Fmc Dialysis Services Terrell

“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: 48749 Based on observation, policy review, and staff interview, one (Staff #20) of 1 direct care staff members failed to change gloves and perform hand hygiene between patient encounters and before touching dialysis equipment and sterile supplies. Also, the facility’s direct care staff failed to follow the facility’s “Central Venous Catheter (CVC) Dressing Change” policy. Findings include: During a tour of the facility’s in-center treatment area on 06/24/2025 at 12:30 PM with Staff #1 and Staff #4, the surveyor observed the following; Staff #20 (Registered Nurse), providing Central Venous Catheter (CVC) care to a Patient #11 at dialysis station #12. Staff #20 was observed pulling the patient’s shirt aside to place the CVC ports on a blue pad and then removing the patient’s CVC occlusive dressing. After removing the CVC occlusive dressing, Staff #20 did not change gloves or perform hand hygiene. Staff #20 was observed touching the dialysis machine and opening supplies with the same gloves on when performing the dressing change on the patient. Also, after touching the dialysis machine and opening supplies, Staff #20 cleaned the patient’s CVC site without changing gloves or performing hand hygiene. A review of the facility’s “Central Venous Catheter (CVC) Dressing Change” policy dated 05/06/2024 revealed the following; “Purpose: The purpose of this procedure is to provide guidance for cleaning the central venous catheter (CVC) exit site, changing the catheter dressing, assessing for signs of infection, and maintaining a protective barrier to prevent infection. Removal of Dressing and Inspection of Site: 3. Perform hand hygiene. 4. Don gloves. 5. Inspect and remove the old dressing. Check to see if the dressing looks visibly soiled with exudate or blood. 6. Visually inspect the exit site and surrounding area. Observe for signs and symptoms of infection or complications such as: *Redness *Swelling *Tenderness *Drainage at the exit site *Thinning or wearing away of the skin, cuff extrusion *Dislodgement of catheter *Change in position or appearance of catheter * Missing sutures if temporary catheter in use Note: If any of the items are observed, notify the treating physician, and obtain orders for culture prior to cleaning. 7. Discard dressing and remove gloves. Perform hand hygiene. Cleaning the Catheter Site: 1. Perform hand hygiene and don clean gloves. 2. Remove swab stick/applicator from package by stick/wand end without touching foam applicator. Handle only the stick/wand portion. Note: Do not contaminate the antiseptic product.” An interview with Staff #1 and Staff #4 on 06/25/2025 at 12:50 PM acknowledged that Staff #20 did not change gloves and complete hand hygiene at the appropriate times and intervals as required in the facility’s “Central Venous Catheter (CVC) Dressing Change” policy.”

“IC-CLEAN/DIRTY;MED PREP AREA;NO COMMON CARTS CFR(s): 494.30(a)(1)(i) Clean areas should be clearly designated for the preparation, handling and storage of medications and unused supplies and equipment. Clean areas should be clearly separated from contaminated areas where used supplies and equipment are handled. Do not handle and store medications or clean supplies in the same or an adjacent area to that where used equipment or blood samples are handled. When multiple dose medication vials are used (including vials containing diluents), prepare individual patient doses in a clean (centralized) area away from dialysis stations and deliver separately to each patient. Do not carry multiple dose medication vials from station to station. Do not use common medication carts to deliver medications to patients. If trays are used to deliver medications to individual patients, they must be cleaned between patients. This Standard is not met as evidenced by: 48749 Based on observation, policy review, and interview, the facility staff failed to ensure that medications maintained in the facility were properly safeguarded and not accessible to unauthorized persons. Additionally, the facility staff failed to label medications with the patient’s name, the name of the medication, the dosages prepared, and the initials of the person that prepared the medication. The facility staff failed to follow the facility’s “Medication Preparation and Administration” policy. Findings include: During a tour of the facility on 06/24/2025 at 10:45 AM with Staff #1 and Staff #4, the surveyor observed the following; 1. There was a pre-drawn Heparin (a medication used to thin the blood) syringe sitting unsecured and accessible to unauthorized persons on the chair-side table of Station #10. No patient was sitting at the station in preparation for treatment. 