Fresenius Kidney Care Pulaski

“CFC-INFECTION CONTROL CFR(s): 494.30 This Condition is not met as evidenced by: 46831 Based on facility policy review, manufacturer’s instructions for use, observation, and interview, the facility failed to ensure adequate Infection control measures were taken to ensure patient safety and a clean and sanitary environment. The findings included: 1. The facility failed to adequately clean eight of eight Dialysis Wall Boxes and failed to ensure the patient lift sling was stored in an appropriate location. Refer to V111 2. The facility failed to dispose of supplies used to by direct patient care staff to perform hand hygiene that were expired and readily available for use on the treatment floor. Refer to V113 3. The facility failed to ensure dialysis machines and stations were adequately cleaned to prevent cross-contamination. Refer to V122 4. The facility failed to dispose of medications that were expired and were readily available for use on the treatment floor. Refer to V143 5. The facility failed to ensure measures to prevent CVC related infections were performed during CVC exit site care. Refer to V147”

“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: 46831 Based on policy review, observation and interview, the facility failed to maintain a clean and sanitary environment for 2 of 2 (1/13/25 and 1/15/2025) days of observation. The findings included: 1. Review of the facility policy titled, “Cleaning and Disinfecting the Dialysis Station” dated 9/5/2023 revealed, “...Definition...Wall Box A box designed to connect central distribution systems to a hemodialysis machine that is located in the chaise wall behind the machine...The dialysis station could become contaminated with blood and other body fluids during treatment...Dialysis wall boxes and the area/wall around the wall box must be routinely cleaned at the end of each treatment day or immediately if splattered with blood. All surfaces shall be disinfected with 1:100 bleach solution. Special attention should be given to removing build-up and/or cleaning splatter and spray of concentrate solution. If Concentration leaks are noted at the wall box, staff should notify biomedical services for repair...” Review of the facility policy, “General Cleanliness and Infection Control Guideline” dated 11/4/2024 revealed, “...The purpose of this policy is to provide guidance for [named facility] staff on preventing the spread of infectious disease and maintaining a clean, safe, and aesthetically pleasant environment for patients, staff, and visitors...All areas must be kept clean and organized, including but not limited to treatment areas, water/supply rooms and offices...Facility staff are accountable or cleaning rooms/areas not assigned to contracted cleaning staff. such cleaning should be done regularly...” 2. Observations on the treatment floor on 1/13/2025 at 10:10 AM, revealed following: A. The wall boxes located behind Station #1 through #16, a total of 8 wall boxes, had heavy rust colored stains. B. The wall boxes located behind Station #1 and #2 were leaking acid concentrate at the connection site. C. The wall boxes behind Station #3 and #4, #5 and #6, #7 and #8, #11 and #12, and #15 and #16 had a heavy buildup of bicarbonate solution. D. The wall boxes located behind Station #5 and #6, #7 and #8, #9 and #10, #11 and #12, #13 and #14, and #15 and #16 had various discarded plastic tops lying in the bottom of the box. E. The sling to the patient lift was stored directly on the treatment floor under the patient lift. 3. Observations on the treatment floor on 1/15/2025, revealed the wall boxes located behind Station #1 through #16, a total of 8 wall boxes, had heavy rust colored stains. 4. During an interview on 1/15/2025 at 12:02 PM, the CM stated the wall boxes should be cleaned daily, and no discarded items should be located in the boxes. The CM stated all leaks should be reported to the biomedical technician when observed by staff. When asked if it was acceptable for the sling for the patient lift to be stored on the treatment floor, the CM stated, “No.””

