Davita Langley Dialysis

“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: 34452 Based on observation, document review and interview, it was determined that the facility staff failed perform hand hygiene after glove removal for four (4) of eight (8) Staff Members (SM) (# 4, # 5, # 6 and # 7), failed to use hand sanitizer correctly for one (1) of eight (8) SMs (# 4), and failed to wear gloves when touching patient equipment for two (2) of eight (8) SMs (# 4 and # 6). The findings include: On May 7, 2024 between 10:00 a.m. and 12:00 p.m. the following was observed during the initiation and termination of treatments: At 10:30 a.m., SM # 4 was observed wrapping a glove around one finger before touching the dialysis machine at station # 20. SM # 4 then placed the dirty glove on the rolling computer cart and began typing on the computer. SM # 4 did not perform hand hygiene or clean the rolling computer cart. At 10:35 a.m., SM # 4 was observed using hand sanitizer then waving hands in air at station # 12. At 10:45 a.m., SM # 6 was observed donning one glove before touching the dialysis machine at station # 10 and failed to perform hand hygiene after removing the glove. At 11:00 a.m., SM # 5 was observed removing dirty gloves and donning clean gloves without performing hand hygiene at station # 20. At 11:01 a.m., SM # 7 was observed removing dirty gloves and donning clean gloves without performing hand hygiene at station # 9. At 11:20 a.m., SM # 6 was observed donning one glove before touching the dialysis machine at station # 10. On May 7, 2024 at 2:00 p.m., a review of the facility’s policy titled “Infection Control” reads in part “hand hygiene: all teammates, Physicians and Non-Physician will perform hand hygiene immediately after removal of gloves. before touching clean areas such as supplies, supply cart and chairside keyboard/mouse. Disposable gloves will be worn when caring for the patient and touching the patient’s equipment at the dialysis station.” According to CDC (Center for Disease Control) guidelines for hand sanitizer use “apply one or two drops of sanitizer gel into one hand. Rub hand together. Rub the gel over all surfaces of your hands and fingers for 20 seconds or until your hands are dry.” On May 8, 2024 at 2:00 p.m., the findings were discussed with SMs # 1, # 2, # 9 and # 10 during the exit interview.”

“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: 34452 Based on observation, document review and interview, it was determined that the facility staff failed to follow standard infection control precautions by not cleaning and disinfecting contaminated surfaces and medical devices for one (1) of eight (8) Staff Members (SM), SM # 4. The findings include: On May 7, 2024 between 10:00 a.m. and 12:00 p.m. the following was observed during the initiation and termination of treatments: At 10:30 a.m., SM # 4 was observed wrapping a glove around one finger before touching the dialysis machine at station # 20. SM # 4 then placed the dirty glove on the rolling computer cart and began typing on the computer. SM # 4 did not perform hand hygiene or clean the rolling computer cart. At 10:35 a.m., SM # 4 was observed touching the patient with a stethoscope then placing the stethoscope around neck without cleaning and disinfecting the stethoscope at station # 12. On May 7, 2024 at 2:00 p.m., a review of the facility’s policy titled “Infection Control” reads in part “Cleaning and/or disinfection of equipment and work surfaces will be performed as soon as possible following exposure. Non-disposable items are to be disinfected after each patient use.” On May 8, 2024 at 2:00 p.m., the findings were discussed with Staff Members # 1, # 2, # 9 and # 10 during the exit interview.”