2. Inside an unsecured cabinet located on the back wall next to the first set of dialysis stations, there were 4 pre-drawn Heparin syringes and 2 syringes with illegible labels. The surveyor was unable to determine what medication and what dosage was in the 2 syringes with illegible labels. The surveyor was unable to determine which patient the medication was for. 3. Inside an unsecured cabinet located on the back wall next to the middle set of dialysis stations, there were 2 pre-drawn Heparin syringes and 2 syringes with missing labels. The surveyor was unable to determine what medication and what dosage was in the 2 syringes with no labels. The surveyor was unable to determine which patients the medication was for. 4. Inside an unsecured cabinet located on the back wall next to the last set of dialysis stations, there were 2 pre-drawn Heparin syringes. Also, there was a pre-drawn Heparin syringe found in a container with Hemostat Clamps disinfecting bleach water. A review of the facility’s “Medication Preparation and Administration” policy dated 02/06/2023 revealed the following; “Purpose: To administer medications with the goals of staff and patient safety, optimal therapeutic response, and infection control. Labeling Reconstituted Medication Solutions and Syringes: All medications in syringes not being administered immediately shall be labeled appropriately with the name of the medication, route, dose, name of patient, date, time, and initials of the person who prepared the medication. If more than one syringe of the same medication is needed for a single patient, mark the label as “1 of 2, 2 of 2. * Reconstituted medication admixtures shall also include on the label the date and time the solution was prepared. Pre-Drawing Medications: Medications may be pre-drawn up to 4 hours prior to administration (unless state-specific requirements, such as New Jersey and New Mexico, where there is a 1-hour maximum for pre-drawing medications). These pre-drawn medications shall be labeled and must be kept under the prepare’s control or in a locked designated medication storage area or refrigerated, if necessary, until delivery to the appropriate patient for administration.” An interview was conducted with Staff #1 and Staff #4 on 06/24/2025 at 11:30 AM. Staff #1 and Staff #4 confirmed that the facility staff failed to follow the facility’s “Medication Preparation and Administration” policy and properly safeguard medications in the in-center treatment area.”

“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: 29191 Based on observation, record review, and staff interview: A. The facility staff failed to disinfect four of the 27 dialysis machines (machine #6TOS-156164, 6TOS-156198, 6TOS-156233, and 6TOS-156236) that were put back into service after maintenance and were not bleached within the seven-day timeframe. Also, the staff did not follow the facility’s policy, “Fresenius Dialysis Delivery System Cleaning and Disinfection.” This deficient practice had the likelihood to place all patients being dialyzed on this machine at risk for potential harm, due to the use of bicarbonate during the dialysis process. Bicarbonate has a high potential for bacterial growth. Findings Include: A review of the April 2025 Machine Disinfect log revealed the following: * On 04/25/2025, dialysis machine #6TOS-156164 was documented as out of service. * On 04/15/2025, dialysis machine #6TOS-156236 was documented as out of service. * On 04/08/2025, dialysis machine #6TOS-156233 was 156236 was documented as out of service. * On 04/22/2025, dialysis machine # 6TOS-156198 was documented out of service. There was no documentation provided to support that dialysis machines #6TOS-156164, 6TOS-156198, 6TOS-156233, and 6TOS-156236 received disinfection before being placed back in service for patient use within the 7-day timeframe. A