VIERA, FL - Federal inspectors found that nurses at Viera Health and Rehabilitation Center falsely documented administering critical kidney medications to dialysis patients when the medications were not available at the facility.
The February 12, 2025 inspection revealed that staff recorded giving Sevelamer Carbonate, a medication essential for kidney disease patients, on seven occasions between February 5-10, despite the drug being unavailable from February 4-12.
Critical Kidney Medication Missing for Eight Days
The violations centered on a resident with end-stage renal disease and rapidly progressive glomerulonephritis, a serious kidney condition that causes rapid kidney function decline over weeks to months. The patient required Sevelamer Carbonate 800 milligrams three times daily before meals to manage hypocalcemia related to kidney failure.
Medication administration records showed nurses documented giving the medication at scheduled times: February 5 at 6:30 AM, February 6 at 6:30 AM and 4:30 PM, February 7 at 6:30 AM, and February 10 at 6:30 AM, 11:30 AM and 4:30 PM.
However, progress notes revealed the medication was consistently unavailable during this period, with entries stating "medication is not available" and "awaiting for pharmacy" appearing daily from February 5-12.
Sevelamer binds phosphorus in the digestive tract, preventing dangerous phosphorus buildup in kidney disease patients. Without this medication, patients face risks including bone disease, cardiovascular complications, and mineral imbalances that can affect heart rhythm and muscle function.
Staff Admits to False Documentation
During the inspection, the Transitional Care Unit Manager confirmed that nurses who documented medication administration when drugs were unavailable "did not have an answer" for their actions. One nurse acknowledged documenting medication administration without actually giving the drug but "could not explain why he did that."
The facility's Director of Nursing explained that new Medicare regulations effective January 1, 2025, shifted responsibility for phosphate binders like Sevelamer to dialysis centers rather than nursing homes. However, this regulatory change does not excuse false documentation in medical records.
The facility requested a five-day supply from their pharmacy but experienced delays in obtaining corporate approval and coordinating with the dialysis center.
Dialysis Communication Breakdowns
Inspectors identified additional concerns with dialysis treatment coordination for a second resident. Dialysis removes waste products and excess fluid from blood when kidneys cannot function properly, making consistent treatment schedules critical for patient safety.
The facility failed to complete required post-dialysis assessment documentation on transfer forms dated February 8 and February 11. These forms serve as communication tools between the nursing home and dialysis center, documenting vital signs, catheter site condition, and treatment-related information.
The dialysis center noted on February 8 that the resident was late for treatment and received abbreviated dialysis as a result. Shortened dialysis sessions may not adequately remove toxins and fluid, potentially leading to complications including fluid overload, electrolyte imbalances, and cardiovascular stress.
Staff also failed to document that the resident missed breakfast and snacks before dialysis on February 11, despite facility protocols requiring proper nutrition coordination for dialysis patients.
Medical Record Integrity Violations
The false medication documentation represents a significant breach of medical record accuracy requirements. Accurate medication records are essential for tracking treatment effectiveness, identifying adverse reactions, and ensuring continuity of care between healthcare providers.
Federal regulations require nursing homes to maintain medical records according to accepted professional standards. Documented medication administration that did not occur compromises the ability of physicians, pharmacists, and other healthcare providers to make informed treatment decisions.
The facility's agreement with the dialysis center specifically requires immediate communication of changes in residents' medical conditions and compliance issues. The missing medication situation and false documentation represented exactly the type of information that should have been communicated promptly.
Regulatory Response and Oversight
The inspection resulted in citations under federal nursing home regulations F842 (medical records) and F698 (pharmaceutical services). Both violations were classified as causing "minimal harm or potential for actual harm" affecting "few" residents.
Professional nursing standards require accurate documentation of all medication administration, including instances when medications are unavailable. The correct procedure would involve documenting the medication as "not given" with an explanation of unavailability and steps taken to obtain the drug.
The Center for Medicare and Medicaid Services requires nursing homes to have systems ensuring medication availability and proper documentation. Facilities must work with pharmacies to maintain adequate medication supplies and communicate with healthcare providers when therapeutic regimens cannot be followed as ordered.
This case highlights the importance of medication management protocols, especially during regulatory transitions affecting specialized patient populations like dialysis recipients. Nursing homes must develop clear procedures for handling medication shortages while maintaining accurate medical records.
The inspection findings demonstrate how administrative challenges, such as regulatory changes and pharmacy coordination issues, cannot justify compromising medical record integrity or patient care documentation standards.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Viera Health and Rehabilitation Center from 2025-02-12 including all violations, facility responses, and corrective action plans.
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