“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: 49570 Based on facility policy review, review of the manufacturer’s label, observation, and interview, the facility failed to ensure supplies provided for hand hygiene and hemodialysis were within the manufacturer’s expiration date for 1 of 2 (1/13/2025) days of observation on the treatment floor and back storage room. The findings included: 1. Review of facility policy, “Storage of Supplies and Supply Expiration Dates of Inpatient Services” published 7/01/2024, revealed, “...The purpose of this document is to provide guidance for storage of supplies, supply expiration dates, and removal of expired supplies...All supplies must be labeled, stored, and handled in accordance with the manufacturer’s instructions for use and Safety Data Sheets: Supplies will be rotated First-in-First-Out (FIFO) to ensure products maintain quality and to monitor expiration dates. Any item that is expired, damaged, or has experienced loss of packaging integrity (torn, wet, punctured) will be removed from stock and disposed of appropriately...” Observations on the treatment floor on 1/13/2025 at 11:01 AM on the treatment floor revealed five (5) bottles of hand sanitizer at Station #3, #5, #6, #7, and #13 with an expiration date of 08/2024; Dirty Sink #1 had one bottle of hand sanitizer with an expiration date of 03/2024; Clean Sink #1 had hand soap with an expiration date of 8/2024; Clean Sink #2 had handwash with an expiration date of 6/2024; Clean Sink #3 had foaming soap with an expiration date of 11/2022; Clean Sink #4 had hand soap with an expiration date of 6/2024; and the supply cart had one carton of antibacterial wipes with an expiration date of 4/15/2024. Observations in the back storage room on 01/13/2025 at 12:43 PM, revealed four (4) one gallon containers of Liquid Acid Concentrate for Bicarbonate Hemodialysis with an expiration date of 12/31/2024. During an interview on 1/13/2025 at 11:01 AM, the DO confirmed the hand sanitizer, antibacterial wipes, foaming hand soap, hand soap, and handwash were all expired. During an interview on 1/13/2025 at 12:43 PM, the BMT confirmed all four of the one gallon containers were expired. During an interview on 1/13/2025 at 11:00 AM, CCHT #1 revealed Clean Sink #1 was used by patients to wash AVG/AVF sites, and Clean Sink #4 was used by staff to perform hand hygiene. During an interview on 1/13/2025 at 12:06 PM, the CM revealed all supplies should be checked on a monthly basis for expiration dates and discarded accordingly.”

“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: 46831 Based on policy review, observation, and interview, the facility failed to ensure dialysis stations were appropriately cleaned between patients by 1 of 2 (CCHT #1) staff members observed. The findings included: 1. Review of the facility policy titled, “Cleaning and Disinfecting the Dialysis Station” dated 9/5/2023 revealed, “...Definition Dialysis Station...Area including the dialysis machine, chair/bed, and other reusable equipment or supplies utilized during dialysis treatment...Equipment in the dialysis station may include (but is not limited to)...Dialysis machine/cycler and attachments such as IV pole, BP cuff and hand sanitizer holder...Individual televisions ...The dialysis station could become contaminated with blood and other body fluids during treatment. After use, any non-disposable equipment and supplies brought into the dialysis station...must be disinfected...Externally disinfect the dialysis machine with 1:100 bleach solutions after each dialysis treatment...Follow the steps below to disinfect the dialysis station after each dialysis treatment...Use a cloth wetted with 1:100 bleach solution or EPA-approved disinfectant to clean and disinfect the dialysis station (chair/bed, tables, machine, television, IV pole, B/P cuff...chaise wall behind chair)...” 2. Observations on the treatment floor at Station #14 on 1/13/2025 at 10:18 AM, revealed CCHT #1 failed to disinfect the dialysate hoses, display screen, internal surfaces of the prime waste container, the BP cuff tubing, TV screen, and chaise wall behind the chair. Observations on the treatment floor at Station #4 on 1/13/2025 at 10:33 AM, revealed CCHT #1 failed to disinfect the dialysate hoses, internal surfaces of the prime waste container, the BP cuff tubing, TV screen, and chaise wall behind the chair. 3. During an interview on 1/15/2025 at 12:02 PM, the CM stated staff were expected to disinfect the dialysis stations after every treatment per policy. The CM stated staff were expected to disinfect the dialysis machines from top to bottom, side to side as well as inside and outside the prime waste container, the TV screen, blood pressure cuff and tubing, and the wall chaise behind the chair.”