review of the facility’s policy titled, “Hemodialysis Machines: Acid Clean, Chemical Rinse and Heat Disinfection” dated 04/05/2021 revealed the following; “The purpose of this policy is to define the minimum requirements for acid clean, chemical rinse and heat disinfection of hemodialysis machines. Manufacturer’s instructions for use must be followed. * The following defines the minimum dialysis machine cleaning and disinfection requirements. The frequency and duration of system cleaning and disinfection will be scheduled to maintain microbiological contamination to conform with company policy and procedures. * At the end of each treatment day of use, the dialysis machine must be: * Acid cleaned with a set acid clean cycle of a minimum of 15 minutes. * If the machine was in conductivity, the acid clean program must be performed prior to heat disinfection or chemical rinse using either vinegar or citric acid. * Heat disinfection must be set to run a minimum of 20 minutes once the timer has started. * Chemical Rinse must be performed at a minimum of weekly (every 7-days) * The machine will automatically perform a HE Leak test upon the start of the Chemical Rinse program. * The machine will automatically perform a Diasafe test after the Chemical Rinse program ends. * When using a hemodialysis machine with SLED capability, a mandatory heat disinfection followed by a rinse must be completed every 12 hours when the same patient is being treated for continuous SLED treatment. * The chemical rinse program will be performed using bleach. * The dialysis machine must be chemically rinsed after a dialyzer blood leak. Operation of the machine in rinse mode during loop disinfection does NOT substitute the daily machine disinfection. * Presence testing for chlorine will be performed using WaterCheckTM RC Residual Chlorine Reagent Test Strips. * Color development must be dark brown/black color indicating at least 500ppm. * Residual testing for chlorine will be performed using WaterCheckTM RC Residual Chlorine Reagent Test Strips: * At the beginning of a treatment day that follows a chemical disinfection of the water treatment system. * Following hemodialysis machine chemical rinse. * Test strip must detect less than 0.5ppm of residual chlorine, the maximum allowable level as recommended by AAMI.” An interview with Staff #7 (Bio-Medical Technician) and Staff #11 (Area Bio-Medical) was conducted on 06/25/2021 at 11:00 AM. Staff #7 and Staff #11 acknowledged the findings that four dialysis machines did not receive disinfection before being put back into service for patient use. B. The facility’s direct care staff failed to properly clean and disinfect the dialysis station and equipment before the next patient’s treatment. Additionally, the staff did not follow the facility’s policies titled “Cleaning and Disinfection of the Dialysis Station” and “General Cleanliness and Infection Control Guidelines.” During a tour of the facility’s in-center treatment area on 06/24/2025 at 11:00 AM with Staff #1 the surveyor observed the following; Direct Care Staff were cleaning and disinfecting Dialysis Stations #3, #4, #12, and #22 after a patient’s hemodialysis treatment. The surveyor observed the staff open the wings of the dialysis chairs, clean, and then promptly close the wings. They did not allow enough time for the disinfectant to dry before closing the wings. The surveyor also saw Staff #21 clean only the dialysis chair and place the sterile dialysis tubing and dialyzer in the chair for the next patient. Staff #21 did not clean the dialysis machine, which had blood splattered on the front. C. During turnover between the first hemodialysis session and the second hemodialysis session, the surveyor observed 3 patients hold the handrail on the scale when obtaining their weight for treatment. The facility staff did not clean and disinfect the scale handrail between each patient. A review of the facility’s policy titled, “Cleaning and Disinfection of the Dialysis Station,” dated 09/05/2023, revealed the following; “PURPOSE: The purpose of this policy is to provide guidelines to prevent the spread of infectious disease in accordance with appropriate regulations, and to maintain a clean, safe, and aesthetically pleasant environment for patients, staff, and visitors. BACKGROUND: