Atlantis San Sebastian

“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 06/03/2025, 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 infection control “standard precautions”. Findings include: 1. During the observations made in the unit with the supervisor (employee# 1) area on 06/03/2025, the following were found: a. On 06/03/2025 at 11:23 AM, biohazard bins were observed touching dialysis machines at stations #5, 11, 22, 24, and 25. b. On 06/03/2025 at 12:11 PM, the nurse (employee #2) was observed washing his hands, picking up the folder, and touching the hemodialysis machine without washing his hands or changing his gloves.”

“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 observations and interviews on 06/03/25, it was determined that the facility failed to be equipped, and maintained to provide dialysis patients, staff, and the public a safe, functional, and comfortable treatment environment. Findings include: 1. During the observation of the treatment area between the first and second shifts, patient number #14 was observed, a bariatric patient brought in on a stretcher. The patient weighed approximately 290 pounds and was harnessed for transfer from the stretcher to the treatment chair. The surveyor asked if the facility used a hoist for the transfer of this patient, to which they replied that they had the hoist, but it was not used with patient. 2. Nursing staff reported not having much knowledge in the operation of the hoist available at the facility.”

“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 observational tour of the patient treatment area on 06/03/2025, 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 patients receiving treatment at the facility, staff, and the public. Findings include: 1. During a visual inspection of the treatment area, the floor was observed to be in poor condition. The seams between the panels were loose, allowing water to accumulate and bacteria to develop. 2. Drain boxes behind treatment stations was observed with brown stain surrounding cover.”

“PE-EQUIPMENT MAINTENANCE-MANUFACTURER’S DFU CFR(s): 494.60(b) The dialysis facility must implement and maintain a program to ensure that all equipment (including emergency equipment, dialysis machines and equipment, and the water treatment system) are maintained and operated in accordance with the manufacturer’s recommendations. This Standard is not met as evidenced by: 47384 Based on observations on 06/03/25, it was determined that the facility failed to maintain a program to ensure that all equipment are maintained and operated in accordance with the manufacturer’s recommendations. Findings include: 1. A sphygmomanometer was observed placed behind the backrest of treatment chair #16 to keep the chair in the position desired by the patient. 2. Twenty-two (22) of twenty-six (26) treatment machines were observed with the placement platform with gallons of dialysate with peeling paint or stained.”

“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 06/03/2025, 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 at patients’ stations #2, and #3. This deficient effect 2 out of 27 stations patients observed receiving treatment. Findings include: During the observations made in the treatment area on 06/03/2025 at 9:20 AM, the following were found: 1.On 06/03/2025 at 9:22 AM, the patient was located on station # 2; it was observed that the vascular access was covered with sheets. 2. On 06/03/2025 at 9:23 AM, the patient was located on station # 3; it was observed that the vascular access was covered with sheets. The facility failed to ensure vascular access sites should be seen by staff members during all dialysis treatment. Allowing patients to cover access provides an opportunity for accidents of needle.”

