Health inspection·August 11, 2023

F 0698 Provide safe, appropriate dialysis care/services for a resident who requires such services. Level of Harm - Actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, observation, and record review the facility failed to ensure that residents who require Dialysis received such services, consistent with professional standards of practice for 2 out of 3 residents (R1, R2) in a sample of 3. This failure resulted in R2 having to be sent to the emergency room and admitted with fluid overload. Residents Affected - Few Findings include: 1.) R2's Physician Order (PO) dated 07/13/23 documents Chronic combined systolic (congestive) and diastolic (congestive) heart failure, type 2 Diabetes Mellitus with diabetic chronic kidney disease, End stage renal disease, and dependence on renal dialysis. R2's PO dated 08/09/23 documents Dialysis - FYI - Dialysis Treatments 3 X Week at 2:45 PM At: (local dialysis center) Every M-W-F. R2's Care Plan dated 08/08/23 documents, Hemodialysis r/t End Stage renal failure. R2's MDS (Minimum Data Set) dated 07/20/23 documents that resident has no cognitive impairment. The MDS documents that R2 requires extensive assistance of one person for dressing, toilet use, and personal hygiene. The MDS documents that R2 is not steady, only able to stabilize with staff assistance. The MDS documents that R2 requires dialysis. R2's Nursing Note dated 08/07/23 at 10:22 AM documents Due to transportation issue, resident missed dialysis treatment on this shift, resident is her own POA and is aware, (V5) NP (Nurse Practitioner), is made aware, this nurse contacted (local dialysis center) and made aware. R2's Nursing Note dated 08/09/23 at 12:05 AM documents 11:17 pm: seen resident sitting on her bed, coughing nonstop, complained of shortness of breath and chest tightness. Legs were also swollen and painful as stated. R2's Nursing Note dated 08/09/23 at 12:16 AM documents 11:30 pm hooked on oxygen inhalation at 2 lpm (liters per minute) called POA (V6) but unable to reached her, instead this nurse left a voicemail. NP (V5) was notified thru (name of app). DON (Director of Nursing), Notified. 12 MN sent resident out to (local hospital), assisted by 2 EMTs (Emergency Medical Technician) via gurney. R2's Hospital Record dated 08/09/23 documents, Pt from (facility) via EMS (Emergency Medical System), for c/o (complaint of) shortness of breath and leg and abdominal swelling. Pt states the driver at the facility called in on Monday so none of the patients were able to go to dialysis. Breathing Page 1 of 2 145571 145571 08/11/2023 Cedar Ridge Health & Rehab Ctr One Perryman Street Lebanon, IL 62254

F 0698 Level of Harm - Actual harm Residents Affected - Few labored, 96% RA (room air), dry cough. Pt hypotensive 89/78. Pt vomiting. Dialysis cath. (catheter) to right chest. End-stage renal failure on hemodialysis with volume overload. Hyponatremia (low sodium). Hyperkalemia (high potassium). Anion Gap metabolic acidosis: patient has about electrolyte abnormalities with anion gap metabolic acidosis likely due to infection as well as missing hemodialysis. Patient to be dialyzed today. On 08/11/23 at 12:05 PM, R2 was observed lying in bed in the local hospital on the fifth floor. 2.) R1's Physician Order dated 02/24/23 documents Type 2 Diabetes Mellitus with Diabetic Nephropathy, End Stage Renal Disease, and Dependence on renal dialysis. R1's Physician order dated 08/09/23 documents, New Dialysis days Mondays & Fridays (local dialysis center). Chair time 2:00pm. R1's Care Plan dated 08/08/23 documents Hemodialysis r/t End Stage renal failure. R1's MDS dated [DATE] documents that resident has no cognitive impairment. The MDS documents that R1 requires limited assistance of one person for bed mobility, transfer, locomotion on unit, locomotion off unit, dressing, and personal hygiene. The MDS documents that R1 requires extensive assistance of one person for toilet use. The MDS documents that R1 is not steady, only able to stabilize with staff assistance. The MDS documents that R1 receives dialysis. R1's Nursing Note dated 08/07/23 at 10:17 am documents Due to transportation issue, resident missed dialysis treatment on this shift, NP (V5) is made aware, resident is his own POA and is aware. On 08/11/23 at 8:15 AM, R1 stated that he missed his Dialysis appointment Monday 8/07/23 because they did not have a driver. He has missed 2 or 3 appointments because of no driver. On 08/11/23 at 9:51 AM, V4 (Medical Director) stated that in his professional opinion it's a serious health concerns that residents are missing dialysis. On 08/11/23 at 10:20 AM, V3 (Driver) stated that on Monday when she called off, she was the only driver for the facility. The facility has hired 3 more driver on Tuesday or Wednesday. She stated that it does not require a special license. The only special training is using the wheelchair lift and how to strap in residents. She stated that the driver must be on the facility's insurance to drive. She stated that she is unsure if the facility uses public transportation or not. On 08/11/23 at 11:16 AM, V1 (Administrator) stated on Monday the driver called and some of the residents were unable to go to their dialysis appointments. She stated that the facility was unable to get any their sister facilities to assist. At that time, the facility did not have outside transportation, but they do now. She stated that now the facility has 4 drivers and outside transportation. On 08/11/23 at 12:05 PM, R2 stated, I would never ever refuse dialysis. R2 stated that she has had to be dialyzed three since being in the hospital. Facility's policy Care of Resident with End-Stage Renal/Dialysis dated 07/22/22 documents Residents with end-stage renal disease (ESRD) will be cared for according to currently recognized standards of care. 145571 Page 2 of 2