The Centers for Medicare and Medicaid Services (CMS) has regulations that in order to prevent cross-contamination, a dialysis station must be cleaned and disinfected between dialysis patients. The chair and dialysis equipment are used by multiple patients during a treatment day and it is critical that these items be thoroughly cleaned and disinfected between uses. To prevent cross-contamination between patients, it is important that the previous patient completely vacate the station before staff begin cleaning and disinfection of the station and set up for the next patient. For patients dialyzing in a treatment area where multiple patients dialyze, the patient must completely vacate the dialysis station before the dialysis machine can be externally disinfected, allowed to dry and set up for the next treatment. All dialysis patients must be clinically stabilized (i.e. stable blood pressure, vascular access hemostasis) following their dialysis treatments before being moved from the dialysis station. If a patient is not sufficiently stable to be moved from the dialysis station, cleaning and disinfection of the equipment at the station and preparations for the next patient must be delayed until the patient is able to be safely moved outside the station.” A review of the facility’s policy titled, “General Cleanliness and Infection Control Guidelines” dated 05/05/2025 revealed the following: “PURPOSE: The purpose of this policy is to provide guidance for FKC 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, offices, and restrooms. *Facilities must adhere to any state-specific regulations that pertain to facility cleaning and disinfection.” During an interview with Staff #1 on 06/24/2025 at 12:30 PM, Staff #1 acknowledged that Direct Care Staff did not allow the chair to air dry before closing the wings. Staff #1 and Staff #4 acknowledged that the staff were not cleaning and disinfecting the handrail on the scale. D. During a tour of the treatment floor, the surveyors observed bleach solution containers that were dated and labeled with the 1:100 bleach solution. The clamps were not submerged in the bleach solution. Also, the surveyors observed a syringe in the bleach solution. The surveyor don gloves and removed the syringe from the bleach solution. The syringe was labeled Heparin, and patient #7’s name was on the syringe. An interview with the Direct Care Staff and the Director of Operations on 06/24/2025 at 11:52 AM acknowledged they had no idea how the Heparin syringe got placed in the bleach solution. A review of the facility’s policy titled, “Cleaning and Disinfecting Plastic Hemostat Clamps and Plastic Vascular Clamps” dated 07/01/2024 revealed the following; “The purpose of this document is to provide guidance for cleaning and disinfecting plastic hemostat clamps and plastic vascular clamps. The term plastic hemostat clamp is being used to refer to the “blue clamp” used to hold vascular lines and underpad securely. In some localities, these types of plastic hemostat clamps may also be referred to as, “blue clamps”, “plastic hemostat clamps”, or “tube occluding forceps”. The term plastic vascular clamp refers to the plastic vascular spring clamps that are used to apply pressure to the venipuncture site post- needle removal. In some localities, these types of clamps may also be referred to as “fistula holders”, “fistula clamps”, or “vascular clamps”. The cleaning and disinfection of plastic hemostat clamps and plastic vascular clamps is required after each use. Clamps should be discarded if there is weakness of the plastic hemostat clamp rivets/plastic, vascular clamp springs are rusted, or weakness is detected. 1) Perform hand hygiene and don PPE. 2) Place soiled plastic, vascular clamps in the labeled opaque plastic container filled with 1:100 bleach solution according to the Mixing Bleach policy. 3) Ensure the plastic vascular clamps are completely submerged. 4) Allow clamps to soak in the bleach solution for 10 minutes. 5) Once completely dry, store plastic vascular clamps in a covered storage container when not in use.” An interview with Staff #1 on 06/24/2025 at 12:30 PM confirmed that the facility staff failed to follow facility guidelines on verifying that the vascular clamps were completely submerged in the bleach solution.”