“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: 47632 Based on seventeen records reviewed (RR), review of policies and procedures on 06/03/2025 through 06/04/2025, 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 12 out of 17 records reviewed (RR #2, #3, #4, #5, #6, #7, #8, #11, #12, #13, #14 and #15 ). Findings include: During the flowsheet review performed on 06/03/2025 and 06/04/2025 at 9:00 AM to 3:00 PM the following were found: 1. RR# 2 is a 58-year-old female admitted to the facility on 10/22/2020 with a diagnostic End Stage Renal Disease. During the record review performed on 06/03/2025 at 2:44 PM, the hemodialysis treatment three times a week for four hours, Dialyzer 180 NRE Elec Beam, Blood Flow Rate (BFR) of 400, Dialysis Flow Rate (DFR) of 600 and Patient Dry Weight (EDW) of 108.18 kilograms (kg). a. On 05/15/2025 at 12:01 PM, it was revealed that the Blood Pressure (BP) was 178/79mg/Hg, at 12:31 PM, it revealed that the BP was 173/83mg/Hg, at 1:02 PM, it was revealed that the BP was 183/86mg/Hg, and at 1:32 PM, it was revealed That the BP was 162/75mg/Hg. b. On 05/24/2025 at 1:31 PM, it was revealed that the BP was 94/48mg/Hg. c. On 05/27/2025 at 2:01 PM, it was revealed that the BP was 192/80mg/Hg, at 2:31 PM, it was revealed that the BP was 195/102mg/Hg and at 3:32 PM, it was revealed that the BP was 195/78mg/Hg. 2. RR# 3 is a 56-year-old male admitted to the facility on 02/07/2025 with a diagnostic End Stage Renal Disease. During the record review performed on 06/03/2025 at 3:14 PM, the hemodialysis treatment three times a week for four hours, Dialyzer 180 NRE Elec Beam, Blood Flow Rate (BFR) of 350, Dialysis Flow Rate (DFR) of 700 and Patient Dry Weight (EDW) of 102.73 kilograms (kg). a. On 05/30/2025 at 11:48 AM, it was revealed that the BP was 163/75mg/Hg. 3. RR# 4 is a 52-year-old male admitted to the facility on 01/26/2021 with a diagnostic End Stage Renal Disease. During the record review performed on 06/04/2025 at 1:17 PM, the hemodialysis treatment three times a week for four hours, Dialyzer 200 NRE Elec Beam, Blood Flow Rate (BFR) of 400, Dialysis Flow Rate (DFR) of 800 and Patient Dry Weight (EDW) of 115.45 kilograms (kg). a. On 05/26/2025 at 7:33 AM, it was revealed that the BP was 164/82mg/Hg, at 8:04 AM, it was revealed that the BP was 164/85mg/Hg, at 8:32 AM, it was revealed that the BP was 163/83mg/Hg, at 9:03 AM, it was revealed that the BP was 163/79, at 9:33 AM, it was revealed that the BP was 173/85mg/Hg and at 10:10 AM, it was revealed that the BP was 166/84mg/Hg. b. On 05/28/2025 at 9:00 AM, it was revealed that the BP was 164/81mg/Hg and at 9:30 AM, it was revealed that the BP was 167/85mg/Hg. c. On 05/30/2025 at 7:04 AM, it was revealed that the BP was 161/83mg/Hg, at 7:33 AM, it was revealed that the BP was 164/84mg/Hg, at 8:03 AM, it was revealed that the BP was 163/85mg/Hg, at 8:43 AM, it was revealed that the BP was 175/85mg/Hg, at 9:33 AM, it was revealed that the BP was 164/80mg/Hg, at 10:03 AM, it was revealed that the BP was 167/84mg/Hg and at 10:10 AM, it was revealed that the BP was 173/86mg/Hg. 4. RR# 5 is a 70-year-old female admitted to the facility on 12/13/2024 with a diagnostic End Stage Renal Disease. During the record review performed on 06/03/2025 at 3:40 PM, the hemodialysis treatment three times a week for four hours, Dialyzer 160 NRE Elec Beam, Blood Flow Rate (BFR) of 350, Dialysis Flow Rate (DFR) of 600 and Patient Dry Weight (EDW) of 84.09 kilograms (kg). a. On 05/21/2025 at 5:05 PM, it was revealed that the BP was 167/88mg/Hg and at 5:32 PM, it was revealed that the BP was 126/93mg/Hg. b. On 05/23/2025 at 7:08 Am, it was revealed that the BP was 161/85mg/Hg, at 7:31 PM, it was revealed that the BP was 168/75mg/Hg and at 8:02 PM, it was revealed that the BP was 161/67mg/Hg. c. On 05/26/2025 at 4:20 PM, it was revealed that the BP was 168/77mg/Hg, at 4:25 PM, it was revealed that the BP was 163/75mg/Hg, at 5:31 PM, it was revealed that the BP was 173/86mg/Hg and at 7:03 PM, it was revealed that the BP was 185/65mg/Hg. d. On 05/28/2025 at 4:35 PM, it was