“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: 46831 Based on policy review, review of the manufacturer’s instructions for use, observation and interview, the facility failed to ensure expired medications and biologicals were not available for use in 2 of 4 (Medication Storage Refrigerator and Medication Storage Cabinet) medication and biological storage areas observed. The findings included: 1. Review of the facility’s policy titled, “Medication Preparation and Administration” dated 2/6/2023 revealed, “...Expired medications are to be discarded...Any open multi dose vials must be discarded 28 days after opening...” 2. Review of the manufacturer’s instructions for use printed on the liquid protein gallon container revealed, “Storage: Use within 3 months of opening.” 3. Observations in the Medication Storage Refrigerator on 1/13/2025 at 10:45 AM, revealed one open multidose vial of Tuberculin Derivative with an open date of 11/7/2024. The medication had been opened a total of 67 days. Observations in the Medication Storage Cabinet on 1/13/2025 at 11:02 AM, revealed one (1) 64 ounce bottle of concentrated liquid protein with an open date of 8/16/2024 was stored in the cabinet above Clean Sink #1. 4. During an interview on 1/13/2025 at 10:50 AM, RN #1 confirmed the Tuberculin Derivative should have been discarded after 30 days from the date it was opened. During an interview on 1/13/2025 at 11:01 AM, the DO confirmed the liquid protein should have been discarded within 3 months of 8/16/2024.”

“IC-STAFF EDUCATION-CATHETERS/CATHETER CARE CFR(s): 494.30(a)(2) Recommendations for Placement of Intravascular Catheters in Adults and Children I. Health care worker education and training A. Educate health-care workers regarding the ... appropriate infection control measures to prevent intravascular catheter-related infections. B. Assess knowledge of and adherence to guidelines periodically for all persons who manage intravascular catheters. II. Surveillance A. Monitor the catheter sites visually of individual patients. If patients have tenderness at the insertion site, fever without obvious source, or other manifestations suggesting local or BSI [blood stream infection], the dressing should be removed to allow thorough examination of the site. Central Venous Catheters, Including PICCs, Hemodialysis, and Pulmonary Artery Catheters in Adult and Pediatric Patients. VI. Catheter and catheter-site care B. Antibiotic lock solutions: Do not routinely use antibiotic lock solutions to prevent CRBSI [catheter related blood stream infections]. This Standard is not met as evidenced by: 46831 Based on policy review, observation, and interview, the facility failed to ensure measures to prevent CVC related infections were followed by 1 of 1 (RN #1) nurses observed performing CVC site care. The findings included: 1. Review of facility policy, “Central Venous Catheter (CVC) Dressing Change”, published 5/06/2024, revealed, “...Cleaning the Catheter Site: ChloraPrep Swabstick/applicator is a combination of 2% chlorhexidine gluconate (CHG) with 70% isopropyl alcohol. The alcohol kills microorganisms on contact while the CHG maintains persistent antimicrobial activity in the epidermis cell layers for up to 48 hours...Cleaning the Catheter Site: Follow the steps below to clean the catheter exit site: Using gentle back and forth friction, clean the exit site beginning in the center and continuing outward the area of the size of the dressing to be applied (2 inches) in a concentric circle for 30 seconds...” 2. Observations on the treatment floor on 1/15/2025 at 10:35 AM, revealed RN #1 provided CVC Exit Site Care for Random Patient #3 and Random Patient #4. During both observations, RN #1 utilized a ChloraPrep Swabstick/applicator to perform the exit site care. While cleaning the exit sites on Random Patients #3 and #4, RN #1 failed to move the Swabstick in a concentric circular motion and instead started at the CVC exit site and moved in both a circular and back and forth motion. RN #1 returned to the exit site multiple times with the same Swabstick after cleaning dirty areas potentially recontaminating the site. 3. During an interview on 01/15/2025 at 12:06 PM, the CM confirmed when utilizing ChlorPrep Swabstick/applicator to perform CVC exit site care, the nurse move the ChlorPrep Swabstick in a concentric circle using back and forth motion and never return to the CVC exit site after moving outward to a dirty site.”