“BICARB JUGS RINSED DAILY/STORED DRY CFR(s): 494.40(a) 6.5 Concentrate distribution: bicarb jugs rinsed daily/stored dry Bicarbonate concentrate jugs should be rinsed with treated water and stored inverted at the end of each treatment day. Pick-up tubes should also be rinsed with treated water and allowed to air dry at the end of each treatment day. This Standard is not met as evidenced by: 29191 Based on observation and interview, the facility staff failed to ensure that the acid pick-up tubes (wands) were fitting securely to the acid jugs being used to dialyze the patients to prevent bacterial contamination and evaporation during dialysis treatment. This deficient practice allowed for cross-contamination and acid spills from the acid jug. While the acid concentrate is not susceptible to bacterial contamination, every effort should be made to keep the system closed to prevent nonbacterial contamination and evaporation per the ANSI/AAMI standards. During a tour of the facility on 06/24/2025 at 11:45 AM, observed 4 patients at stations #1, #4, #7, and #18 receiving dialysis treatment. The pick-up tubes (wand) were observed to be hanging out of the acid jug. There was no secure connection from the pick-up tube to the opening of the acid jug. The surveyor observed one wand that was fitting securely, and all other wands did not fit the acid jugs. There was no tight connection of the wand to the opening of the acid jug. An interview with Staff #7 on 06/24/2025 at 11:45 AM was conducted to ask why there are different acid wands being used in the facility. Staff #7 stated, “I will get new wands ordered that fit the acid jugs. A review of the facility’s policy titled, “Acid Concentrate Storage and Handling,” dated 09/03/2024 revealed the following: “Remove the wand assembly, replace the clean cap on the container, rinse wand with RO water, hang vertically and allow to dry. Once wand is dry, store in a covered container labeled: “Clean Wands” . An interview with Staff #7 on 06/24/2025 at 12:15 PM confirmed the wands were unsecured and hanging from the acid jugs on 4 patients receiving dialysis treatments. Also, the facility was not following the facility’s policy for wand storage.”

“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: 48749 Based on observation and staff interviews, the facility staff failed to ensure the emergency pull cord (a call light strategically placed throughout the facility to provide a user with a means of summoning help in an emergency) was accessible for the facility’s patients in the event of an emergency. This deficient practice had the likelihood of causing harm and delay of care to patients in the event of an emergency. Findings include: Upon entering the facility’s lobby on 06/24/2025 at 10:10 AM, the surveyor observed the following; *The emergency pull cord in the lobby was against the wall behind a table and chair. The emergency pull cord was not easily accessible for the facility’s patients in the event of an emergency. The emergency pull cord should be within 6 inches of the floor, hanging freely, and accessible to patients. An interview was conducted with Staff #1 on the afternoon of 06/24/2025. Staff #1 acknowledged the surveyor’s findings of the emergency pull cord behind a table and chair in the main lobby.”

“PR-PTS INFORMED OF RIGHTS WHEN BEGIN TX CFR(s): 494.70 The dialysis facility must inform patients (or their representatives) of their rights (including their privacy rights) and responsibilities when they begin their treatment and must protect and provide for the exercise of those rights. This Standard is not met as evidenced by: 29191 Based on record review and staff interview, the facility staff failed to ensure a properly executed informed consent for hemodialysis treatment was completed for 2 (# 5 and #14 ) of 7 patient medical records reviewed. Also, the facility staff failed to follow the “Informed Consent” and “Patient Rights and Responsibilities” policies. Patient # 5 A review of the medical record for Patient # 5 revealed the patient was admitted to the facility on 02/26/2025. A review of the patient’s “Confirmation of Consent for In-Center Hemodialysis Treatment” revealed the form was signed by the patient on 02/13/2025. There was no time or witness signature on the informed consent form. The facility staff could not provide evidence that the consent was obtained before the patient’s first dialysis treatment on 02/13/2025, because there was no date, time, or signature witness on the informed consent form verifying the patient’s signature. The facility staff could not provide evidence that the physician or physician extender explained the dialysis therapy, alternatives, and associated risks, benefits, and consequences to the patient, as required by the facility’s “Informed Consent” policy. There was no witness signature on the informed consent form; therefore, it could not be determined whether the appropriate clinical personnel, such as a registered nurse, were present and available to reinforce information, answer questions posed by the patient, or explain other aspects of the treatment. It also could not be determined which, if any, appropriate clinical personnel reviewed the informed consent before the patient started hemodialysis treatment. Patient # 14 A review of medical records for Patient # 14 revealed the patient was admitted to the facility on 05/25/2025. A review of the patient’s “Confirmation of Consent for In-Center Hemodialysis Treatment” revealed