revealed that the BP was 169/64mg/Hg, at 5:32 PM, it was revealed that the BP was 162/82mg/Hg and at 8:30 PM, it was revealed that the BP was 161/67mg/Hg. 5. RR# 6 is a 79-year-old male admitted to the facility on 01/09/2014 with a diagnostic End Stage Renal Disease. During the record review performed on 06/03/2025 at 3:16 PM, the hemodialysis treatment three times a week for three hours thirty minutes, Dialyzer 180 NRE Elec Beam, Blood Flow Rate (BFR) of 350, Dialysis Flow Rate (DFR) of 800 and Patient Dry Weight (EDW) of 46.82 kilograms (kg). a. On 05/20/2025 at 4:40 PM, it was revealed that the BP was 170/96mg, at 4:45 PM, it was revealed that the BP was 168/99mg/Hg, at 5:01 PM, it was revealed that the BP was 175/88mg/Hg, at 5:31 PM, it was revealed that the BP was 182/99mg/Hg, at 7: 01 PM, it was revealed that the BP was 176/101mg/Hg, at 7:31 PM, it was revealed that the BP was 178/100mg/Hg, at 8:01 PM, it was revealed that the BP was 187/100mg/Hg and at 8:10 PM, it was revealed that the BP was 190/97mg/Hg. b. On 05/24/2025 at 3:45 PM, it was revealed that the BP was 159/91mg/Hg, at 3:50 PM, it was revealed that the BP was 165/100mg/Hg, at 4:02 PM, it was revealed that the BP 162/94mg/Hg, at 4:32 PM, it was revealed that the BP was 163/88mg/Hg, at 5:01 PM, it was revealed that the BP was 163/93m/Hg, at 5:32 PM, it was revealed that the BP was 174/96mg/Hg, at 6:02 PM, it was revealed that the BP was 167/91mg/Hg, and at 7:15 PM, it was revealed that the BP was 161/69mg/Hg. c. On 05/31/2025 at 4:00 PM, it was revealed that the BP was 163/88mg/Hg, at 6:02 PM, it was revealed that the BP was 167/92mg/Hg, and at 6:32 PM, it was revealed that the BP was 165//89mg/Hg. 6. RR# 7 is a 87-year-old female admitted to the facility on 03/05/2024 with a diagnostic End Stage Renal Disease. During the record review performed on 06/04/2025 at 8:56 AM, the hemodialysis treatment three times a week for three hours, Dialyzer 160 NRE Elec Beam, Blood Flow Rate (BFR) of 350, Dialysis Flow Rate (DFR) of 700 and Patient Dry Weight (EDW) of 53.18 kilograms (kg). a. On 05/20/2025 at 4:44 PM, it was revealed that the BP was 170/61mg/Hg. b. On 05/27/2025 at 7:34 PM, it was revealed that the BP was 168/78mg/Hg. c. On 05/29/2025 at 4:10 PM, it was revealed that the BP was 180/80mg/Hg, at 4:15 PM, it was revealed that the BP was 178/84mg/Hg, at 4:33 PM, it was revealed that the BP was 178/87mg/Hg, at 5:02 PM, it was revealed that the BP was 178/79mg/Hg, 5:32 PM, it was revealed that the BP was 174/76mg/Hg, at 6:03 PM, it was revealed that the BP was 186/46mg/Hg, at 6:36 PM, it was revealed that the BP was 178/65mg/Hg, at 7:02 PM, it was revealed that the BP was 170/54mg/Hg and 7:10 PM, it was revealed that the BP was 168/76mg/Hg. d. On 05/31/2025 at 4:35 PM, it was revealed that the BP was 177/70mg/Hg. 7. RR# 8 is a 54-year-old male admitted to the facility on 09/21/2021 with a diagnostic End Stage Renal Disease. During the record review performed on 06/03/2025 at 8:53 AM, the hemodialysis treatment three times a week for four hours, Dialyzer 180 NRE Elec Beam, Blood Flow Rate (BFR) of 400, Dialysis Flow Rate (DFR) of 800 and Patient Dry Weight (EDW) of 90.45 kilograms (kg). a. On 05/20/2025 at 7:01 AM, it was revealed that the BP was 163/92mg/Hg, at 8:31 AM, it was revealed that the BP was 97/62mg/Hg and at 9:32 AM, it was revealed that the BP was 94/44mg/Hg. b. On 05/22/2025 at 8:01 AM, it was revealed that the BP was 93/54mg/Hg, at 8:32 AM, it was revealed that the BP was 78/40mg/Hg, at 8:47 AM, it was revealed that the BP was 79/45mg/Hg and at 9:02 AM, it was revealed that the BP was 82/45mg/Hg. c. On 05/24/2025 at 6:45 AM, it was revealed that the BP was 164/90mg/Hg and at 7:15 AM, it was revealed that the BP was 158/92mg/Hg. d. On 05/29/2025 at 7:02 AM, it was revealed that the BP was 176/99mg/Hg and at 8:02 AM, it was revealed that the BP was 165/91mg/Hg. 8. RR# 9 is a 61-year-old male admitted to the