Fmc of Juana Diaz

“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 05/13/2025, 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”, expired medications and medical surgical supplies. Findings include: 1. During the observations made in the medication room area with Supervisor (employee #1) and Charge Nurse (employee #5) on 05/13/2025, the following were found: a. On 05/13/2025 at 9:44 AM, two bottles of clonidine 0.1 milligrams (mg) of 100 tablets were observed without signature or date. b. On 05/13/2025 at 9:49 AM, two vials of Solucortef 100 mg in 2 milliliters (ml) expired on 04/2025 were found in the emergency kit. c. On 05/13/2025 at 9:50 AM, two monofilament foot screen tests observed expired 04/2025. d. On 05/13/2025 at 9:56 AM, two bottles of sublingual nitroglycerin 0.4 of 100 tablets were observed to be expired on 01/2025. e. On 05/13/2025 at 9:59 AM, three vials of heparin 30,000 units in 30 ml were observed expired on 03/2025. f. On 05/14/2025 at11:42 AM, it was noted that a 100-unit vial of Humalog insulin had expired on 01/28/2025. g. On 05/14/2025 at 11:48 AM, one box of Prevnar 13 expired 12/2024 was observed. 51629 2. During observation and inspection of the room currently used for patient training in the modalities of Home Hemodialysis (HH) and Continuous cyclic peritoneal dialysis (CCPD) on 05/13/2025 at 10:00 AM, the following sterile supplies (medical surgical material) were found expired: a. Two Stay - safe - catheter extension set with expiration dates of April 30, 2025. b. One Peritoneal Dialysis Accessory with expiration date of December 25, 2023. 51829 3. On 05/13/2025 at 9:26 AM during the review of the medical-surgical equipment at Station #1, the following was identified: a. The supply of medical-surgical material known as recirculatory, total quantity 42 units, with expiration date of 03/31/2025. 4. On 05/13/2025 at 10:00 AM during the review of the crash cart, the following was identified: a. One NSS 0.9% 500 ml with expiration date of 02/2025. b. Two suction tubes with expiration date of 07/2024.”

“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 observation made in the treatment area on 05/13/2025 at 10:05 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 for 9 out of 9 observations at station #3, #5, #6, #9, #16, #17, #19, #20 and #21, Findings include: During observation of the treatment area, station #3, #5, #6, #9, #16, #17, #19, #20 and #21, 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: 47384 Based on the observational tour of the facility treatment area on 05/13/2025, 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: The facility failed to maintain emergency disconnection kit on every chair where a patient is receiving treatment or orientation. One kit was missing on chairs #4, #5, #19 and two kits missing on chair #20.”

“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 the observational tour of the facility on 05/13/2025, it was determined that the facility failed to observe 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. During the visual observation of the parking area, 4 handicapped parking spaces were observed in front of the unit. This 4 parking’s do not comply with the requirements of at least 96 inches wide and did not have an access aisle of at least 60 inches wide as required by the American Disability Act (ADA). 2. During a visual inspection of the parking area, it was observed that the route from the parking lot via the ramp to the entrance of the unit had excessive gravel and dirt, making it difficult for people in wheelchairs or walkers to move around.”

“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 observation made in the treatment area on 05/13/2025 at approximately 8:45 AM, it is determined that the facility failed to maintain a program to ensure that all equipment is maintained and operated in accordance with the manufacturer’s recommendations. Findings include: Nine (9) out of twenty (20) dialysis machines were observed with peeled paint on the platform where dialysate gallons are placed.”

“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: 47384 Based on observation made in the treatment area on 05/13/2025 at approximately 8:45 AM, it is determined that the facility failed to comply with sufficient space to provide needed care and services, prevent cross-contamination, and to accommodate medical emergency equipment and staff. Findings include: During visual observation of clinical treatment area it was observed that stations #9 and #11 did not comply with the required minimum of 36 inches on both sides of the station in order to accommodate medical emergency equipment and staff in a medical emergency.”