the form was signed by the patient on 05/25/2025. There was no witness signature on the informed consent form. The facility staff could not provide evidence that the consent was obtained before the patient’s first dialysis treatment on 02/13/2025, because there was no date, time, or signature witness on the informed consent form verifying the patient’s signature. The facility staff could not provide evidence that the physician or physician extender explained the dialysis therapy, alternatives, and associated risks, benefits, and consequences to the patient, as required by the facility’s “Informed Consent” policy. There was no witness signature on the informed consent form; therefore, it could not be determined whether the appropriate clinical personnel, such as a registered nurse, were present and available to reinforce information, answer questions posed by the patient, or explain other aspects of the treatment. It also could not be determined which, if any, appropriate clinical personnel reviewed the informed consent before the patient started hemodialysis treatment. A review of the facility’s policy, “Informed Consent,” with a published date of 04/05/2021, revealed the following, “PURPOSE: The purpose of this policy is to ensure each patient or authorized decision maker has authorized to perform designated procedures. RESPONSIBILITY: Nephrologist, physician extended, or licensed nurse (as defined by job description, license, certification, and State and Federal Regulation). Prior to starting dialysis, the patient will have spoken to his or her physician(s), a physician extended, who will have explained dialysis therapy, alternatives, and associated risks, benefits, and consequences. The nurse may reinforce this information while obtaining a signature on the consent and answer any questions raised by the patient. It is inappropriate to have the consent reviewed with the patient by other non-medical personnel such as a social worker or facility clerical staff. Although these persons may explain various aspects of treatment and have expertise in their area of work, the person reviewing the consent requires a broader scope of knowledge ...” A review of the facility’s policy, “Patient Rights and Responsibilities,” with a published date of 04/04/2012, revealed the following, “Purpose: To comply with Federal Regulations that require dialysis facilities to: Educate staff regarding the rights of dialysis patients. Inform and educate all dialysis patients about their rights and responsibilities as a patient at the dialysis facility. Ensure that patients’ rights are respected and protected by the facility ... The Conditions for Coverage, §494.70 Condition: Patients’ Rights require dialysis facilities to inform patients or their representatives of their rights (including their privacy rights) and responsibilities when they begin their treatment and must protect and provide for the exercise of those rights. Patients’ rights as stated in the Conditions for Coverage: The patient has the right to - 1. Respect, dignity, and recognition of his or her individuality and personal needs, and sensitivity to his or her psychological needs and ability to cope with ESRD; 2. Receive all information in a way that he or she can understand; 3. Privacy and confidentiality in all aspects of treatment; 4. Privacy and confidentiality in personal medical records; 5. Be informed about and participate if desired, in all aspects of his or her care, and be informed of the right to refuse treatment, to discontinue treatment, and to refuse to participate in experimental research; 6. Be informed about his or her right to execute advance directives, and the facility’s policies regarding advance directives; 7. Be informed about all treatment modalities and settings, including but not limited to transplantation, home dialysis modalities (home hemodialysis, intermittent peritoneal dialysis, continuous ambulatory peritoneal dialysis, continuous cycling peritoneal dialysis), and infacility hemodialysis. The patient has the right to receive resource information for dialysis modalities not offered by the facility, including information about alternative scheduling options for working patients; 8. Be informed of facility policies regarding patient care, including, but not limited to isolation patients; 9. Be informed of facility policies regarding the reuse of dialysis supplies, including hemodialyzers; 10. Be informed by the physician, nurse practitioner, clinical nurse specialist, or physician’s assistant treating the patient for ESRD of his or her own medical status as documented in the patient’s medical record, unless the medical record contains a documented contraindication; 11. Be informed of services available in the facility and charges for services not covered under Medicare; 12. Receive the necessary services outlined in the patient plan of care; 13. Be informed of the rules and expectations of the facility regarding patient conduct and responsibilities; 14. Be informed of the facility’s internal grievance process; 15. Be informed of external grievance mechanisms and processes, including how to contact the ESRD Network and the State survey agency; 16. Be informed of his or her right to file internal grievances or external grievances, without reprisal or denial of services; and 17. Be informed that he or she may file internal grievances or external grievances personally, anonymously or through a representative of the patient’s choosing. 