“SOFTENERS: TESTING HARDNESS/LOG CFR(s): 494.40(a) 6.2.4 Softeners: Testing hardness/log Users should ensure that test accuracy and sensitivity are sufficient to satisfy the total hardness monitoring requirements of the reverse osmosis machine manufacturer. Total hardness of the water exiting the water softener should be measured at the end of each treatment day. Water hardness test results should be recorded in a water softener log. This Standard is not met as evidenced by: 46831 Based on policy review, personnel file review, observation and interview, the facility failed to ensure water hardness monitoring and testing was completed accurately by 1 of 1 (CCHT #1) CCHTs observed and failed to ensure the water hardness test results were documented per facility policy. The findings included: 1. Review of the facility policy titled, “Color Blindness Testing,” dated 1/23/2019, revealed “ ...Patient care and biomed staff are in positions that require the ability to interpret or distinguish color when performing water and/or other quality tests or maintenance on dialysis or other equipment. People who suffer from color blindness, may not be able to distinguish between certain colors used in water and other testing methodologies ...required to take the [named color blind test] Test for Color Blindness to ensure the ability to perform the essential functions of their job ...Colorblindness Glasses and Contact Lenses ...There are devices such as color blindness glasses or contact lenses that may help distinguish color ...” Review of the facility policy titled, “Total Hardness Testing with SteriChek Sensitive Low-Range Water Hardness Test Strip Procedure,” dated 9/30/2024, revealed “ ...Quality Control Procedure ...Quality control is not required for the [named water check company] Sensitive Low Range Water Hardness Test Strips. IFU state: “The test strips are supplied ready-to-use.” ...Usage Procedure ...Inspect test strip bottle and verify strips are not expired ...Discard bottle. Obtain a capped, unexpired bottle of strips ...Document results in the approved Computerized Maintenance Management System (CMMS) ...” 2. Review of the CCHT #1’s personnel file revealed documentation the staff member demonstrated competencies required for Water Skills Validation and Annual Water Skills Checklist on 9/4/2024. Review of CCHT #1’s Ishihara’s Test for Color Blindness dated 9/4/2024, revealed the CCHT was able to pass the while using colorblindness corrective glasses. CCHT #1 completed Annual Water Training 0n 9/20/2024. 3. Observations in the water room on 1/13/2025 at 1:28 PM, CCHT #1 performed the water harness test using water hardness test strips with an expiration date of 6/2024. CCHT #1 was not observed wearing colorblindness corrective glasses. After the test was completed, the CCHT documented the test results on the water hardness log. 4. During an interview on 1/13/2025 at 1:35 PM, CCHT #1 stated “ ...They are expired [test strips] ...I could have had an inaccurate reading based on the expiration date ...” CCHT #1 then verified the expired strips were used on the morning of 1/13/2025, for the AM check. 5. Review of the water hardness testing log revealed no documentation the tests were performed at the end of the treatment day from 12/13/2024 through 1/13/2025, a total of 14 treatment days. 6/ During an interview on 1/13/2025 at 2:14 PM, the ATOM verified the water hardness testing documentation was missing. During an interview on 1/13/2024 at 2:24 PM, the BMT stated the water hardness test is performed at the beginning and end of the day. The BMT then verified there was no documentation the end of day water hardness tests were completed from 12/12/2024 through 1/13/2025. During an interview on 1/15/2025 at 12:02 PM, the CM verified the facility failed to remove the expired water hardness test strips from the water room prior to use and staff should document all water hardness test results. When asked if CCHT #1 should have been wearing colorblindness corrective glasses while performing the water hardness test, the CM stated, “Yes, because without the glasses, the test would not be valid.””

“POC-VASCULAR ACCESS-MONITOR/REFERRALS CFR(s): 494.90(a)(5) The interdisciplinary team must provide vascular access monitoring and appropriate, timely referrals to achieve and sustain vascular access. The hemodialysis patient must be evaluated for the appropriate vascular access type, taking into consideration co-morbid conditions, other risk factors, and whether the patient is a potential candidate for arteriovenous fistula placement. This Standard is not met as evidenced by: 46831 Based on policy review, medical record review, and interview, the facility failed to ensure physician’s orders for heparin administration were followed for 1 of 5 (Patient #4) sampled hemodialysis patients. The findings included: 1. Review of the facility’s policy titled, “Patient Assessment and Monitoring” dated 5/1/2023 revealed, “...During Treatment...Document machine parameters and safety checks every 30 minutes or more as needed but not to exceed 45 minutes...Machine parameters and extracorporeal Circuit...If heparin pump is used, ensure heparin is infusing at prescribed rate...” Review of the facility’s policy titled, “Heparinization” dated 8/3/2020 revealed, “...Anticoagulation is required to prevent thrombosis, occlusion, and malfunction of the blood circuit...The physician must order the heparin dose and method of administration...It is recommended the heparin pump be stopped...at the end of treatment in accordance with a physician order on patients dialyzing through a central venous catheter... 