“PA-APPROPRIATENESS OF DIALYSIS RX CFR(s): 494.80(a)(2) The patient’s comprehensive assessment must include, but is not limited to, the following: (2) Evaluation of the appropriateness of the dialysis prescription, This Standard is not met as evidenced by: 34452 Based on document review and interview, it was determined that the facility staff failed to ensure the Physician ordered blood flow rate (BFR) was achieved or if unable to achieve, the Physician and/or Registered Nurse (RN) was notified for four (4) of ten (10) Patients (P), P # 4, # 6, # 8 and # 9. The findings include: On May 8, 2024 at 9:30 a.m., clinical record reviews revealed the following: P # 4- The flowsheet dated April 27, 2024 documented the BFR as 350 from 7:01 a.m. to 9:33 a.m. The Physician ordered BFR was 400. There was no documented reason for the decreased BFR and no documentation that the Physician and/or RN was notified. The flowsheet dated May 2, 2024 documented the BFR as 300 from 9:02 a.m. to 9:44 a.m. The Physician ordered BFR was 400. There was no documented reason for the decreased BFR and no documentation that the Physician and/or RN was notified. P # 6- The flowsheet dated April 24, 2024 documented the BFR as 380 from 5:01 p.m. to 6:01 p.m. The Physician ordered BFR was 400. There was no documented reason for the decreased BFR and no documentation that the Physician and/or RN was notified. P # 8- The flowsheet dated April 23, 2024 documented the BFR as 350 from 1:00 p.m. to 3:05 p.m. The Physician ordered BFR was 400. There was no documented reason for the decreased BFR and no documentation that the Physician and/or RN was notified. The flowsheet dated April 30, 2024 documented the BFR as 200 from 10:46 a.m. to 11:01 a.m. and as 350 from 11:31 a.m. to 1:52 p.m. The Physician ordered BFR was 400. There was no documented reason for the decreased BFR and no documentation that the Physician and/or RN was notified. P # 9- The flowsheet dated May 2, 2024 documented the BFR as 345 from 12:30 p.m. to 1:18 p.m. and 300 at 1:31 p.m. The Physician ordered BFR was 400. There was no documented reason for the decreased BFR and no documentation that the Physician and/or RN was notified. On May 8, 2024 at 2:00 p.m., a review of the facility’s policy titled “Pre-Intra-Post Treatment Data” reads in part “If the dialysis prescription is not being met (including dialysis flow rate or change to/inability to obtain prescribed blood flow rate) the reason will be documented and the licensed nurse informed.” On May 8, 2024 at 2:00 p.m., the findings were discussed with Staff Members # 1, # 2, # 9 and # 10 during the exit interview.”

“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: 34452 Based on document review and interview, it was determined that the facility failed to obtain and document standing blood pressures (BP) for five (5) of ten (10) In Center Hemodialysis (ICHD) Patients (P), P # 3, # 4, # 5, # 6 and # 7; failed to complete nursing assessments by the Registered Nurse (RN) within an hour of treatment initiation for two (2) of ten (10) Patients, P # 3 and # 10; failed to verify the treatment prescription by the Registered Nurse (RN) within an hour of treatment initiation for two (2) of ten (10) Patients, P # 3 and # 6; and failed to assess and document treatment data to include blood pressure (BP) at least every 30 minutes during the treatment for three (3) of ten (10) Patients, P # 4, # 5 and # 8. The findings include: On May 8, 2024 at 9:30 a.m., clinical record reviews revealed the following: P # 3- The flowsheet dated April 22, 2024 revealed treatment initiation was documented at 10:13 a.m., the nurse prescription verification documented at 12:20 p.m.(more than one hour), and the RN assessment was documented at 12:21 p.m. (more than one hour). The flowsheet dated April 24, 2024 revealed initiation of the treatment was documented at 10:42 a.m. and the nurse prescription verification documented at 12:36 p.m. (more than one hour). The flowsheet dated April 26, 2024 revealed initiation of the treatment was documented at 10:13 a.m., the nurse prescription verification documented at 11:39 a.m. (more than one hour), and the RN assessment was documented at 11:40 a.m. (more than one hour). The flowsheet dated April 29, 2024 revealed pre-treatment standing blood pressure (BP) N/A and post-treatment BP 90/45. The pre-treatment nurse assessment for observations reads “ambulates - no assistance needed”. The initiation of the treatment was documented at 10:23 a.m. The RN assessment was documented at 11:55 a.m. (more than one hour). The flowsheet dated May 1, 2024 revealed initiation of the treatment was documented at 10:25 a.m., the nurse prescription verification documented at 11:28 a.m. (more than one hour), and the RN assessment was documented at 11:29 a.m. (more than one hour). The flowsheet dated May 3, 2024 revealed the initiation of the treatment was documented at 10:22 a.m. and the nurse prescription verification documented at 11:50 a.m. (more than one hour). P # 4- The flowsheet dated April 23, 2024 revealed pre-treatment standing blood pressure (BP) N/A and post-treatment BP N/A. The pre-treatment and post-treatment nurse assessments for observations reads “ambulates - no assistance needed”. The flowsheet dated April 25, 2024 revealed