18. Be informed of the facility’s policies for transfer, routine or involuntary discharge, and discontinuation of services to patients; 19. Receive written notice 30 days in advance of an involuntary discharge, if discharge is justified and not due to an immediate threat to the health and safety of others. Policy: All patients and/or their representatives will be informed of their rights (including privacy rights) and responsibilities. Patient rights and the ability to exercise these rights must be protected by the facility. The FMCNA Patient Rights and Responsibilities brochure explains the rights patients can expect to have while receiving treatment at this facility. The brochure also provides guidance as to certain responsibilities that are expected of the patient. Each patient will be informed of their rights and given a copy of the FMCNA Patient Rights and Responsibilities within the first six (6) treatments in the facility. More in-depth discussions with patients about their rights and responsibilities are expected. These discussions may occur over a longer period of time. Facilities should ensure that this information is provided to patients in a manner they can understand. For example, providing the FMCNA Patient Rights and Responsibilities brochure in the patient’s primary language or having it interpreted based on assessment of the patient’s language and reading preferences, or enlisting the aid of communication aids or interpreters for patients who are blind or have low vision, or are deaf or hard of hearing. Dialysis facilities must prominently display a copy of the patient’s rights in a visible and accessible area in the facility and must include contact information for the State survey agency and ESRD Network. The FMCNA Patient Rights and Responsibilities brochures are available in English and Spanish. They may be purchased from the FMS Marketing Online Ordering Center. Audio versions in English and Spanish may also be ordered through the FMS Marketing Online Ordering Center. Patients have the right to privately discuss their condition and treatment. There should be ready access to a room in the facility where patient and/or family meetings may be held in private. Patients have the right to privacy during activities that may require the exposure of private body parts while in the dialysis facility. Privacy screens or curtains may be used to provide privacy. Blankets may also be used as long as staff are able to observe the patient’s vascular access, bloodline connections, and face at all times. Patients or their representatives must be provided unbiased education about transplantation and all dialysis treatment options regardless of whether these options are available in the current facility. Evidence of failure to treat patients with respect and dignity, provide an opportunity for private communication, or prevent exposure of private body areas resulting in emotional discomfort for the patient, and evidence that cognizant patients/designees are not aware of their options for treatment or available grievance mechanisms could result in the facility receiving a Condition level citation.” An interview was conducted with Staff # 1 on 06/25/2025 at 10:00 AM, which confirmed the facility staff did not obtain a properly executed informed consent before the patient’s treatment started.”

“PR-PARTICIPATE IN CARE;DISC/REFUSE TX CFR(s): 494.70(a)(5) The patient has the right to- (5) Be informed about and participate, if desired, in all aspects of his or her care, and be informed of the right to refuse treatment, to discontinue treatment, and to refuse to participate in experimental research; This Standard is not met as evidenced by: 29191 Based on the record review and interview, the facility failed to provide evidence of patient participation in the care plan process for 7 (#5, #9, #12, #13, #14, #15, and #16) of 7 patients. Patients have the right to know about and participate in their care and treatment to the extent they wish. Findings include: A review of the care plans for Patients #5, #9, #12, #13, #14, #15, and #16 revealed that these patients had not been invited to the IDT (Interdisciplinary Team) meeting. None of the seven patients had any documentation showing they were invited to attend their Plan of Care meeting. An interview with Staff #4 on 6/25/2025 at 10:00 AM confirmed the lack of evidence that the patients had been invited to attend an IDT (Interdisciplinary Team) meeting to discuss the patient’s Plan of Care. A review of the facility’s policy titled, “Comprehensive Interdisciplinary Assessment and Plan of Care,” dated 07/03/2023 revealed the following: “The following are recommendations for involving the patient in the development and review of the plan of care: *Provide appropriate patient education to enable to patient to participate in the development of the Plan of Care *Encourage both patients and family to participate in the Plan of Care discussions in whatever format the facility and attending physician develop *Notify the patient in writing of the time and date of the Plan of Care review *Review expectations for participation in the Plan of Care with each patient *Review the expectations again when Rights and Responsibilities are reviewed.” An interview with Staff #1 on 06/25/2025 at 10:00 AM confirmed that there was no evidence that patients were being invited in advance to attend an IDT (Interdisciplinary Team) meeting to decide whether to participate and discuss their Plan of Care.”