facility on 06/28/2021 with a diagnostic End Stage Renal Disease. During the record review performed on 06/04/2025 at 8:20 AM, the hemodialysis treatment three times a week for four hours and forty-five minutes, Dialyzer 180 NRE Elec Beam, Blood Flow Rate (BFR) of 375, Dialysis Flow Rate (DFR) of 800 and Patient Dry Weight (EDW) of 95.91 kilograms (kg). a. On 05/20/2025 at 8:01 AM, it was revealed that the BP was 165/74mg/Hg. b. On 05/22/2025 at 5:56 AM, it was revealed that the BP was 186/98mg/Hg and at 7:02 AM, it was revealed that the BP was 187/89mg/Hg. c. On 05/24/2025 at 9:02 AM, it was revealed that the Bp was 92/49mg/Hg. d. On 05/29/2025 at 6:45 AM, it was revealed that the BP was 173/76mg/Hg, at 6:50 AM, it was revealed that the BP was 170/70mg/Hg and at 7:00 AM, it was revealed that the BP was 176/86mg/Hg. e. On 05/31/2025 at 7:04 AM, it was revealed that the BP was 185/92mg/Hg. 9. RR# 11 is a 52-year-old female admitted to the facility on 10/14/2022 with a diagnostic End Stage Renal Disease. During the record review performed on 06/04/2025 at 9:56 AM, the hemodialysis treatment three times a week for four hours, Dialyzer 160 NRE Elec Beam, Blood Flow Rate (BFR) of 350, Dialysis Flow Rate (DFR) of 500 and Patient Dry Weight (EDW) of 69.09 kilograms (kg). a. On 04/14/2025 at 2:04 PM, it was revealed that the BP was 180/88mg/Hg, at 2:35 PM, it was revealed that the BP was 180/88mg/Hg, at 3:04 PM, it was revealed that the BP was 188/90mg/Hg, at 3:33 PM, it was revealed that the BP was 180/90mg/Hg, at 4:03 PM it was revealed that the BP was 182/66mg/Hg, at 4:10 PM, it was revealed that the BP was 178/88mg/Hg and at 4:21 PM, it was revealed that the BP was 178/88mg/Hg. b. On 04/16/2025 at 3:33 PM, it was revealed that the BP was 168/94mg/Hg and 4:34 PM, it was revealed that the BP was 198/86mg/Hg. c. On 04/18/2025 at 12:12 PM, it was revealed that the BP was 170/90mg/Hg, at 12:17 PM, it was revealed that the BP was 212/105mg/Hg, at 12:36 PM, it was revealed that the BP was 208/113mg/Hg, at 1:06 PM, it Was revealed that the BP was 226/113mg/Hg, at 2:35 PM, it was revealed that the BP was 206/110mg/Hg, at 3:03 PM, it was revealed that the BP was 217/107mg/Hg, at 3:33 PM, it was revealed that the BP was 198/107mg/Hg and at 4:03 PM, it was revealed that the BP was 192/109mg/Hg. d. On 04/21/2025 at 2:04 PM, it was revealed that the BP was 180/88mg/Hg, at 2:34 PM, it was revealed that the BP was 187/88mg/Hg, at 3:04 PM, it was revealed that the BP was 187/89mg/Hg, at 3:32 PM, it was revealed that the BP was 184/88mg/Hg and 4:03 PM, it was revealed that the BP was 180/87mg/Hg. e. On 05/23/2025 at 1:33 PM, it was revealed that the BP was 196/78mg/Hg, at 1:39 PM, it was revealed that the BP was 176/71mg/Hg, at 2:04 PM, it was revealed that the Bp was 162/84mg/Hg and at 2:32 PM, it was revealed that the BP was 165/77mg/Hg. f. On 05/26/2025 at 12:12 PM, it was revealed that the BP was 170/84mg/Hg, at 12:33 PM, it was revealed that the BP was 198/84mg/Hg and at 1:30 PM, it was revealed that the BP was 166/84mg/Hg. No evidence was found of nursing interventions, documentation for hypertension or notification of the physician. 17959 During the patient record review performed on 06/03/2025 and 06/04/2025 at 9:00 AM to 3:00 PM the following was found: 10. RR# 12 is a 58-year-old male admitted to the facility on 08/15/2016 with a diagnostic End Stage Renal Disease. During the record review performed on 06/03/2025 at 2:32 PM, the patient receives hemodialysis treatment three times a week for four hours, Dialyzer 160 NRE Elec Beam, Blood Flow Rate (BFR) of 400, Dialysis Flow Rate (DFR) of 700 and Patient Dry Weight (EDW) of 79.09 kilograms (kg). a. On 05/21/2025 at 6:22 AM, it was revealed that the BP was 160/69 mg/Hg, at 6:32 AM, it was revealed that the BP was 223/80 mg/Hg, at 7:03 AM, it was revealed that the BP was 202/61 mg/Hg, at 7:31 AM, it was revealed that the BP was 182/71 mg/Hg, at 