2. Medical record review for Patient #4 revealed an admission date of 2/5/2024 with diagnoses which included End Stage Renal Disease. A physician’s order dated 12/4/2024 revealed Patient #4 was to undergo hemodialysis treatments for 3 hours and 30 minutes via a CVC 3 days a week. A physician’s order dated 12/20/2024 revealed Patient #4 was to receive “...Heparin Sodium...1,000 Units/mL...Infusion (Pump) 1000 units IVP per hour, turn pump off 60 minutes prior to the end of treatment...” The heparin infusion was ordered to run for 2 hours and 30 minutes each treatment for a total of 2500 units of heparin infusion. Review of the Treatment Sheet dated 12/22/2024 revealed a total of 3,000 units of heparin was infused instead of 2,500 units as prescribed. There was no documentation why the patient was given the extra 500 units of heparin. Review of the Treatment Sheet dated 12/24/2024 revealed a total of 3,000 units of heparin was infused instead of 2,500 units as prescribed. There was no documentation why the patient was given the extra 500 units of heparin. Review of the Treatment Sheet dated 12/29/2024 revealed a total of 2,200 units of heparin was infused instead of 2,500 units as prescribed. There was no documentation why the patient was not given the full dose of 2,500 units of heparin. There were no machine safety checks for the heparin pump documented from the start of treatment at 7:14 AM to end of treatment at 10:48 AM. There was no documentation why the safety checks were not completed. Review of the Treatment Sheet dated 12/31/2024 revealed a total of 3,000 units of heparin was infused instead of 2,500 units as prescribed. There was no documentation why the patient was given the extra 500 units of heparin. There were no machine safety checks documented for the heparin pump from 7:30 AM to end of treatment at 10:42 AM. There was no documentation why the safety checks were not completed. Review of the Treatment Sheet dated 1/03/2025 revealed a total of 2,300 units of heparin was infused instead of 2,500 units as prescribed. There was no documentation why the patient was not given the full dose of 2,500 units of heparin. There were no machine safety checks documented for the heparin pump from start of treatment at 7:10 AM to end of treatment at 10:44 AM. There was no documentation why the safety checks were not completed. Review of the Treatment Sheet dated 1/06/2025 revealed a total of 3,500 units of heparin was infused instead of 2,500 units as prescribed. There was no documentation why the patient was given the extra 1,000 units of heparin. Review of the Treatment Sheet dated 1/08/2025 revealed a total of 3,500 units of heparin was infused instead of 2,500 units as prescribed. There was no documentation why the patient was given the extra 1,000 units of heparin. Review of the Treatment Sheet dated 1/09/2025 revealed a total of 1,500 units of Heparin was infused instead of 2,500 units as prescribed. There was no documentation why the patient was not given the full dose of 2,500 units of heparin. Review of the Treatment Sheet dated 1/13/2025 revealed a total of 1,000 units of heparin was infused instead of 2,500 units as prescribed. There was no documentation why the patient was not given the full dose of 2,500 units of heparin. During an interview on 1/14/2025 at 11:25 AM, the CM stated staff were expected to monitor and document the heparin pump was on and functioning properly during treatment, and the machine checks should be documented. The CM confirmed physician orders should be followed for heparin. The CM stated, “I believe that it [total heparin infused] is just documented wrong and that they [patients] did get the correct amount of heparin, but becuase we don’t doucment heparin flow rate during treatment, there is no way to verify.””

“POC-VA MONITOR/PREVENT FAILURE/STENOSIS CFR(s): 494.90(a)(5) The patient’s vascular access must be monitored to prevent access failure, including monitoring of arteriovenous grafts and fistulae for symptoms of stenosis. This Standard is not met as evidenced by: 46831 Based on policy review, observation, and interview, the facility failed to ensure vascular access sites were assessed for thrill and/or bruit prior to cannulation by 2 of 2 (CCHT #2, and RN #1) staff members observed providing direct patient care. The findings included: 1. Review of facility policy, “Access Assessment and Cannulation” published 5/06/2024, revealed, “ ...Before each treatment, the internal access must be assessed for patency, signs of infection, and any abnormal findings ...Evaluation and preparation of the access will be performed routinely prior to cannulation at each dialysis session ...The CM or nurse in charge will assign clinical staff for the initial cannulations based on experience and expertise ...Check fistula for adequate bruit and thrill to confirm patency ...Follow the steps below to assess the vascular access: Step 6: LISTEN: Bruit high pitch/whistle, Bruit not present throughout access, If no sounds present, assume the access is thrombosed and do not attempt cannulation. Nurse will communicate with physician ...Step 7: FEEL: Pulse not soft/not easily compressible, Thrill not strong at anastomosis, Thrill not present throughout access ...” 2. Observations on 1/15/2025 at 9:30 AM, revealed CCHT #2 prepped Random Patient #1’s arteriovenous graft at Station #14 for hemodialysis. CCHT #2 did not listen for a bruit or feel the access before cannulation. Observations on 1/15/2025 at 10:15 AM, revealed RN #1 prepped Random Patient #2’s arteriovenous graft at Station #8 for hemodialysis. RN #1 did not listen for a bruit before cannulation. 3. During an interview on 1/15/2025 at 12:06 PM, the CM stated that staff were expected to follow facility policy regarding AVG cannulation, including to look, listen, and feel the patient’s arteriovenous graft before cannulation.”

