Killeen Kidney Center

“COMPLIANCE WITH FED/STATE/LOCAL LAWS CFR(s): 494.20 The facility and its staff must operate and furnish services in compliance with applicable Federal, State, and local laws and regulations pertaining to licensure and any other relevant health and safety requirements. This Standard is not met as evidenced by: 43999 Based on review of documentation and interview, it was determined the facility Charge Nurses were assigned patient care duties contrary to Texas ESRD Rules and Regulations. Findings : During observation of the facility treatment room and review of patient/staff assignments on 6/10 /25 & 6/11/25 it was found the Charge Nurse (CN) was assigned direct patient care and charge nurse responsibilities. Direct patient care for the nurse team lead who is assigned as the CN includes patient care to assigned patients that have a CVC (Central venous catheter), medication administration, patient assessments, and supervision of patient care technician and other CN duties . Additional review of the facilities January 2025 through May 2025 staff schedule it was revealed this was the two RN (team leads )were scheduled with no designated CN scheduled. In an interview with staff #7 & #8, 6/10/25 they confirmed the assigned CN is assigned direct patient care along with other nurses that provide direct patient care on the schedule.”

“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: 43999 Based on observation, interview, and review of the facility’s policy, the facility failed to ensure that cleaning and disinfection of equipment used for all patients was completed properly and according to the facility’s policy. Failure to use recommended infection control practices increases the risk for cross contamination and has the potential to expose patients, staff, and others to blood-borne pathogens. This deficient practice had the potential to affect all patients receiving treatment in the dialysis unit. Findings: Facility policy titled, “Infection Control Overview” , published 05/02/2022 stated in part, All dialysis programs will incorporate the FKC infection control program, which is comprehensive in nature...All infection control policies for patient care are consistent with recommendation of the Centers for Disease Control (CDC). All infection control policies will adhere to CMS and OSHA rules and regulations.” On 6/11/25 a patient was observed using the handheld electronic thermometer at the weigh in area prior to treatment and did not disinfect after use. Staff # 11 used the thermometer to take another patient’s temperature, without disinfecting the thermometer between patients. The patient and the staff did not use gloves when handling the thermometer and did not sanitize hands before or after use. Staff #12 confirmed on 6/11/25 that patients and staff use the thermometer and do not disinfect between use and this does not follow the infection control procedures.”

“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: 43999 Based on record review and interview, the facility failed to ensure that dialysis staff annual competencies and skills checklist were completed. Findings: Review of personnel files for 4 of 6 staff members revealed the following documentation were unavailable: Staff # 9 missing annual competency exam and water skills validation with checklist. Staff # 10 missing annual skills competency checklist. Staff # 11 did not have a personnel file to review at the facility ( nurse is a float nurse from a different area) Staff # 14 missing water skills validation with checklist During an interview on the afternoon of 6/11/25, Staff #8 confirmed the documents requested for the staff listed were not available.”

“PQ-NURSE MANAGER-12 MO RN+6 MO DIALYSIS CFR(s): 494.140(b)(1) (1) Nurse manager. The facility must have a nurse manager responsible for nursing services in the facility who must- (i) Be a full time employee of the facility; (ii) Be a registered nurse; and (iii) Have at least 12 months of experience in clinical nursing, and an additional 6 months of experience in providing nursing care to patients on maintenance dialysis. This Standard is not met as evidenced by: 43999 Based on observation, interview and record review, the facility failed to have a full-time registered nurse in charge of nursing who provides supervision and manages care and services of patients and staff in the facility. Findings: Staff #8 is the interim supervising nurse in the facility and is also the Regional Float Manager. Staff # 8 is available at the facility 2-3 days a week, with no other supervising nurse assigned to be available. The current Charge Nurse II , staff #19 is on Leave for 30 days. The Interim Facility Administrator (FA) is available 2-3 days a week but is not a nurse. Staff #8 interviewed 6/10/25 shared they are recruiting for a full time supervising nurse since the previous nurse resigned unexpectedly in April 2025. The Interim FA and the CN II on leave were filling the potions pending position being filled. In an interview 6/11/25, staff # 7, Director of Operations (DO) confirmed the facility did not currently have a full time supervising nurse. She stated they were beginning interviews for the position. She further confirmed the current interim supervising nurse is only at the facility maybe 2 days a week and also supervises another facility that is greater than two and a half hours away.”

“MD RESP-ENSURE ALL ADHERE TO P&P CFR(s): 494.150(c)(2)(i) The medical director must- (2) Ensure that- (i) All policies and procedures relative to patient admissions, patient care, infection control, and safety are adhered to by all individuals who treat patients in the facility, including attending physicians and nonphysician providers; This Standard is not met as evidenced by: 43999 Based on record reviews, and interviews, the medical director did not ensure facility staff followed policies and procedures relative to patient care and safety. The documentation of the daily, weekly and monthly logs for the mixing, handling and using of 2% Citric acid were not complete. Findings: Facility policy titled “Mixing Handling and Using 2% Citric Acid published 5/5/2024 partly states, “Facility staff will document the mixing of 2% citric acid on the 2% Citric Acid Solution Mixing Log located in the corporate approved electronic documentation system. Facility staff will document the weekly rinsing of 2% citric acid individual machine bottles and caps on the 2% Citric Acid Individual Machine Bottle/Caps Weekly Rinse Log located in the corporate approved electronic documentation system. Documentation Document the disinfection on the 2% Citric Acid Container and Bottle of Disinfection Bleach Disinfection Log located in the corporate approved electronic documentation system.” On 6/11/25 , review of the 2% Citric Acid logs located in the corporate approved electronic documentation system 3/1/25 to 6/11/25 revealed the following: Mixing 2% Citric Acid ( required daily) : April 15, 2025; May 13.14.16, 21, 31,2025 ;June 5,6,10 11,2025 2% Citric Acid Individual Machine Bottle/Caps Weekly Rinse Log : unavailable 2% Citric Acid Container and Bottle Bleach Disinfection Log : unavailable On 6/11/25, Staff # 8 confirmed facility staff did not follow policy and procedures for Mixing Handling and Using 2% Citric Acid to include missing documentation in the electronic documentation system..”