8:32 AM it was revealed that the BP was 164/73mg/Hg, at 9:03 AM, it was revealed that the BP was 195/85mg/Hg, at 9:03 AM, it was revealed that the BP was 183/75 mg/Hg, at 10:02 AM, it was revealed that the BP was 156/69 mg/Hg and at 10:22 AM, it was revealed that the BP was 173/80 mg/Hg. b. On 05/23/2025 at 16:57, it was revealed that the BP was 160/72mg/Hg, at 17:03 it was revealed that the BP was 189/70 mg/Hg., at 17:33 it was revealed that the BP was 187/72mg/Hg, at 18:03 it was revealed that the BP was 164/57 mg/Hg., at 18:33 it was revealed that the BP was 176/63mg/Hg, at 19:03 it was revealed that the BP was 159/66 mg/Hg., at 19:33 it was revealed that the BP was 167/61 mg/Hg and 19:57 it was revealed that the BP was 160/62 mg/Hg. c. On 05/26/2025 at 6:33 AM, it was revealed that the BP was 210/79 mg/Hg, at 6:38 AM, it was revealed that the BP was 207/74 mg/Hg, at 6:42 AM, it was revealed that the BP was 218/90 mg/Hg, at 7:02 AM, it was revealed that the BP was 171/69 mg/Hg, at 7:33 AM, it was revealed that the BP was 149/50mg /Hg. d. On 05/28/2025 at 6:35 AM, it was revealed that the BP was 190/90 mg/Hg, at 6:40 AM, it was revealed that the BP was 222/91 mg/Hg, at 7:05 AM, it was revealed that the BP was 209/93 mg/Hg, at 7:35 AM, it was revealed that the BP was 181/80 mg/Hg, at 8:04 AM it was revealed that the BP was 171/82 mg/Hg, at 9:33 AM, it was revealed that the BP was 197/82 mg/Hg., at 10:03 AM, it was revealed that the BP was 167/68 mg/Hg. and at 10:35 AM, it was revealed that the BP was 172/74 mg/Hg. e. On 05/30/2025 at 6:22 AM, it was revealed that the BP was 178/90 mg/Hg, at 6:27 AM, it was revealed that the BP was 215/90 mg/Hg, at 6:30 AM, it was revealed that the BP was 221/97 mg/Hg, at 6:31 AM, it was revealed that the BP was 234/87 mg/Hg, at 7:02 AM it was revealed that the BP was 194/82 mg/Hg, at 7:33 AM, it was revealed that the BP was 163/66 mg/Hg., at 8:01 AM, it was revealed that the BP was 157/86 mg/Hg., at 8:34 AM, it was revealed that the BP was 192/94 mg/Hg., at 9:02 AM, it was revealed that the BP was 185/55 mg/Hg., at 9:02 AM, it was revealed that the BP was 185/55 mg/Hg., at 9:33 AM, it was revealed that the BP was 191/50 mg/Hg., at 10:01 AM, it was revealed that the BP was 174/69 mg/Hg. and at 10:22 AM, it was revealed that the BP was 159/68 mg/Hg. f. On 05/21/2025 at 10:25 AM the RN #4 documentation indicates ’’ The patient complied with his medical order and still did not reach his processed liters,’’ but according to a nurse’s note at 10:22 indicates ’’ The patient exonerated of his own free will. Hemodialysis treatment is completed without complications. ’’ The physician medical orders on 05/17/2025 provide evidence that the patient have 240 minutes. ’’ However, no evidence of record of relief of responsibility. ’’ 11. RR# 13 is a 78-year-old male admitted to the facility on 05/25/2023 with a diagnostic End Stage Renal Disease. During the record review performed on 06/04/2025 at 10:00 AM, the patient receives hemodialysis treatment on the first shift three times a week for four hours, Dialyzer 160 NRE, Blood Flow Rate (BFR) of 300, Dialysis Flow Rate (DFR) of 600 and Patient Dry Weight (EDW) of 95.49 kilograms (kg). a. On 05/22/2025 at 6:22 AM, it was revealed that the BP was 172/73 mg/Hg, at 6:15 AM, it was revealed that the BP was 182/89 mg/Hg, at 6:33 AM, it was revealed that the BP was 181/70 mg/Hg, at 7:03 AM, it was revealed that the BP was 172/97 mg/Hg, at 7:34 AM it was revealed that the BP was 129/70mg/Hg, at 8:04 AM, it was revealed that the BP was 132/62 mg/Hg, at 8:35 AM, it was revealed that the BP was 103/52 mg/Hg, at 9:03 AM, it was revealed that the BP was 118/56 mg/Hg, at 9:33 AM, it was revealed that the BP was 112/49 mg/Hg., at 10:03 AM, it was revealed that the BP was 110/51 mg/Hg. and at 10:10 AM, it was revealed that the BP was 128/53 mg/Hg. b. On 05/24/2025 at 6:10 AM, it was revealed that the BP was 202/72 mg/Hg, at 