Davita Collierville Dialysis

“CFC-INFECTION CONTROL CFR(s): 494.30 This Condition is not met as evidenced by: 46831 Based on facility policy review, 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 ensure appropriate infection control measures were taken by allowing team members to wear artificial nails and failed to ensure supplies were discarded once opened. Refer to V-111 2. The facility failed to ensure dialysis machines and stations were adequately cleaned to prevent cross-contamination between patients. Refer to V-122 3. The facility failed to dispose of medications that were expired and were readily available for use on the treatment floor. Refer to V-143 4. The facility failed to ensure measures to prevent CVC related infections were performed during CVC exit site care. Refer to V-147”

“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: 49570 Based on facility policy, observation, and interview, the facility failed to ensure appropriate infection control measures were taken by allowing 1 of 2 (CCHT #1) team members providing patient care to wear artificial nails and failed to ensure supplies were discarded once opened in 1 of 4 (Top of Storage Cabinet) supply storage areas. The findings included: 1. Review of facility policy, “Infection Control for Dialysis Facilities” revised April 2023 revealed, “ ...HAND HYGIENE: It is a requirement for all [name of Corporation] teammates whose primary location is working in a facility to have only natural nails and fingernail length should not extend more than ¼ inch ...SUPPLIES... Supplies will be stored in a manner that maintains their integrity... Supplies will not be opened until time of use. Anytime the integrity of a package with or without an expiration date is in question, i.e., torn, ripped, wet or contaminated, the package and its contents must be disposed of and not used ...” 2. Observations on the treatment floor on 05/12/2025 at 11:28 AM revealed CCHT #1 wearing artificial nails that were longer than ¼ inch while providing patient care. During an interview on 05/13/2025 at 12:30 PM the FA stated that nails were supposed to be natural per facility policy. 3. Observations on the treatment floor on 05/12/2025 at 10:00 AM revealed a F200NRe (named Brand) capillary dialyzer (a dialyzer is used in hemodialysis to assist in cleaning the blood) laying on top of the storage cabinet open to air and outside of the package. During an interview on 05/12/2025 at 10:37 AM the MCS verified the dialyzer had been opened and stated that it should have been thrown away. During an interview on 05/13/2025 at 12:30 PM the FA stated that any opened dialyzers should be discarded if not immediately used.”

“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: 49570 Based on facility policy, observations and interview, the facility failed to ensure the hemodialysis chair was cleaned and disinfected between patient use by 1 of 2 (RN #1) observed on the treatment floor. The findings included: 1. Review of facility policy “Infection Control For Dialysis Facilities” dated April 2025 revealed, “...To minimize the spread of infections of bloodborne pathogens in the dialysis facility environment ...At the end of each treatment the dialysis station will be cleaned and disinfected ...Surfaces to disinfect include ...dialysis chair ...” 2. Observations on the treatment floor at Station #7 on 05/12/2025 at 10:43 AM revealed RN#1 failed to wipe down the entirety of the chair when performing cleaning and disinfection of a dialysis station. 3. During an interview on 05/13/2025 at 12:33 PM, the FA verified that the chair should be completely broken down and wiped down with bleach after each treatment.”

“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 facility policy, observation, and interview, the facility failed to ensure medications were labeled with initials, date, and time after being opened and failed to ensure medications were discarded before their expiration date for 1 of 1 medication rooms. The findings included: 1. Review of facility policy, “Medication Policy” revised November 2023, revealed, “...Each vial is labeled with the initials of the person opening the vial and the expiration date...All medications are checked monthly for expiration dates... Medications are ordered and replaced prior to expiration...Disposal of expired medications, including all over the counter and nutritional product samples are removed from the treatment and inventory areas and disposed of per state/local regulations...” 2. Observations in the medication room on 05/12/2025 at 8:45 AM revealed the following unlabeled medications: One (1) bottle of Cinacalcet (medication used to manage hyperthyroidism) 30 mg tablets with no opened date, time, or initials present on the label; One (1) bottle of Cinacalcet 60 mg tablets with no opened date, time, or initials present on the label. One (1) bottle of Acetaminophen (over-the-counter medication used to relieve pain and reduce fever) 325 mg tablets with no opened date, time, or initials present on the label; One (1) bottle of Clonidine (medication used to manage high blood pressure) 0.1 mg tablets with no opened date, time, or initials present on the label, and One (1) bottle of Tums (Antacid used to relieve heartburn, sour stomach, and acid indigestion) 750 mg with no opened date, time, or initials present on the label. Observations in the medication room on 05/12/2025 at 9:05 AM revealed the following expired medications: Sixty-two (62) Diphenhydramine HCL (antihistamine used to relieve symptoms of allergies, hay fever, common cold, and itching) 25 mg capsules with expiration date of 03/2025. and One (1) 32 oz. bottle of LiquaCel (Protein supplement) Liquid Protein with expiration date of 04/26/2025. 3. During an interview on 05/12/2025 at 9:15 AM, the FA verified the above medications were outdated and should have been discarded. The FA then verified the above medications had no opened date, no time present on the label, and were not initialed by the nurse.”