pre-treatment standing blood pressure (BP) N/A and post-treatment BP 125/73. The pre-treatment nurse assessment for observations reads “ambulates - no assistance needed”. There was no treatment data to include BP between 5:31 a.m. and 6:12 a.m. (greater than 30 minutes). The flowsheet dated April 27, 2024 revealed pre-treatment standing blood pressure (BP) N/A and post-treatment BP 101/50. The pre-treatment nurse assessment for observations reads “ambulates - no assistance needed”. The flowsheet dated April 30, 2024 revealed pre-treatment standing blood pressure (BP) N/A and post-treatment BP 133/69. The pre-treatment nurse assessment for observations reads “ambulates - no assistance needed”. The flowsheet dated May 2, 2024 revealed pre-treatment standing blood pressure (BP) N/A and post-treatment BP 119/52. The pre-treatment nurse assessment for observations reads “ambulates - no assistance needed”. The flowsheet dated May 4, 2024 revealed pre-treatment standing blood pressure (BP) N/A and post-treatment BP 106/54. The pre-treatment nurse assessment for observations reads “ambulates - no assistance needed”. The flowsheet dated May 6, 2024 revealed pre-treatment standing blood pressure (BP) N/A and post-treatment BP 104/50. The pre-treatment nurse assessment for observations reads “ambulates - no assistance needed”. P # 5- The flowsheet dated April 30, 2024 revealed pre-treatment standing blood pressure (BP) N/A and post-treatment BP 130/70. The pre-treatment nurse assessment for observations reads “cane. ambulates - no assistance needed”. There was no treatment data to include BP between 6:04 a.m. and 7:04 a.m. (greater than 30 minutes). The flowsheet dated May 2, 2024 revealed pre-treatment standing blood pressure (BP) N/A and post-treatment BP 182/83. The pre-treatment nurse assessment for observations reads “cane. ambulates - no assistance needed”. There was no treatment data to include BP between 6:04 a.m. and 6:38 a.m. (greater than 30 minutes). P # 6- The flowsheet dated April 24, 2024 revealed pre-treatment standing blood pressure (BP) N/A and post-treatment BP N/A. The pre-treatment and post-treatment nurse assessments for observations reads “ambulates - no assistance needed”. The flowsheet dated April 29, 2024 revealed pre-treatment standing blood pressure (BP) N/A and post-treatment BP N/A. The pre-treatment and post-treatment nurse assessments for observations reads “ambulates - no assistance needed”. The initiation of the treatment was documented at 2:28 p.m. The nurse prescription verification was documented at 4:14 p.m. (more than one hour). The flowsheet dated May 1, 2024 revealed pre-treatment standing blood pressure (BP) N/A and post-treatment BP N/A. The pre-treatment and post-treatment nurse assessments for observations reads “ambulates - no assistance needed”. The flowsheet dated May 6, 2024 revealed pre-treatment standing blood pressure (BP) N/A and post-treatment BP 113/43. The pre-treatment nurse assessment for observations reads “ambulates - no assistance needed”. P # 7- The flowsheet dated April 24, 2024 revealed pre-treatment standing blood pressure (BP) N/A and post-treatment BP N/A. The pre-treatment and post-treatment nurse assessment for observations reads “ambulates - no assistance needed”. The flowsheet dated April 26, 2024 revealed pre-treatment standing blood pressure (BP) 171/87 and post-treatment BP N/A. The post-treatment nurse assessment for observations reads “ambulates - no assistance needed”. The flowsheet dated April 29, 2024 revealed pre-treatment standing blood pressure (BP) 184/95 and post-treatment BP N/A. The post-treatment nurse assessment for observations reads “ambulates - no assistance needed”. The flowsheet dated May 3, 2024 revealed pre-treatment standing blood pressure (BP) 141/71 and post-treatment BP N/A. The post-treatment nurse assessment for observations reads “ambulates - no assistance needed”. The flowsheet dated May 6, 2024 revealed pre-treatment standing blood pressure (BP) 184/95 and post-treatment BP N/A. The post-treatment nurse assessment for observations reads “ambulates - no assistance needed”. P # 8- The flowsheet dated May 4, 2024 revealed there was no treatment data to include BP between 10:55 a.m. and 11:55 a.m. (greater than 30 minutes). P # 10- The flowsheet dated May 6, 2024 revealed initiation of the treatment was documented at 4:49 p.m. and the RN assessment wad documented at 6:28 p.m. (more than one hour). On May 8, 2024 at 2:00 p.m., a review of the facility’s policy titled “Pre-Intra-Post Treatment Data” reads in part “Data collection includes but is not necessarily limited to sitting and standing BP measurement required pre and post treatment (if patient unable to stand, document reason in the patient electronic record or flowsheet). The licensed nurse will round on those patients without reported abnormal findings and completed the nursing assessment within one (1) hour of dialysis treatment initiation. The prescription components are confirmed by a licensed nurse within one (1) hour of treatment initiation. Vital signs and treatment monitoring for non nocturnal treatments are completed at least every thirty (30) minutes.” On May 8, 2024 at 2:00 p.m., the findings were discussed with SMs # 1, # 2, # 9 and # 10 during the exit interview.”