Usrc Chinatown Dialysis

“PR-RECEIVE SERVICES OUTLINED IN POC CFR(s): 494.70(a)(12) The patient has the right to- (12) Receive the necessary services outlined in the patient plan of care described in §494.90; This Standard is not met as evidenced by: 48020 Based on observation, record review and interview, the facility’s licensed nurses and direct care staff failed to administer patients’ hemodialysis treatments based on physicians’ orders in of 10 sampled patients: Patient #s 5, 10 B) the registered nurses failed to document the review of patient treatment prescription and equipment parameters to verify correct settings, and if dialysis prescription is being followed in of 10 sampled patients: Patient #s 5, 10, 1, 3, 8 Findings: Review of the facility’s current Policy and Procedure on Pre-Dialysis Equipment Assessment; Policy # C-PT-0020, revision date: 07/2024 directs staff as follows: PROCEDURE: d. Verify: i. Prescription is programmed correctly into the dialysis machine’s interface; Review of the facility’s current Policy and Procedure on Intradialytic Monitoring of Patient; Policy # C-ID-0010, revision date: 07/2024 directs staff as follows: MONITORING: Direct patient care staff will monitor the following parameters during each dialysis treatment: 8. Delivery of dialysis prescription: review prescribed treatment orders against actual machine settings. Machine Settings Patient #5 On 1/7/2026 at 9:39 AM Patient #5 was observed on the treatment floor of the facility at station #10 machine #13. The patient was receiving hemodialysis treatment at a blood flow rate of 250 milliliters/minute (mL/min) and dialysate flow rate of Autoflow 1.5 (a500) mL/min. The patient was utilizing an Optiflux F180 non reuse dialyzer via a right upper arm vascular access. The Surveyor asked Charge Nurse (A) who was chairside to reveal the dialysate settings on machine #13. The machine dialysate settings were: potassium 3.1 mEq/L, calcium 2.5 mEq/L, bicarbonate 30 mEq/L, sodium 136 mEq/L. The hemodialysis machine’s acid connector was attached to the wall box which was administering the standard dialysate bath of potassium 2.0 mEq/L and calcium 2.5 mEq/L and not to a jug of potassium 3.0 mEq/L. The Surveyor notified Charge Nurse (A) of the incorrect potassium dialysate setting. Charge Nurse (A) said, “I saw the mistake. It was not changed.” Patient #10 Review of the patient’s clinical record on 1/7/2026 revealed the patient was admitted to the facility on 04/05/2024 with diagnoses of end stage renal disease, hypertension, seizure, anemia, and CKD-MBD, on in-center hemodialysis three times weekly. Treatment sheet review: Review of the patient’s treatment sheet dated 01/06/2026 revealed documentation which indicated the patient was prescribed a dialysate flow rate of 800 mL/min on the treatment sheet but received hemodialysis treatment at a dialysate flow rate of 600 mL/min from 16:07 PM - 18:31 PM. There was no justification documented for the dialysate flow rate of 600 mL/min. Review of the patient’s treatment sheet dated 01/04/2026 revealed documentation which indicated the patient was prescribed a dialysate flow rate of 800 mL/min on the treatment sheet but received hemodialysis treatment at a dialysate flow rate of 600 mL/min from 16:12 PM - 18:25 PM. There was no justification documented for the dialysate flow rate of 600 mL/min. Review of the patient’s treatment sheet dated 01/02/2026 revealed documentation which indicated the patient was prescribed a dialysate flow rate of 800 mL/min on the treatment sheet but received hemodialysis treatment at a dialysate flow rate of 600 mL/min from 16:15 PM - 18:47 PM. There was no justification documented for the dialysate flow rate of 600 mL/min. Review of the patient’s treatment sheet dated 12/30/2025 revealed documentation which indicated the patient was prescribed a dialysate flow rate of 800 mL/min on the treatment sheet but received hemodialysis treatment at a dialysate flow rate of 600 mL/min from 16:08 PM - 18:18 PM. There was no justification documented for the dialysate flow rate of 600 mL/min. Interview during record review with covering Facility Administrator, RN (D) on 01/07/2026 at 3:58 PM confirmed the patients did not receive the hemodialysis treatment according to physicians’ orders. Covering Facility Administrator, RN (D) said, “Okay.” RN Prescription Verification Patient #5 