Davita North Providence Renal Center

“IC-DISINFECT SURFACES/EQUIP/WRITTEN PROTOCOL CFR(s): 494.30(a)(4)(ii) [The facility must demonstrate that it follows standard infection control precautions by implementing- (4) And maintaining procedures, in accordance with applicable State and local laws and accepted public health procedures, for the-] (ii) Cleaning and disinfection of contaminated surfaces, medical devices, and equipment. This Standard is not met as evidenced by: 47279 Based on record review, surveyor observation, and staff interview, it has been determined that the facility has failed to ensure that the disinfection solution for the cleaning of multi-use dialysis equipment is maintained at a ratio of 1:100 (1 part bleach to 100 parts water). Findings are as follows: Review of a facility policy titled, “PREPARATION OF 1% OR 10% BLEACH SOLUTION UTILIZING THE ON DEMAND BLEACH AUTODILUTION SYSTEM [automatically combines bleach and water and dispenses the premixed solution via a tube]” states in part, “...Press and hold the front cover of the On Demand Bleach Auto dilution System to dispense 1% Bleach solution...Test dispensed solution using WaterCheck CP Bleach Strip...Complete the 1%...Bleach Solution Utilizing the On Demand Bleach Autodilution System Log...” Review of an additional facility policy titled, “UTILIZING VASCULAR ACCESS CLAMPS” states in part, “...vascular access clamps are reusable and disinfected between each use with a 1:100 (one to one hundred) bleach solution...” During a surveyor observation on 6/24/2025 at approximately 12:10 PM, a clear bin used for the disinfection of vascular access clamps was noted to have handwritten instructions on it that read, “All to 8000 mL [milliliter] BLEACH 1:100 (FOR CLAMPS) PUT 80ML OF BLEACH IN CONTAINER ADD WATER TO...[8000ML] LINE”. Additionally, the water level in the bin was noted to be above the line drawn that indicated the 8,000 mL mark. Further, there were no clamps observed within the bin. During a surveyor observation and simultaneous interview on 6/24/2025 at approximately 12:30 PM with Certified Clinical Hemodialysis Technician, Staff A, she acknowledged that the bleach solution was above the 8,000 mL mark and revealed that she had prepared the bleach solution earlier that morning. She indicated that she uses the auto dilution system to prepare the bleach solution rather than manually preparing the solution. She further revealed that she tests the bleach solution using test strips but indicated that the test strips she utilizes now are different than the test strips she has used in the past. Additionally, she revealed that there is no log to document the testing of the bleach solution after it has been prepared to ensure the appropriate 1:100 ratio. During surveyor interviews on 6/24/2025 at approximately 12:55 PM and 2:25 PM with the Clinical Nurse Manager, she revealed that the test strips being utilized to test the bleach solution are not the appropriate test strips for testing the bleach solution. Additionally, she was unable to provide evidence that the staff maintained a daily testing documentation log as per facility policy or ensured that the multi-use clamps are being appropriately disinfected in a 1:100 ratio bleach solution.”

“PA-APPROPRIATENESS OF DIALYSIS RX CFR(s): 494.80(a)(2) The patient’s comprehensive assessment must include, but is not limited to, the following: (2) Evaluation of the appropriateness of the dialysis prescription, This Standard is not met as evidenced by: 46715 Based on surveyor observation, record review, and staff interview, it has been determined that the facility failed to ensure that staff follow the dialysis prescription when administering dialysis treatments for 1 of 4 patients reviewed, Patient ID #15. Findings are as follows: Record review revealed that Patient ID #15 was admitted to the facility in March of 2024 with a diagnosis including, but not limited to, end stage renal disease. Additionally, s/he receives hemodialysis (a procedure where a dialysis machine and a special filter called an artificial kidney are used to clean the patient’s blood) three times a week. Review of the patient’s dialysis prescription revealed that s/he is to receive dialysate (a fluid that is used in dialysis treatment that is made up of water, electrolytes, and salt) with 2K (potassium). During a surveyor observation on 6/25/2025 at approximately 9:30 AM, revealed the patient was receiving dialysate with 3K and not the 2K that was prescribed for him/her. During a surveyor interview immediately following the above observation with Registered Nurse, Staff B, she acknowledged that the patient was receiving the dialysate with 3K and not the 2K that was prescribed. During a surveyor interview on 6/25/2025 at approximately 10:40 AM with the Senior Regional Operations Manager, she acknowledged that the dialysate with 3K was administered in error. 47279”

“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: 46715 Based on record review, surveyor observation, and staff interview, it has been determined that the facility failed to maintain accurate records for 1 of 4 patients reviewed, Patient ID #15. Findings are as follows: Record review revealed that Patient ID #15 was admitted to the facility in March of 2024 with a diagnosis including, but not limited to, end stage renal disease. Additionally, s/he receives hemodialysis (a procedure where a dialysis machine and a special filter called an artificial kidney are used to clean the patient’s blood) three times a week. Review of the patient’s dialysis prescription revealed that s/he is to receive dialysate (a fluid that is used in dialysis treatment that is made up of water, electrolytes, and salt) with 2K (potassium). During a surveyor observation on 6/25/2025 at approximately 9:30 AM, revealed the patient receiving dialysate with 3K and not the 2K that was prescribed for him/her. Record review revealed that Registered Nurse, Staff B, signed a prescription verification indicating that the patient’s prescription matches what the patient is receiving. During a surveyor interview immediately following the above observation with Staff B, she acknowledged that the patient was receiving the dialysate with 3K and not the 2K that was ordered. During a surveyor interview on 6/25/2025 at approximately 10:40 AM with the Senior Regional Operations Manager, she was unable to provide evidence that the patient’s medical record was maintained accurately. 47279”