Davita Camelot Dialysis Center

“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: 46466 Based on observations, and facility document review, the staff failed to ensure that clean areas were not contaminated by used equipment. Findings: During the flash tour of the treatment area on 2/12/24 at 11:40 a.m., the surveyor observed a cellular phone lying face down on the countertop where the clean supplies were located. Staff Member #2 provided the mobile device policy from the employee handbook. The policy titled “5.16 Mobile Device Policy” did not include a date and read in part, “To ensure that patient care is our primary focus, use of mobile devices is not permitted in the patient care areas. Cell phone use for personal reasons is strictly prohibited on the treatment floor and in other clinical work areas...”. The findings were discussed with Staff Members #1, #2, #3, #4 and #11 at the exit conference on 2/12/24 at 5:15 p.m.”

“POC-MANAGE VOLUME STATUS CFR(s): 494.90(a)(1) The plan of care must address, but not be limited to, the following: (1) Dose of dialysis. The interdisciplinary team must provide the necessary care and services to manage the patient’s volume status; This Standard is not met as evidenced by: 46466 Based on clinical record review, and facility document review, the facility staff failed to (A) document notification of abnormally high and/or low blood pressure (BP) readings to the Charge RN and (B) ensure the Registered Nurse (RN) assessed patients within an hour of dialysis treatment start as per facility policy. The findings include: A review of treatment records for the sampled patients revealed the following: Patient #3 (Pt. #3): Four (4) treatment records were reviewed, from 12/24/23 to 1/17/24. (A) Two (2) of four (4) treatment records documented systolic blood pressures lower than 90 mm/Hg. The records failed to provide evidence that the RN was notified about these BPs on 12/24/23 and 1/17/24. (B) On 12/29/23, Pt .#3’s treatment began at 7:24 a.m., and the RN assessment was documented at 9:27 a.m. Patient #5 (Pt. #5): Six (6) treatment records were reviewed, from 1/29/24 through 2/9/24. (A) One (1) of the six (6) treatment records documented systolic blood pressures greater than 180 mm/Hg. The records failed to provide evidence that the RN was notified about this BP on 2/5/24. (B) On 2/7/24, Pt. #5’s treatment began at 12:56 p.m., and the RN assessment was not completed until 2:11 p.m. A review of the facility’s policy “PRE-INTRA-POST TREATMENT DATA COLLECTION, MONITORING AND NURSING ASSESSMENT”, last revised October 2023, stated in part: “ ...PRE-TREATMENT DATA COLLECTION/ASSESSMENT 4. Any abnormal findings or findings outside of any patient specific physician ordered parameters discovered during the pre-treatment data collection will be documented and immediately reported to the licensed nurse (refer to “Abnormal Findings” section of this policy. If an abnormal finding is reported to the licensed nurse pre-treatment, the nurse will assess the patient prior to the initiation of dialysis ... 7. If there are no abnormal findings or concerns identified during the pretreatment data collection, the treatment may be initiated ... INTRADIALYTIC DATA COLLECTION/ASSESSMENT 8. The licensed nurse will round on those patients without reported abnormal finding and complete the nursing assessment within one (1) hour of dialysis treatment initiation. 11. Abnormal findings or findings outside of any patient specific physician ordered parameters will be reported to the licensed nurse immediately (refer to “Abnormal Findings” section in this policy) ... ABNORMAL FINDINGS ...Members of the patient care team should report ANY changes in patient conditions or concerns of patient well-being immediately to the licensed nurse at any time. ...Blood pressure: Pre dialysis: - Systolic greater than 180 mm/Hg or less than 90 mm/Hg - Diastolic greater than or equal to 100 mm/Hg...”. The findings were discussed with Staff Members #1, #2, #3, #4 and #11 at the exit conference on 2/12/24 at 5:15 p.m.”