“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 05/13/2025, 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 #7, #19, and #21. This deficient effect 3 out of 22 stations patients observed receiving treatment. Findings include: During the observations made in the treatment area on 05/13/2025 at 10:05 AM, the following were found: 1. On 05/13/2025 at 10:05 AM, the patient was located on station # 5, it was observed that the vascular access was covered with sheets. 2. On 05/13/2025 at 10:08 AM, the patient was located on station # 17; it was observed that the vascular access was covered with sheets. 3. On 04/14/2025 at 10:12 AM, the patient was located on station # 21, 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 nineteen records reviewed (RR), review of policies and procedures and interview with Clinical Manager (employee #6), 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 19 records reviewed (RR #2, #4, and #6). Findings include: Upon review of the facility’s policy Title: Hypertension last update on 09/07/2021, Version: 1, Policy clearly stated on the procedures that during hemodialysis treatment personnel will recognized, report and immediately address diastolic blood pressures greater than 100-millimeter mercury (mm/Hg), Page:1. During the flowsheet review performed on 05/13/2025 and 05/14/2025 at 9:00 AM to 3:00 PM the following were found: 1. RR# 2 is a 67-year-old female admitted to the facility on 04/26/2022 with a diagnostic End Stage Renal Disease. During the record review performed on 05/13/2025 at 3:29 PM, the hemodialysis treatment three times a week for four hours, Dialyzer 180 NRE Optiflux, Blood Flow Rate (BFR) of 400, Dialysis Flow Rate (DFR) of 700 and Patient Dry Weight (EDW) of 74 kilograms (kg). a. On 05/06/2025 at 5:50 PM, pre dialysis treatment revealed that the Blood Pressure (BP) was 209/60 mg/Hg, at 5:58 PM, it was revealed that the BP was 209/60 mg/Hg, at 6:14 PM, it was revealed that the BP was 229/69 mg/Hg, at 6:34 PM, it was revealed that the BP was 199/86 mg/Hg, at 7:34 PM, it was revealed that the BP was 182/75 mg/Hg, at 8:07 PM, it was revealed that the BP was 186/79 mg/Hg, at 8:34 PM, it was revealed that the BP was 213/84mg/Hg, at 9:09 PM, it was revealed that the BP was 200/84 mg/Hg, at 9: 35 PM, it was revealed that the BP was 193/74 mg/Hg, at 9:57 PM it was revealed that the BP was 191/74 mg/Hg and post dialysis treatment revealed that the BP was 192/74 mg/Hg. No evidence was found of nursing interventions, documentation for hypertension or notification of the physician. 2. RR# 4 is a 52-year-old male admitted to the facility on 11/01/2024 with a diagnostic End Stage Renal Disease. During the record review performed on 05/14/2025 at 10:00 AM, the hemodialysis treatment three times a week for four hours and fifteen minutes, Dialyzer 180 NRE Optiflux, Blood Flow Rate (BFR) of 425, Dialysis Flow Rate (DFR) of 800 and Patient Dry Weight (EDW) of 102.5 kilograms (kg). a. On 04/25/2025 at 6:04 PM, it was revealed that the BP was 172/107 mg/HG, at 6:34 PM, it was revealed that the BP was 167/101 mg/hg, at 7:02 PM, it was revealed that the BP 173/105 mg/Hg, and at 9:02 PM, it was revealed that the BP was 164/102 mg/Hg. b. On 05/05/2025 at 6:04 PM, it was revealed that the BP was 167/101 mg/Hg, at 6:34 PM, it was revealed that the BP was 169/105 mg/Hg, and at 7:04 PM, it was revealed that the BP was 177/106 mg/Hg. c. On 05/07/2025 at 8:09 PM, It was revealed that the BP was 182/89 mg/Hg, at 9:41 PM, it was revealed that the BP 183/102 mg/Hg, and at 10:06 PM, it was revealed that the BP was 184/104 mg/Hg. d. On 05/09/2025 at 6:33 PM, it was revealed that the BP was 175/100 mg/Hg and at 8:45 PM, it was revealed that the BP was 186/99 mg/Hg. No evidence was found of nursing interventions, documentation for hypertension or notification of the physician. 3. RR# 6 is a 52-year-old male admitted to the facility on 03/16/2022 with a diagnostic End Stage Renal Disease. During the record review performed on 05/13/2025 at 2:17 PM, 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 600 and Patient Dry Weight (EDW) of 78.5 kilograms (kg). a. On 04/30/2025 at 6:34 PM, it was revealed that the BP 202/80 mg/HG, at 7:07 PM, it was revealed that the bp was 215/82 mg/Hg, at 7:39 PM, it was revealed that the BP was 219/81 mg/Hg, at 8:0 PM, it was revealed that the BP was 200/84 mg/Hg, and at 8:44 PM, it was revealed that the BP was 185/69 mg/Hg. b. 05/05/2025 at 7:06 PM, it was revealed that the BP was 188/85 mg/Hg, at 7:41 PM, it was revealed that the BP was 190/85 mg/Hg, at 8:08 PM, it was revealed that the BP was 190/57 mg/Hg, and at 8:23 PM, it was revealed that the BP was 190/57 mg/Hg. No evidence was found of nursing interventions, documentation for hypertension or notification of the physician.”