Usrc Premier Mesquite

“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: 30377 Based on observation and interview, the facility failed to monitor and maintain a sanitary environment to minimize the transmission of infectious agents within the dialysis center. These findings have the likelihood to cause harm by increasing the risk of infection to all patients receiving care at the dialysis facility. During a tour of the facility’s in-center treatment area with the Facility Administrator on the morning of 08/28/2024, the surveyor observed the following: BIOMED WORK AREA: *Disorganized and cluttered. *Stored alongside the BioMed’s tools were cup of drinking water. IN-CENTER TREATMENT AREA: *Patient’s wheelchairs/walkers were stored alongside used biohazard containers in the treatment area. *Observed dried brown stain that appeared to be dry blood splatter on top of sharps container. *Observed laminate countertops throughout the treatment area with missing and chipped laminate. *Observed chipped and peeling paint inside drawers where patient supplies were stored. *Observed walls (below wall boxes) throughout the treatment area that were damaged with paint peeling away. An interview with the Facility Manager on 08/28/2024 confirmed the infection control issues found in the BioMed area and in-center treatment area at time of observation.”

“PA-ASSESS B/P, FLUID MANAGEMENT NEEDS CFR(s): 494.80(a)(2) The patient’s comprehensive assessment must include, but is not limited to, the following: Blood pressure, and fluid management needs. This Standard is not met as evidenced by: 30377 Based on review of hemodialysis flow sheets and staff interview the facility failed to ensure that direct patient care staff reported significant changes in patient health status while receiving hemodialysis to the charge nurse and or the charge nurse failed to reassess the patient when significant changes occurred during treatment. The facility also failed to ensure that vital signs were obtained and documented every thirty minutes. The findings included: Review of hemodialysis flow sheets dated 8/26/24 and 8/27/24 in the facility conference room revealed an example of the following discrepancies: Patient # 1 Flow Sheet Dated: 8/27/24 Initiation of treatment: 0630 AM Termination of treatment: 10:33 AM. Pre-Vitals: 189/71 heart rate 63. During treatment blood pressure recorded from 197/68 to 157/43 with heart rate recorded from 40-94. Post Vitals: 194/56 heart rate 44. The Following vitals were recorded: 07:03 AM: Blood Pressure: 175/62 with heart rate 46. There was no documentation found that the direct patient care staff notified the registered nurse of the low heart rate. 07:33 AM: Blood Pressure: 176/64 with heart rate 43: The direct patient care staff documented “ ...notified nurse about b/p” There was no documentation found that the direct patient care staff notified the registered nurse of the low heart rate. 08:03 AM: Blood Pressure: 174/02 with heart rate 40. The direct patient care staff documented “ ...notified nurse about pulse.” There was no documentation found that the registered nurse addressed the low heart rate. 08:33 AM: Blood Pressure: 184/58 with heart rate 45. The direct patient care staff documented “ ...B/P elevated, HR low, per RN ok to continue to run ...” There was no documentation found by the registered nurse to address the elevated blood pressure and the low heart rate. Treatment termed at 10:33 AM. Post Vitals: 194/56 heart rate 44. There was no documentation found that the registered nurse addressed the elevated blood pressure and low heart rate at time of discharge. Patients # 2, # 3, and #4: There was no documentation found that the registered nurse completed the charge nurse round. Patient # 5: The Following vitals were recorded: 10:55 AM: Blood Pressure: 140/68 with heart rate 86. The direct patient care staff acknowledged this vital set at 12:30 PM as a late entry. 11:25 AM: Blood Pressure: 146/76 with heart rate 80. The direct patient care staff acknowledged this vital set at 12:30 PM as a late entry. 11:55 AM: Blood Pressure: 155/76 with heart rate 76. The direct patient care staff acknowledged this vital set at 12:30 PM as a late entry. 12:26 AM: Blood Pressure: 155/75 with heart rate 76. The direct patient care staff acknowledged this vital set at 12:30 PM as a late entry. A review of the facility policy, “Reportable Parameters to CN” with a revision date of January 2020 stated: PCT/CCHT/LPN: Reports to Charge Nurse Pre-Dialysis: B/P Systolic >180 Pulse < 50 PCT/CCHT/LPN: Reports to Charge Nurse Intra-Dialysis: B/P Systolic >180 Pulse < 50 PCT/CCHT/LPN: Reports to Charge Nurse Post-Dialysis: B/P Systolic >180 Pulse < 50 A review of the facility policy, “Intradialytic Monitoring of Patient” with a revision dare of September 2020 stated: Patient: 1. Must be in direct view of staff members at all times. 2. Vital signs: Obtained and documented at least every 30 minutes and reported to charge nurse if outside of standing orders or reportable parameters. An interview conducted with (Staff #2) on 8/28/24 following her own review of the findings revealed she was unaware of the discrepancies found in the flow sheets. Staff #2 confirmed the above findings.”