6:15 AM, it was revealed that the BP was 194/75 mg/Hg, at 6:33 AM, it was revealed that the BP was 167/74 mg/Hg, at 7:05 AM, it was revealed that the BP was 133/59 mg/Hg, at 7:34 AM it was revealed that the BP was 131/60mg/Hg, at 8:04 AM, it was revealed that the BP was 111/59 mg/Hg, at 8:33 AM, it was revealed that the BP was 100/50 mg/Hg, at 9:04 AM, it was revealed that the BP was 130/61 mg/Hg, at 9:33 AM, it was revealed that the BP was 160/62 mg/Hg., at 10:03 AM, it was revealed that the BP was 131/55 mg/Hg. and at 10:10 AM, it was revealed that the BP was 161/64 mg/Hg. c. On 05/27/2025 at 6:12 AM, it was revealed that the BP was 247/84 mg/Hg, at 6:17 AM, it was revealed that the BP was 235/77 mg/Hg, at 6:33 AM, it was revealed that the BP was 147/66 mg/Hg, at 7:05 AM, it was revealed that the BP was 144/64 mg/Hg, at 7:33 AM it was revealed that the BP was 129/60mg/Hg, at 8:04 AM, it was revealed that the BP was 134/63 mg/Hg, at 8:34 AM, it was revealed that the BP was 149/58 mg/Hg, at 9:04 AM, it was revealed that the BP was 147/59 mg/Hg, at 9:33 AM, it was revealed that the BP was 133/58 mg/Hg., at 10:03 AM, it was revealed that the BP was 130/55 mg/Hg. and at 10:12 AM, it was revealed that the BP was 118/56 mg/Hg. d. On 05/29/2025 at 6:06 AM, it was revealed that the BP was 253/90 mg/Hg, at 6:11 AM, it was revealed that the BP was 194/147 mg/Hg, at 6:35 AM, it was revealed that the BP was 120/53 mg/Hg, at 7:05 AM, it was revealed that the BP was 155/67 mg/Hg, at 7:34 AM it was revealed that the BP was 158/73 mg/Hg, at 8:04 AM, it was revealed that the BP was 153/66 mg/Hg, at 8:34 AM, it was revealed that the BP was 165/67 mg/Hg, at 9:04 AM, it was revealed that the BP was 153/68 mg/Hg, at 9:34 AM, it was revealed that the BP was 131/62 mg/Hg., at 10:03 AM, it was revealed that the BP was 118/56 mg/Hg. and at 10:06 AM, it was revealed that the BP was 120/60 mg/Hg. e. On 05/31/2025 at 6:10 AM, it was revealed that the BP was 219/85 mg/Hg, at 6:15 AM, it was revealed that the BP was 221/80 mg/Hg, at 6:33 AM, it was revealed that the BP was 174/70 mg/Hg, at 7:04 AM, it was revealed that the BP was 138/56 mg/Hg, at 7:34 AM it was revealed that the BP was 132/51 mg/Hg, at 8:04 AM, it was revealed that the BP was 140/66 mg/Hg, at 8:33 AM, it was revealed that the BP was 146/63 mg/Hg, at 9:05 AM, it was revealed that the BP was 127/65 mg/Hg, at 9:33 AM, it was revealed that the BP was 121/56 mg/Hg., at 10:03 AM, it was revealed that the BP was 135/62 mg/Hg. and at 10:10 AM, it was revealed that the BP was 127/51 mg/Hg. 12. RR# 14 is a 56-year-old male admitted to the facility on 02/14/2024 with a diagnostic End Stage Renal Disease. During the record review performed on 06/03/2025 at 2:50 PM, the patient receives hemodialysis treatment on the second shift three times a week for four hours 15 minutes, Dialyzer 200 NRE, Blood Flow Rate (BFR) of 425, Dialysis Flow Rate (DFR) of 600 and Patient Dry Weight (EDW) of 127.73 kilograms (kg). a. On 05/17/2025 at 11:45 AM, it was revealed that the BP was 169/90 mg/Hg, at 11:50 AM, it was revealed that the BP was 180/95 mg/Hg, at 12:15 PM, it was revealed that the BP was 188/93 mg/Hg, at 12:45 PM, it was revealed that the BP was 160/86 mg/Hg, at 1:15 PM it was revealed that the BP was 187/70mg/Hg, at 1:45 PM, it was revealed that the BP was 161/83 mg/Hg, at 2:33 PM, it was revealed that the BP was 175/69 mg/Hg, at 3:03 PM, it was revealed that the BP was 185/90 mg/Hg, at 3:33 PM, it was revealed that the BP was 184/94 mg/Hg., and at 4:00 PM, it was revealed that the BP was 197/96 mg/Hg. b. On 05/20/2025 at 12:46 PM, it was revealed that the BP was 160/88 mg/Hg, at 12:51 PM, it was revealed that the BP was 159/89 mg/Hg, at 1:00 PM, it was revealed that the BP was 154/90 mg/Hg, at 1:21 PM, it was revealed that the BP was 151/90 mg/Hg, at 1:30 PM it was revealed that the BP was 155/90mg/Hg, at 2:23 PM, it was revealed that the BP was 167/82 