“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 facility policy review, observation, and interview, the facility failed to ensure measures to prevent CVC related infections were followed for 2 of 5 (Random Patient #1 and Random Patient #2) observed patients and by 2 of 2 (RN #1 and RN #2) nurses observed on the treatment floor. The findings included: 1. Review of facility policy, “Central Venous Catheter (CVC) with Clearguard HD Antimicrobial End Caps Procedure” revised April 2025, revealed, “ ...Discard used barrier that was used during treatment and place a new clean, moisture proof barrier under catheter to prevent contamination ...disinfect the CVC hubs with a new alcohol prep pad for each CVC hub ...Do not allow the hub to touch non-sterile surfaces ...Apply label to the dressing indicating: date dressing change was performed, initials of TM performing procedure ...” 2. Observations on the treatment floor at Station #13 on 05/12/2025 at 9:25 AM, revealed RN #2 performing CVC exit site care on RP #1. RN #2 failed to change the moisture proof barrier beneath the CVC before discontinuation of treatment. 3. Observations on the treatment floor at Station #11 on 05/12/2025 at 10:00 AM, revealed RN #1 discontinuing hemodialysis on RP #2 via a CVC. RN #1 disconnected the treatment lines from the CVC ports and laid both ports, open to air, on the barrier/pad underneath the CVC. RN #1 then picked up both ports, cleaned them with an alcohol pad, and laid them both, still open to air, back on the field under the CVC. After 15 seconds RN #1 picked each port up, did not reclean with an alcohol pad, and proceeded to attach a closure device to each port. 4. Observations on the treatment floor at Station #13 on 05/12/2025 at 10:15 AM, revealed RN #2 performing CVC exit site care on Patient #2. RN #2 failed to label the exit site dressing with the date dressing change was performed and initials per facility policy. 5. During an interview on 05/13/2025 at 12:30 PM, the FA stated the under pad should be replaced with a new one before disconnection of the CVC, stated the CVC ports should be held until the closure devices are attached and never laid down on the field underneath while still open to air, and stated that the CVC exit site dressings should contain the date it was changed and initials of the TM per facility policy.”