On 1/7/2026 at 9:39 AM Patient #5 was observed on the treatment floor of the facility at station #10 machine #13. The patient was receiving hemodialysis treatment at a blood flow rate of 250 milliliters/minute (mL/min) and dialysate flow rate of Autoflow 1.5 (a500) mL/min. The patient was utilizing an Optiflux F180 non reuse dialyzer via a right upper arm vascular access. Treatment sheet review: Review of the patient’s treatment sheet dated 12/31/2025 revealed documentation which indicated the patient received the hemodialysis treatment from 6:59 AM - 10:26 AM. There was no documented review of the prescribed treatment orders against actual machine settings per the facility’s policy. Review of the patient’s treatment sheet dated 12/29/2025 revealed documentation which indicated the patient received the hemodialysis treatment from 7:02 AM - 10:35 AM. There was no documented review of the prescribed treatment orders against actual machine settings per the facility’s policy. Patient #10 Review of the patient’s clinical record on 1/7/2026 revealed the patient was admitted to the facility on 04/05/2024 with diagnoses of end stage renal disease, hypertension, seizure, anemia, and CKD-MBD, on in-center hemodialysis three times weekly. Treatment sheet review: Review of the patient’s treatment sheet dated 12/30/2025 revealed documentation which indicated the patient received the hemodialysis treatment from 16:08 PM - 18:18 PM. There was no documented review of the prescribed treatment orders against actual machine settings per the facility’s policy. Interview during record review with covering Facility Administrator, RN (D) on 01/07/2026 at 3:58 PM confirmed the direct care staff did not complete the prescription verification according to policy. Covering Facility Administrator, RN (D) said, “Okay.” Patient ID #1 Review of the patient’s clinical records revealed the patient was admitted to the facility on 02/08/2017 with a diagnosis of end stage renal disease and hypertension, on in-center dialysis three times a week. Record review of selected hemodialysis treatment revealed the following documentation: 12/29/2025 patient hemodialysis treatment was initiated at 6:23 AM, no documentation was identified the registered nurse verified the patient was on the correct hemodialysis prescription as ordered by the medical doctor. 12/31/2025 patient hemodialysis treatment was initiated at 6:16 AM, no documentation was identified the registered nurse verified the patient was on the correct hemodialysis prescription as ordered by the medical doctor. Patient ID #3 Review of the patient’s clinical records revealed the patient was admitted to the facility on 10/18/2019 with a diagnosis of end stage renal disease and Type II Diabetes Mellitus with diabetic chronic renal failure, on in-center dialysis three times a week. Record review of selected hemodialysis treatment revealed the following documentation: 12/29/2025 patient hemodialysis treatment was initiated at 6:11 AM, no documentation was identified the registered nurse verified the patient was on the correct hemodialysis prescription as ordered by the medical doctor. 12/31/2025 patient hemodialysis treatment was initiated at 6:02 AM, no documentation was identified the registered nurse verified the patient was on the correct hemodialysis prescription as ordered by the medical doctor. Patient ID #8 Review of the patient’s clinical records revealed the patient was admitted to the facility with a diagnosis of end stage renal disease, hypertension, Type II Diabetes Mellitus with diabetic chronic renal failure, on in-center dialysis three times a week. Record review of selected hemodialysis treatment revealed the following documentation: 12/29/2025 patient hemodialysis treatment was initiated at 6:16 PM, no documentation was identified the registered nurse verified the patient was on the correct hemodialysis prescription as ordered by the medical doctor. 12/31/2025 patient hemodialysis treatment was initiated at 14:46 PM, no documentation was identified the registered nurse verified the patient was on the correct hemodialysis prescription as ordered by the medical doctor. Interview on 01/07/2026 at 15:50 PM with Facility Administrator (D) confirmed the above findings and stated they had used a registered nurse floater on 12/29/2025 and 12/31/2025 and prescription verification was not done.”