“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: 48749 Based on observation, policy review, and interview, the facility’s direct care staff failed to: A. Monitor the vascular access during dialysis treatment for 8 (#5, #17, #18, #19, #20, #21, #22, and #23) of 8 patients observed. The facility staff failed to follow the facility’s “Access Checklist”. B. Assess the vascular access to determine the access patency for 2 (#25 and #26) of 2 patients observed. The facility staff failed to follow the facility’s “Access Assessment and Cannulation” policy. This deficient practice of not assessing the patient’s access had the likelihood of not detecting potential problems, such as infection, clotting, stenosis, and access failure. Additionally, failure to ensure the patient’s dialysis access was visible throughout treatment had the likelihood to result in the patient’s needle becoming dislodged. A dislodged needle could result in the patient bleeding out without the facility staff recognizing it. Findings include: During a tour of the in-center treatment area on 06/24/2025 at 10:45 AM, the surveyor observed the following; A. *The Central Venous Catheter (CVC) (A long, thin, flexible tube inserted into a large vein to access the bloodstream for administration of medications, fluids, and blood products) for Patient #5 was covered with the patient’s personal towel at Station #1 *The Arteriovenous (AV) graft (A form of vascular access which is created by inserting a synthetic tube to connect a vein to an artery) for Patient #17 was covered with a blanket at Station #4 *The AV graft for Patient #18 was covered with a blanket at Station #7 *The AV graft for Patient #19 was covered with a blanket at Station #8 *The AV graft for Patient #20 was covered with a blanket at Station #12 *The AV graft for Patient #21 was covered with a blanket at Station #15 *The AV graft for Patient #22 was covered with a blanket at Station #16 *The AV graft for Patient #23 was covered with a blanket at Station #17 A review of the facility’s “Access Checklist” revealed the following; “Keep access visible at all times. Keep bloodline connections visible.” B. *The surveyor observed Staff #19 access Patient #25’s AV graft without completing a full assessment of the access. Staff #19 failed to auscultate the AV graft to determine patency and check for a bruit (the sound of blood flowing through the graft, and it should sound like a continuous hum or whooshing). *The surveyor observed Staff #22 access Patient #26’s AV graft without completing a full assessment of the access. Staff #22 failed to auscultate the AV graft to determine patency and check for a bruit. A review of the facility’s policy titled, “Access Assessment and Cannulation” dated 05/05/2025 revealed the following; “Purpose: The purpose of this procedure is to provide guidance for assessing patency and placement of needles in an AV Fistula or AV Graft to obtain access to the circulatory system for hemodialysis. Before each treatment, the internal access must be assessed for patency, signs of infection, and any abnormal findings. The access must be prepared properly for needle placement to prevent bacteria from entering the bloodstream through the skin. Cannulation of an access is a skill that, when performed properly, increases the longevity of the access, minimizes trauma, complications, and the possibility of recirculation during the treatment, and also ensures good blood flow through the dialysis system. Evaluation and preparation of the access will be performed routinely prior to cannulation at each dialysis session. Assessment of Vascular Access: 6. LISTEN: *Bruit high pitch/whistle *Bruit not present throughout access. *Document in treatment record.” An interview was conducted with Staff #1 and Staff #4 on the afternoon of 06/25/2025. Staff #1 and Staff #4 confirmed the findings of the patients’ access sites covered and not monitored by the facility Direct Care Staff. Staff #1 and Staff #4 acknowledged the surveyor’s findings of staff not assessing the patient’s access site before initiating treatment.”