“CARBON ADSORP-MONITOR, TEST FREQUENCY CFR(s): 494.40(a) 6.2.5 Carbon adsorption: monitoring, testing freq Testing for free chlorine, chloramine, or total chlorine should be performed at the beginning of each treatment day prior to patients initiating treatment and again prior to the beginning of each patient shift. If there are no set patient shifts, testing should be performed approximately every 4 hours. Results of monitoring of free chlorine, chloramine, or total chlorine should be recorded in a log sheet. Testing for free chlorine, chloramine, or total chlorine can be accomplished using the N.N-diethyl-p-phenylene-diamine (DPD) based test kits or dip-and-read test strips. On-line monitors can be used to measure chloramine concentrations. Whichever test system is used, it must have sufficient sensitivity and specificity to resolve the maximum levels described in [AAMI] 4.1.1 (Table 1) [which is a maximum level of 0.1 mg/L]. Samples should be drawn when the system has been operating for at least 15 minutes. The analysis should be performed on-site, since chloramine levels will decrease if the sample is not assayed promptly. This Standard is not met as evidenced by: 49570 Based on facility policy, Manufacturer’s Guidelines for Use/Product Profile, Facility Routine Total Chlorine Testing Log, observation and interview, the facility failed to ensure 2 of 2 (FA #1 and RN #2) nurses were competent in performing Total Chlorine Water Testing and failed to ensure the facility was using the correct test strips to test for the appropriate Total Chlorine Levels from the Primary Carbon Tank to ensure patient safety during in-center hemodialysis. The Findings Included: 1. Review of the facility policy “[Brand name] Hisense Ultra 0.1 Test For Total Chlorine In Feed Or Rinse Water” issued October 2011 revealed, “ ...The Semi-Quantitative procedure is used: For routine testing for Total Chlorine in water ...fill the sample cup with 20 ml water to be tested ...Discard contents and refill before testing ...Remove test strip from test water and shake to remove excess ...Immediately compare reacted test strip to color chart ... If the Quantitative test, confirms a total chlorine level in the water leaving the Primary Carbon Filter is greater than 0.1 ppm (mg/L) (> 0.1 ppm), document on the routine Total Chlorine Test Log in the comment section, “Primary Carbon Breakthrough. Initiated Breakthrough Log.” ...Proceed with testing water leaving the Secondary Carbon Tank ...” The Total Chlorine Monitoring Decision Tree revealed the following steps: Perform Total Chlorine Test on Primary Carbon Tank, IF Result is greater than or equal to 0.1 ppm: Immediately Repeat Total Chlorine Test on Primary Carbon Tank, IF result is still greater than or equal to 0.1 ppm: Immediately perform Total Chlorine Test on Secondary Carbon Tank, IF result is greater than or equal to 0.1 ppm on the Secondary Carbon Tank “DO NOT DIALYZE PLACE ALL MACHINES IN BYPASS by placing dialysis delivery system in bypass, discontinue treatment and do not rinse patient’s blood back; Notify Facility Medical Director. 2. Review of Manufacturer’s Guidelines for Use/Product Profile for (Brand Name) HiSENSE ULTRA 0.1 (Trademark) Test Strips “ ...provide a quick and convenient means for indicating low levels of total chlorine (chloramines/free chlorine) in water used to prepare dialysate ... Using a 30-second semi-quantitative procedure, the strips will detect total chlorine concentrations between 0 and 3.0 ppm. The [Brand Name] ULTRA 0.1 Test has color blocks at 0, 0.1, 0.5 and 3.0 ppm. In post-carbon water, a result of 0.1 ppm total chlorine or above indicates that the water should not be used to prepare dialysate because of chloramine/free chlorine breakthrough or exhaustion of the carbon adsorption media in the water purification system ...” Review of Manufacturer’s Guidelines for Use/Product Profile for (Brand Name) Residual Chlorine Test Strips “ ...give a semi-quantitative indication that the chlorine bleach solution has been adequately rinsed from the hemodialysis machine, bicarb jugs, bicarb mixing tanks or water delivery systems following disinfection...AAMI Hemodialysis Water Quality Guidelines set the maximum allowable concentration of free chlorine at 0.5 ppm, therefore the concentration of residual bleach must be below 0.5 ppm prior to initiating dialysis ...Use [Brand Name] Residual Chlorine Test Strips after rinsing the bleach solution from the hemodialysis system and prior to initiating dialysis ...” 