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Based on observations, interviews with the contracted dialysis nurse and the facility's Chief Nursing Officer, review of the facility's contract for acute dialysis services, and review of the acute dialysis staffing schedule, it was determined the facility failed to provide registered nurse supervision of all patient care.

The findings include:

On Tuesday April 6, 2010 at approximately 11:00 a.m. while touring patient care areas with the Chief Nursing Officer (CNO), the Medical Facilities Inspector (MFI) noted a "patient of the hospital" receiving bedside dialysis. During a bedside interview with the contracted dialysis nurse, MFI discovered the contracted dialysis nurse was a Licensed Practical Nurse (LPN) who stated she'd been working at the facility for approximately three (3) months. There was no other contracted dialysis nurse present.

At 12:45 p.m. on the same day, the acute dialysis services contract was reviewed. The contract stated in part, "3.9 Staff. Company shall provide properly trained and qualified non-physician personnel (the "Staff"), which may include but is not limited to, registered nurses, licensed vocational or practical nurses and dialysis technicians practicing under the direct supervision of Company's registered nurses, in adequate numbers to provide the ordered Services."

On Tuesday April 6, 2010 at approximately 4:30 p.m. during the end of day conference, the CNO acknowledged being unaware of the contracted dialysis nurse being an LPN. She stated she thought the contracted dialysis nurses were all Registered Nurses (RN). The MFI requested a schedule for the previous three months of contracted dialysis staffing coverage.

On Wednesday April 7, 2010 after reviewing the staffing schedule for contracted dialysis services between January 1, 2010 and March 7, 2010, an LPN without RN supervision was scheduled for 53 out of 66 days and provided 65 dialysis treatments during those dates.