mg/Hg, at 2:31 PM, it was revealed that the BP was 189/96 mg/Hg, at 3:01 PM, it was revealed that the BP was 190/90 mg/Hg, at 3:05 PM, it was revealed that the BP was 189/103 mg/Hg., at 3:30 PM, it was revealed that the BP was 187/97 mg/Hg. at 4:01 PM, it was revealed that the BP was 185/92 mg/Hg., at 4:30 PM, it was revealed that the BP was 175/90 mg/Hg. and at 5:01 PM, it was revealed that the BP was 164/95 mg/Hg. c. On 05/24/2025 at 11:30 AM, it was revealed that the BP was 153/87 mg/Hg, at 11:35 AM, it was revealed that the BP was 179/97 mg/Hg, at 12:03 PM, it was revealed that the BP was 168/83 mg/Hg, at 12:33 PM, it was revealed that the BP was 169/80 mg/Hg, at 1:03 PM it was revealed that the BP was 163/82 mg/Hg, at 1:33 PM, it was revealed that the BP was 154/85 mg/Hg, at 2:02 PM, it was revealed that the BP was 160/85 mg/Hg, at 2:30 PM, it was revealed that the BP was 158/88 mg/Hg, at 3:09 PM, it was revealed that the BP was 155/74 mg/Hg. and at 3:45 PM, it was revealed that the BP was 158/88 mg/Hg. d. On 05/27/2025 at 12:20 PM, it was revealed that the BP was 164/86 mg/Hg, at 12:25 PM, it was revealed that the BP was 196/87 mg/Hg, at 12:37 PM, it was revealed that the BP was 148/80 mg/Hg, at 1:01 PM, it was revealed that the BP was 139/67 mg/Hg, at 1:32 PM it was revealed that the BP was 138/72 mg/Hg, at 2:01 PM, it was revealed that the BP was 153/59 mg/Hg, at 2:33 PM, it was revealed that the BP was 156/80 mg/Hg, at 3:01 PM, it was revealed that the BP was 140/76 mg/Hg, at 3:36 PM, it was revealed that the BP was 139/63 mg/Hg. and at 4:01 PM, it was revealed that the BP was 131/47 mg/Hg. and at 4:35 PM, it was revealed that the BP was 122/62 mg/Hg. e. On 05/29/2025 at 12:04 PM, it was revealed that the BP was 127/75 mg/Hg, at 12:09 PM, it was revealed that the BP was 154/84 mg/Hg, at 12:35 PM, it was revealed that the BP was 172/92 mg/Hg, at 1:04 PM, it was revealed that the BP was 180/91 mg/Hg, at 1:33 PM it was revealed that the BP was 159/71 mg/Hg, at 2:04 PM, it was revealed that the BP was 140/74 mg/Hg, at 2:35 PM, it was revealed that the BP was 130/78 mg/Hg, at 3:02 PM, it was revealed that the BP was 150/75 mg/Hg, at 3:37 PM, it was revealed that the BP was 142/85 mg/Hg., at 4:10 PM, it was revealed that the BP was 140/50 mg/Hg., at 4:32 PM, it was revealed that the BP was 136/71 mg/Hg. and at 4:33 PM, it was revealed that the BP was 146/80 mg/Hg. f. On 05/31/2025 at 11:30 AM, it was revealed that the BP was 150/77 mg/Hg, at 11:35 AM, it was revealed that the BP was 163/85 mg/Hg, at 12:00 MD, it was revealed that the BP was 149/76 mg/Hg, at 12:30 PM, it was revealed that the BP was 126/59 mg/Hg, at 12:56 PM it was revealed that the BP was 155/76 mg/Hg, at 1:01 PM, it was revealed that the BP was 140/79 mg/Hg, at 1:31 PM, it was revealed that the BP was 143/73 mg/Hg, at 2:00 PM, it was revealed that the BP was 131/75 mg/Hg, at 2:30 PM, it was revealed that the BP was 135/72 mg/Hg., at 3:00 PM, it was revealed that the BP was 137/70 mg/Hg., at 3:30 PM, it was revealed that the BP was 126/71 mg/Hg. and at 3:45 PM, it was revealed that the BP was 140/65 mg/Hg. 13. RR# 15 is a 56-year-old male admitted to the facility on 12/08/2020 with a diagnostic End Stage Renal Disease. During the record review performed on 06/04/2025 at 8:19 AM, the patient receives hemodialysis treatment on the second shift three times a week on second ship for three hours 15 minutes, Dialyzer 180 NRE, Blood Flow Rate (BFR) of 325, Dialysis Flow Rate (DFR) of 800 and Patient Dry Weight (EDW) of 62.73 kilograms (kg). Access Type Catheter Double Lumen Cuffed on Right Femoral Vein. a. On 05/22/2025 at 11:35 AM, it was revealed that the BP was 129/77 mg/Hg, at 11:40 AM, it was revealed that the BP was 128/79 mg/Hg, at 12:01 PM, it was revealed that the BP was 115/79 mg/Hg, at 12:32 PM, it was revealed that the BP was 116/72 mg/Hg, at 1:02 PM it was revealed that the BP was 132/74 mg/Hg, at 1:33 