3. Review of Facility Routine Total Chlorine Testing Log revealed the CM-130 Automatic Chlorine Monitoring System (system that monitors total chlorine levels in pre-treatment water used in hemodialysis) was experiencing network issues (not communicating with dialysis stations) due to a cyber attack for (named Facility) CorporateOffice from 04/12/2025 to 05/06/2025 and required manual checking of the total chlorine by facility staff prior to every hemodialysis shift and/or every four hours. The log revealed total chlorine testing was performed by the following staff members on the following dates: On 04/14/2025 at 4:00 AM CCHT #2 performed test and documented result 0.00 ppm On 04/16/2025 at 4:00 AM CCHT #2 performed test and documented result 0.00 ppm; On 04/16/2025 at 8:00 AM CCHT #2 performed test and documented result 0.00 ppm; On 04/16/2025 at 12:00 PM CCHT #2 performed test and documented result 0.00 ppm, and On 04/16/2025 at 4:00 PM FA performed test and documented result 0.00 ppm. On 04/18/2025 at 4:00 AM CCHT #2 performed test and documented result 0.00 ppm; On 04/18/2025 at 8:00 AM CCHT #2 performed test and documented result 0.00 ppm; On 04/18/2025 at 12:00 PM CCHT #2 performed test and documented result 0.00 ppm, and On 04/18/2025 at 3:00 PM CCHT #2 performed test and documented result 0.00 ppm. On 4/21/2025 at 4:00 AM CCHT #2 performed test and documented result 0.00 ppm; On 4/21/2025 at 8:00 AM CCHT #2 performed test and documented result 0.00 ppm, and On 4/21/2025 at 12:00 PM CCHT #2 performed test and documented result 0.00 ppm. On 04/23/2025 at 5:00 AM illegible performed test and documented result 0.00 ppm; On 04/23/2025 at 9:00 AM FA performed test and documented result 0.00 ppm, and On 04/23/2025 at 1:00 PM FA performed test and documented result 0.00 ppm. On 04/25/2025 at 5:00 AM FA performed test and documented result 0.00 ppm; On 04/25/2025 at 9:00 AM FA performed test and documented result 0.00 ppm, and On 04/25/2025 at 1:00 PM FA performed test and documented result 0.00 ppm. On 04/28/2025 at 5:00 AM FA performed test and documented result 0.00 ppm; On 04/28/2025 at 9:00 AM FA performed test and documented result 0.00 ppm, and On 04/28/2025 at 1:00 PM FA performed test and documented result 0.00 ppm. On 04/30/2025 at 5:00 AM FA performed test and documented result 0.00 ppm; On 04/30/2025 at 9:00 AM FA performed test and documented result 0.00 ppm, and On 04/30/2025 at 1:00 PM FA performed test and documented result 0.00 ppm. On 05/02/2025 at 5:00 AM FA performed test and documented result 0.00 ppm; On 05/02/2025 at 9:00 AM FA performed test and documented result 0.00 ppm; On 05/02/2025 at 1:00 PM illegible performed test and documented result 0.00 ppm, and On 05/02/2025 at 5:00 PM illegible performed test and documented result 0.00 ppm. On 05/05/2025 at 5:15 AM FA performed test and documented result 0.00 ppm; On 05/05/2025 at 9:15 AM FA performed test and documented result 0.00 ppm, and On 05/05/2025 at 1:15 PM FA performed test and documented result 0.00 ppm. On 05/07/2025 at 5:00 AM FA performed test and documented result 0.00 ppm; On 05/07/2025 at 9:00 AM illegible performed test and documented result 0.00 ppm; On 05/07/2025 at 1:00 PM illegible performed test and documented result 0.00 ppm, and On 05/07/2025 at 5:00 PM illegible performed test and documented result 0.00 ppm. On 05/09/2025 at 5:10 AM FA performed test and documented result 0.00 ppm. On 05/12/2025 at 5:15 AM FA performed test and documented result 0.00 ppm. 3. Observations in the water room on 05/11/2025 at 11:00 AM revealed RN #2 did not discard original content of test water and refill sample cup prior to testing per facility policy. RN #2 was unable to specify/fill sample container to the proper amount, RN #2 stated sample cup should be filled to “30mLs” instead of 20mLs per facility policy. RN #2 was unable to specify/demonstrate proper time to validate test strip, RN#2 stated “You wait 10 seconds” instead of Immediately per facility policy. Observations in the water room on 05/11/2025 at 1:00 PM revealed FA did not discard original content of test water and refill sample cup prior to testing per facility policy. The FA was unable to specify/fill sample container to proper amount, FA stated sample cup should be filled to “10mLs” instead of 20mLs per facility policy. Observations in the water room on 05/11/2025 at 11:00 AM and 1:00 PM revealed 2 of 2 (FA and RN #2) nurses utilized the incorrect test strips to test the Total Chlorine levels from the Primary Carbon Tank. FA and RN #2 both were observed using [Brand name] Residual Chlorine test strips that detects 0 ppm,0.5 ppm residual chlorine instead of using test strips for Total Chlorine that detects 0 ppm, 0.1 ppm Total Chlorine as specified in the facility policy. 4. During an interview on 05/12/2025 at 10:00 AM, the MCS stated, the staff “should know how to do it” when questioned about Total Chlorine testing procedure.”