“PQ-STAFF LIC AS REQ/QUAL/DEMO COMPETENCY CFR(s): 494.140 All dialysis facility staff must meet the applicable scope of practice board and licensure requirements in effect in the State in which they are employed. The dialysis facility’s staff (employee or contractor) must meet the personnel qualifications and demonstrated competencies necessary to serve collectively the comprehensive needs of the patients. The dialysis facility’s staff must have the ability to demonstrate and sustain the skills needed to perform the specific duties of their positions. This Standard is not met as evidenced by: 46831 Based on policy review, document review, personnel file review, observation and interview, the facility failed to ensure staff met the personnel qualifications and demonstrated competencies necessary to provide safe patient care when CCHT #1, who was colorblind, failed to wear colorblindness corrective glasses when performing the water test for chlorine and the water hardness test and failed to recognize the water hardness test strips used to perform the test were expired. The findings included: 1. Review of the facility policy titled, “Color Blindness Testing,” dated 1/23/2019, revealed “ ...Patient care and biomed staff are in positions that require the ability to interpret or distinguish color when performing water and/or other quality tests or maintenance on dialysis or other equipment. People who suffer from color blindness, may not be able to distinguish between certain colors used in water and other testing methodologies ...required to take the [named color blind test] Test for Color Blindness to ensure the ability to perform the essential functions of their job ...Colorblindness Glasses and Contact Lenses ...There are devices such as color blindness glasses or contact lenses that may help distinguish color ...” 2. Review of the facility’s document titled, “Job Title: PCT II” version 7/12/2022 revealed, “...Functions as part of the dialysis health care team in providing safe and effective dialysis therapy for patients under the direct supervision of a licensed nurse in accordance with organization policies, procedures, and training and in complicance with regulations setforth by the corporation, state, and federal agencies. Responsible for the set up and operation of hemodialysis machines...” 3. Review of CCHT #1’s personnel file revealed the CCHT completed the “Annual Water Skills Checklist” and “ ...Water Skills Validation” on 9/4/2024. Further review revealed CCHT #1 was able to pass the “[named color blind test] Test for color Blindness” on 9/4/2024 while using colorblindness corrective glasses. Review of a letter dated 9/5/2024 in CCHT #1’s personnel file revealed, “This letter summarizes our discussions regarding your request for an accommodation to perform the essential functions of your position. You have requested the following accommodation: Use of colorblind corrective lenses/glasses. This accommodation is approved ...” 4.Observations in the water room on 1/13/2025 at 12:35 PM, revealed CCHT #1 tested the water for chlorine without the use of colorblindness corrective glasses. RN #1 was present during the test, did not verify the test results. Observations in the water room on 1/13/2025 at 1:28 PM, revealed CCHT #1 obtained a water hardness test strip from a bottle with an expiration date of 6/2024. Without opening another bottle of test strips, CCHT #1 completed the water hardness test. The CCHT did not wear the colorblindness corrective glasses during the test. 5. During an interview on 1/13/2025 at 1:28 PM, CCHT #1 stated, “...they are expired (water hardness test strips)...I could have had an inaccurate reading based on expiration date...” During an interview on 1/15/2025 at 11:27 AM, RN #2 stated, “ ...If CCHT #1 was not wearing colorblind glasses, he should not do the test...He must wear the glasses, or the test would not be valid...” During an interview on 1/15/2025 at 12:06 PM, the CM stated CCHT #1 had been given colorblindness corrective glasses. The CM stated, if the CCHT “doesn’t wear them, the check would not be valid.””