BP was 169/110mg/Hg, at 8:02 PM the BP was 183/112mg/Hg and at 8:28 PM the BP was 184/122mg/Hg. No evidence was found of the nurse intervention or documentation performed. c. On 01/31/2024 at 4:09 PM it was revealed that the BP was 171/108mg/Hg, at 4:32 PM the BP was 172/104mg/Hg, at 6:03 PM the BP was 180/118mg/Hg, at 6:33 PM the BP was 170/116mg/Hg, at 7:01 PM the BP was 178/117mg/Hg, at 7:32 PM the BP was 150/100mg/Hg and at 8:05 PM the BP was 170/103mg/Hg. No evidence was found of the nurse intervention or documentation performed. d. On 02/07/2024 at 4:46 PM it was revealed that the BP was 208/134mg/Hg, at 5:02 PM the BP was 209/134mg/Hg, at 5:30 PM the BP was 208/139mh/Hg, at 6:01 PM the BP was 205/141mg/Hg, at 6:35 PM the BP was 212/126mg/Hg, at 7:06 PM the BP was 201/110mg/Hg, at 7:31 PM the BP was 167/110mg/Hg, at 8:04PM the BP was 117/119mg/Hg and at 8:20 PM the BP was 182/122mg. No evidence was found of the nurse intervention or documentation performed.”

“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: 20423 Based on an unannounced a ESRD Core survey, fifteen records reviewed (RR) with the Vascular Assess Manager (employee #6), it was determinate that the facility failed to ensure provide hemodialysis treatment accordingly with patient’s dialysis prescription ordered by the physician of dialyzer Blood Flow Rate (BFR), and to document as part of hemodialysis treatment sheet and during the dialysis treatment for 5 out of 15 records reviewed (RR #1, #8, #9, #12 and #14). Findings include: During flowsheet review performed on 02/13/2024 at 8:00 AM to 3:30 PM the following was found: 1. RR #1 is a 58-year-old female patient admitted to the facility on 12/14/2023 with diagnosis of End Stage Renal Disease (ESRD). During the record review performed on 02/14/2024 at 1:50 PM, it was found that patient has hemodialysis treatment three a week for four hours, Blood Flow Rate (BFR) of 350, Dialysis Flow Rate (DFR) of Manual 500, Dialyzer with 160 NRe Optiflux and patient Dry Weight (EDW) 85 kilogram (kg). a. On 02/01/2024 at 18:03 the BFR was decrease to 250. No evidence was found of the justification on the nurse note or authorized decrease from the physician. 2. RR #8 is a 63-year-old male patient admitted to the facility on 06/25/2020 with diagnosis of ESRD. During the record review performed on 02/13/2024 at 1:48 PM, it was found that patient has hemodialysis treatment three a week for four hours, BFR of 350, DFR of Manual 500, Dialyzer with 160 NRe Optiflux and patient EDW 62 kg. a.On 01/31/2024 at 06:41 the BFR was increased to 400. No evidence was found of the justification on the nurse note or authorized increase from the physician. b. On 002/05/2024 at 07:05 the DFR was increased to 800. No evidence was found of the justification on the nurse note or authorized increase from the physician. 3. RR #14 is a 74-year-old male patient admitted to the facility on 03/21/2019 with diagnosis of ESRD. During the record review performed on 02/14/2024 at 11:52 AM, it was found that patient has hemodialysis treatment three a week for 4 hours, BFR of 400, DFR of Manual 800, Dialyzer with 180 NRe Optiflux and patient EDW 90 kg. a. On 02/03/2024 from 12:20 till 14:01 the DFR was decrease to 500. No evidence was found of the justification on the nurse note or authorized increase from the physician. 47632 4. RR #9 is an 84-year-old female patient admitted 10/08/2021 with End Stage Renal Disease. During the record review performed on 2/13/2004 at 2:54 PM, the hemodialysis treatment three a week for four hours, Dialyzer 160NRe Optiflux, Blood Flow Rate (BFR) of 350, Dialysis Flow Rate (DFR) of 500 and Patient Dry Weight (EDW) 37.5 kilogram (kg). a. On 02/05/2024 at 12:35 PM the BFR was decrease to 300. No evidence was found of the justification on the nurse note or authorized decrease from the physician. 5. RR #12 is a 37-year-old male patient admitted 08/07/2023 with End Stage Renal Disease. During the record review performed on 2/13/2004 at 10:55 AM, the hemodialysis treatment three a week for four hours, Dialyzer 160NRe Optiflux, Blood Flow Rate (BFR) of 400, Dialysis Flow Rate (DFR) of 800 and Patient Dry Weight (EDW) 56.5 kilogram (kg). a. On 01/17/2024 at 8:48 PM a shortening of treatment time was observed. The medical order for treatment time was 4 hours. The patient only spent 3:38 in treatment. No evidence was found of the reasons for shortening treatment or exoneration. b. On 01/31/2024 at 8:35 PM a shortening of treatment time was observed. The medical order for treatment time was 4 hours. The patient only spent 3:35 in treatment. No evidence was found of the reasons for shortening treatment or exoneration.”