“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: 46831 Based on facility policy review, observation, and interview, the facility failed to dispose of supplies that were expired and were readily available for use in the medication room. The findings included: 1. Review of the facility policy, “Emergency Equipment Checks” revised October 2024, revealed, “Verify that emergency equipment is maintained in a ready-to-use condition ...a list of all dated supplies will be posted, with expiration dates, on the cart ...” 2. Observations on 05/12/2025 at 9:05 AM, revealed the following expired supplies in the medication room: Thirteen (13) BD Eclipse Needles 22 G x 1 ½ inch [a safety-engineered hypodermic needle designed to reduce the risk of needlestick injuries] Observations on 05/12/2025 at 11:00 AM revealed the following expired supplies on the crash cart: Six (6) [Brand Name] Tri-Flo Suction Catheter 14 Fr [a specialized medical device used to suction, or remove fluids and secretions, from the airway] with an expiration date of 09/30/2024 3. During an interview on 05/13/2025 at 12:30 PM the FA confirmed that supplies should be monitored on a monthly basis and any expired supplies should be discarded.”

“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: 49570 Based on review of facility policy, observation, and interview, the facility failed to ensure appropriate measures were taken by 2 of 2 (RN #1 and CCHT #1) staff members to effectively evaluate access and prevent infection before cannulation of an AVF and/or AVG prior to initiation of hemodialysis on 1 of 1 observation days. The findings included: 1. Review of facility policy, “AV Fistula or Graft Cannulation with Nipro or Medisystems Safety Fistula Needles (SFN) and Administration of Heparin Loading Dose” revised April 2025 revealed, “ ...Have patient wash access site with appropriate antibacterial soap, if able. If patient unable to wash access site, patient care teammate will clean access extremity with skin cleansing agent and pat dry ...while maintaining aseptic technique, cleanse the site by applying skin antiseptic using a circular rubbing motion, moving from the center out and allow to dry. (For contact and dry time refer to the table above.) ...Skin Antiseptic: Isopropyl Alcohol 70%; Effective Volume: At least 4 prep pads per site; Effective Contact Time: 60 seconds; Air Drying Time: 15 seconds ...” Review of the facility policy titled, “Post Dialysis Vascular Access Care: Fistula/Graft Using Safety Fistula Needles” revised April 2023 revealed, “... Once bleeding has stopped, discard gauze or band-aid used to hold site ... Inspect site for any trauma and for hemostasis ... Apply Band-Aid type or sterile dressing over cannulation site ...’’ 2. Observations on the treatment floor at Station #8 on 05/12/2025 at 10:17 AM revealed CCHT #1 initiating hemodialysis on RP #4 via an AVF. CCHT #1 failed to ensure the access site was cleaned with soap and water prior to antisepsis and failed to allow a 15 second dry time per facility policy. CCHT #1 failed to wash or verbally confirm with the patient that the access site was washed with soap and water before proceeding with skin antisepsis. CCHT #1 performed antisepsis with an alcohol pad on both access sites, then allowed one access site to dry for 5 seconds before cannulation and allowed the other access site to dry for 7 seconds before cannulation. Observations on the treatment floor at Station #7 on 05/12/2025 at 11:08 AM on the treatment floor at Station #7 revealed RN # 1 initiating hemodialysis on Random Patient #1 via AVG/AVF. RN #1 failed to ensure the access site was cleaned with soap and water prior to antisepsis; failed to clean each access site for 60 seconds per facility policy; failed to allow a 15 second dry time per facility policy; and failed to appropriately clean access sites after recontamination. RN #1 failed to wash or verbally confirm with the patient that the access site was washed with soap and water before proceeding with skin antisepsis. RN #1 performed antisepsis with an alcohol pad for 8 seconds on one access site and 5 seconds on the other access site, then palpated both access sites, recleaned the access sites with alcohol for 2 seconds on one site and 4 seconds on the other site and then immediately cannulated without allowing for any dry time. Observations on the treatment floor at Station #2 on 5/12/2025 at 11:10 AM revealed CCHT #1 initiating hemodialysis on Patient #3 via an AVG/AVF. CCHT #1 failed to wash or verbally confirm with the patient that the access site was washed with soap and water before proceeding with skin antisepsis. During an interview on 05/13/2025 at 12:30 PM, the FA confirmed that AVF/AVG access sites should be washed with soap and water before antisepsis; confirmed access sites should be cleaned with an alcohol pad for at least 60 seconds and allowed to dry for at least 15 seconds. 3. Observations on the treatment floor at Station #8 on 05/12/2025 at 9:56 AM revealed RN #3 performing post dialysis CVC exit care on RP #5. RN #3 failed to replace blood soiled bandage/gauze on needle sites once hemostasis was achieved. During an interview on 05/13/2025 at 12:30 PM, the FA confirmed that a clean dressing should be used once hemostasis is achieved.”

“GOV-STAFF # & RATIO MEET PT NEEDS CFR(s): 494.180(b)(1) The governing body or designated person responsible must ensure that- (1) An adequate number of qualified personnel are present whenever patients are undergoing dialysis so that the patient/staff ratio is appropriate to the level of dialysis care given and meets the needs of patients; This Standard is not met as evidenced by: 46831 Based on observation and interview, the facility failed to ensure an adequate number of qualified personnel were present whenever patients are undergoing dialysis so that the patient/staff ratio is appropriate to the level of dialysis care given and meets the needs of patients. The findings included: 1. Review of the Job Description for the Facility Administrator dated 12/10/2023, revealed, “ ...The Facility Administrator (FA) will be accountable for driving results and is responsible for day-to-day operations of the facility ...” 2. The facility was unable to provide a staffing policy upon request by the surveyor. 3. Observation on the treatment floor on 05/12/2025 at 8:30 AM, revealed one (1) RN and one (1) CCHT working the treatment floor with 13 patients receiving hemodialysis. 4. During an interview on 05/13/2025 at 12:45 PM, the FA stated she did not feel the facility was adequately staffed at this time.”