“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: 48020 Based on observation, record review and interview, the facility’s registered nurses failed to conduct assessments when patients experienced a change in condition during hemodialysis treatment per the facility’s policy in 2 of 10 sampled patients: Patient #s 5, 1 Findings: Review of the facility’s current Policy and Procedure on Intradialytic Monitoring of Patient; Policy # C-ID-0010, revision date: 07/2024 directs staff as follows: MONITORING: Direct patient care staff will monitor the following parameters during each dialysis treatment: PATIENT: Vital signs: Obtained and documented at least every 30 minutes and reported to charge nurse if outside of standing orders and/or reportable parameters, refer to C-FORMS-0081 Reportable Parameters to CN. Patient #5 On 1/7/2026 at 9:39 AM Patient #5 was observed on the treatment floor of the facility at station #10 machine #13. The patient was receiving hemodialysis treatment at a blood flow rate of 250 milliliters/minute (mL/min) and dialysate flow rate of Autoflow 1.5 (a500) mL/min. The patient was utilizing an Optiflux F180 non reuse dialyzer via a right upper arm vascular access. Review of the patient’s clinical record on 01/07/2026 revealed the following: Treatment sheet review: Review of treatment sheet dated 12/31/2025 revealed the following documentation: 7:02 AM: documented blood pressure of 181/77 and pulse rate of 84 beats per minute - patient care technician documented “Patient resting and eyes closed” 7:32 AM: documented blood pressure of 154/71 and pulse rate of 74 beats per minute - patient care technician documented “Patient resting and eyes closed” 8:02 AM: documented blood pressure of 111/51 and pulse rate of 71 beats per minute - patient care technician documented “Patient resting and eyes closed” 8:32 AM: documented blood pressure of 105/49 and pulse rate of 69 beats per minute - patient care technician documented “Patient resting and eyes closed” 9:02 AM: documented blood pressure of 123/63 and pulse rate of 71 beats per minute - patient care technician documented “UFR off due to cramps, Monitoring” 9:33 AM: documented blood pressure of 170/74 and pulse rate of 73 beats per minute - patient care technician documented “UFR resumed, Monitoring” 10:02 AM: documented blood pressure of 146/63 and pulse rate of 72 beats per minute - patient care technician documented “Patient talking” 10:26 AM: documented blood pressure of 159/82 and pulse rate of 73 beats per minute - patient care technician documented “Treatment completed” The patient care technician failed to report the of the ultrafiltration being turned off due to patient complaint of cramping to the registered nurse thus the registered nurse did not complete an assessment. Interview during record review with covering Facility Administrator, RN (D) on 01/07/2026 at 3:58 PM confirmed the registered nurses did not conduct assessments when patients experienced a change in condition during hemodialysis treatment. covering Facility Administrator, RN (D) said, “They didn’t notify the nurse.” 30124 Patient #1 On 1/7/2026 at 9:39 AM Patient #1 was observed on the treatment floor of the facility at station #7. The patient was receiving hemodialysis treatment at a blood flow rate of 350 milliliters/minute (mL/min) and dialysate flow rate of Autoflow 1.5 (600) mL/min. The patient was utilizing an Optiflux F160 non reuse dialyzer via a left upper arm vascular access. Review of the patient’s clinical record on 01/07/2026 revealed the following: Treatment sheet review: Review of treatment sheet dated 01/07/2026 revealed the following documentation: 9:16 AM: documented blood pressure of 209/115, pulse rate 82 beats per minute - Licensed Vocational Nurse documented “ Possible error in bp, cuff readjusted and retaking” 9:30 AM: documented blood pressure 184/92, pulse rate 64 beats per minute - Licensed Vocational Nurse documented “Possible error in bp, cuff readjusted and retaking” 9:31 AM: documented blood pressure 184/93, pulse rate 63 beats per minute - Licensed Vocational Nurse documented “ BP still elevated; no complaints; continue to monitor” Review of treatment sheet dated 01/05/2026 revealed the following documentation: 7:00 AM: documented blood pressure of 181/86, pulse rate 61 beats per minute - Licensed Vocational Nurse documented “ BP still elevated; eyes closed; continue to monitor” 7:30 AM: documented blood pressure of 187/90, pulse rate 58 beats per minute - Licensed Vocational Nurse documented “Patient resting and eyes closed. Dialysis in Progress. Respirations regular. Access visualized and lines secure, bp still elevated; continue to monitor” 8:32 AM: documented blood pressure of 188/86, pulse rate 62 beats per minute - Licensed Vocational Nurse documented “ BP still elevated; pt talking; continue to monitor” Review of treatment sheet dated 01/03/2025 revealed the following documentation: 7:30 AM: documented blood pressure of 182/90, pulse rate 60 beats per minute - Patient Care Technician documented “Patient resting and eyes closed. Dialysis in Progress. Respirations regular. Access visualized and lines secure” 8:02 AM: documented blood pressure of 185/77, pulse rate 63 beats per minute - Patient Care Technician documented “Patient resting and eyes closed. Dialysis in Progress. Respirations regular. Access visualized and lines secure” Review of treatment sheet dated 12/31/2025 revealed the following documentation: 6:30 AM: documented blood pressure of 181/84, pulse rate 58 beats per minute - Licensed Vocational Nurse documented “Patient watching TV while dialysis in progress. Will continue to monitor. Access visualized and lines secure. Elevated BP at 300 d/t high venous pressure” 7:00 AM: Late Entry: no internet Patient resting and eyes closed. Dialysis in Progress. Respirations regular. Access visualized and lines secure” 9:03 AM: documented blood pressure of 186/58, pulse rate 64 beats per minute - Licensed Vocational Nurse documented “Patient is tolerating treatment well. Sitting in chair with feet elevated and back of chair reclined. Access visualized and no problems noted. Machine/Lines checked. Respirations regular” There was no documentation the registered nurse was notified when BP was out of parameters. No documentation was found the nurse conducted a reassessment of the patient. Interview on 01/07/2026 at 16:00 PM with Facility Administrator (D) confirmed the above findings and stated the registered nurse should have been notified when the patient’s vital signs were out of parameters.”