PM, it was revealed that the BP was 121/67 mg/Hg, at 2:02 PM, it was revealed that the BP was 125/85 mg/Hg, at 2:34 PM, it was revealed that the BP was 124/82 mg/Hg, and at 2:50 PM, it was revealed that the BP was 124/86 mg/Hg. b. On 05/24/2025 at 11:44 AM, it was revealed that the BP was 133/77 mg/Hg, at 11:49 PM, it was revealed that the BP was 125/77 mg/Hg, at 12:01 PM, it was revealed that the BP was 130/73 mg/Hg, at 12:31 PM, it was revealed that the BP was 106/73 mg/Hg, at 1:02 PM it was revealed that the BP was 128/66mg/Hg, at 1:31 PM, it was revealed that the BP was 125/70 mg/Hg, at 2:01 PM, it was revealed that the BP was 131/76 mg/Hg, at 2:31 PM, it was revealed that the BP was 134/73 mg/Hg, and at 2:59 PM, it was revealed that the BP was 125/74 mg/Hg. c. On 05/27/2025 at 11:45 AM, it was revealed that the BP was 142/71 mg/Hg, at 11:50 AM, it was revealed that the BP was 132/83 mg/Hg, at 12:05 PM, it was revealed that the BP was 137/81 mg/Hg, at 12:32 PM, it was revealed that the BP was 139/86 mg/Hg, at 1:02 PM it was revealed that the BP was 135/86 mg/Hg, at 1:31 PM, it was revealed that the BP was 129/72 mg/Hg, at 1:50 PM, it was revealed that the BP was 121/50 mg/Hg, at 2:02 PM, it was revealed that the BP was 124/74 mg/Hg, at 2:32 PM, it was revealed that the BP was 125/74 mg/Hg. and at 3:00 PM, it was revealed that the BP was 150/82 mg/Hg. d. On 05/27/2025 at 12:20 PM, it was revealed that the BP was 164/86 mg/Hg, at 12:25 PM, it was revealed that the BP was 196/87 mg/Hg, at 12:37 PM, it was revealed that the BP was 148/80 mg/Hg, at 1:01 PM, it was revealed that the BP was 139/67 mg/Hg, at 1:32 PM it was revealed that the BP was 138/72 mg/Hg, at 2:01 PM, it was revealed that the BP was 153/59 mg/Hg, at 2:33 PM, it was revealed that the BP was 156/80 mg/Hg, at 3:01 PM, it was revealed that the BP was 140/76 mg/Hg, at 3:36 PM, it was revealed that the BP was 139/63 mg/Hg. and at 4:01 PM, it was revealed that the BP was 131/47 mg/Hg. and at 4:35 PM, it was revealed that the BP was 122/62 mg/Hg. e. On 05/31/2025 at 11:30 AM, it was revealed that the BP was 131/76 mg/Hg, at 11:35 AM, it was revealed that the BP was 162/69 mg/Hg, at 12:01 PM, it was revealed that the BP was 116/70 mg/Hg, at 12:32 PM, it was revealed that the BP was 118/68 mg/Hg, at 12:32 PM it was revealed that the BP was 120/73 mg/Hg, at 1:32 PM, it was revealed that the BP was 120/73 mg/Hg, at 2:02 PM, it was revealed that the BP was 118/73 mg/Hg, at 2:32 PM, it was revealed that the BP was 141/81 mg/Hg, and at 2:45 PM, it was revealed that the BP was 142/77. f. On 06/03/2025 at 12:30 PM, it was revealed that the BP was 139/80 mg/Hg, at 12:35 PM, it was revealed that the BP was 139/80 mg/Hg, at 1:05 PM, it was revealed that the BP was 135/74 mg/Hg, at 1:33 PM, it was revealed that the BP was 125/68 mg/Hg, at 2:02 PM it was revealed that the BP was 137/76 mg/Hg, at 2:33 PM, it was revealed that the BP was 127/75 mg/Hg, at 3:03 PM, it was revealed that the BP was 123/69 mg/Hg, at 3:32 PM, it was revealed that the BP was 134/74 mg/Hg, and at 3:45 PM, it was revealed that the BP was 142/88. 14. No evidence was found related to intervention performed by the nurse accordance to the patient hypotensive or hypertension standing order. 15. No evidence was found that the nurse’s personal takes the Manual B/P to corroborate the measure and notified the physician. 16. No evidence was found that the RN assess patient B/P stand. 17. No evidence was found that the nurse documented justification or reason to not assess the B/P. 18.The facility failed to ensure that the nursing personnel documented interventions performed during management of patient who presents signs/symptoms of fluid overload. 19. No evidence on the patient record of relief of responsibility when the exonerated time of treatment. 20. No evidence was found of nursing interventions, documentation for hypertension or notification of the physician.”