Health inspection·February 10, 2025

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** During an interview on 2/10/25 at 2:40 PM; the Infection Preventionist (ICP) stated, I have been ICP for two years. I in-service staff weekly on infection control protocols and as needed depending on if I see incorrect practices performed. The last in-service for catheter care was November and December of last year. We in-service staff on ways to prevent Urinary Tract Infections (UTI) through proper catheter care and hydration care .Certified Nursing Assistants are to wash their hands before and during incontinence care when going from a dirty to clean surface. Staff should be washing hands with soap and water in the sink in the bathroom, not in a basin. Staff should use the soap provided by the facility when cleaning the perineal area. When emptying the urinary drainage bag, The port is to be cleaned with an alcohol pad, not sanitizing wipes. On 2/10/25 at 1:45 PM, The Director of Nursing (DON) stated, Protocols we have in place to help prevent UTIs are keeping residents, performing routine labs for all residents which include a urine analysis and practice routine peri-care. The CNAs are to clean resident's perineal area every shift with soap and water using the fragrant free soap provided by the facility and report any abnormalities to the nurse. Fragrant soaps can irritate the perineal area and lead to an infection. We also change the indwelling catheter and drainage bags bi-monthly. When a resident is admitted with an indwelling urinary catheter, we verify if there is a pertinent diagnosis. If there is no pertinent diagnosis, we receive an order from the doctor to remove it. Based on observations, record review and interviews the facility failed to provide catheter care according to professional standards for two (Residents #2 and Resident #3) out of two residents sampled for indwelling urinary catheter care as evidenced by two observations of incorrect indwelling urinary catheter care being provided. The findings included: On 02/10/25 at 11:09 AM, during observation of Resident #2 's indwelling urinary catheter care performed by Staff D, Certified Nursing Assistant (CNA) and Staff C, Registered Nurse (RN), it was noted that Staff C, RN did not perform handwashing before the procedure started. Staff D,CNA drained the catheter bag and cleansed the tip of the catheter bag with [Germicidal Disinfectant Wipes]. Staff D, CNA washed her hands at the bedside with the residents soap [brand body wash] that was personally selected by Staff D, CNA to be used. Staff D, CNA cleaned the outer perineum area first, then the inside labia and lastly the catheter in a top to bottom motion. Review of the medical records for Resident #2 revealed the resident was admitted to the facility on [DATE]. Clinical diagnoses included but not limited to: Urinary Tract Infection (UTI) and Page 1 of 6 105172 105172 02/10/2025 Fountain Manor Health & Rehabilitation Center 390 NE 135th St North Miami, FL 33161

F 0690 Overactive Bladder. Level of Harm - Minimal harm or potential for actual harm Review of Resident #2's Physician's Orders Sheet revealed an order with a start date of 12/30/2022 for indwelling urinary catheter related to (r/t) diagnosis (dx) Obstructive Uropathy and catheter care every shift and as needed (PRN). Residents Affected - Some Review of Resident #2's Annual Minimum Data Set (MDS) dated [DATE] revealed the resident is cognitively impaired, and for Bladder and Bowel urinary continence is not rated because the resident has a catheter and always incontinent for bowel. Review of Resident #2's Care Plans revealed the resident requires an indwelling catheter related to diagnoses of Obstructive Uropathy. Interventions include- Always cover indwelling urinary draining bag. Observe the catheter and change the catheter or bag as indicated or as needed. Be alert for signs of infection including increased temperature, abdominal or flank pain, changes in quantity and quality of urine, hematuria, and disorientation of residents. Resident #3 During observation on 02/10/25 at 12:05 PM, Staff E, CNA and Staff F, RN providing indwelling urinary catheter care for Resident #3; Staff E, CNA and Staff F, RN did not perform hand hygiene before the procedure started. Staff gathered supplies that contained the facility's approved soap, a basin with warm water, wash cloths and towels. Staff E, CNA cleansed the outside of the perineum area first, then pushed back the foreskin and cleaned the tip of the penis in a circular motion, next Staff E, CNA cleaned the catheter in a top to bottom motion without folding or changing washcloths. Staff E, CNA changed gloves, washed hands and dried the resident's perineum area. Review of the medical records for Resident #3 revealed the resident was admitted to the facility on [DATE]. Clinical diagnoses included but not limited to UTIs. Review of the Physician's Orders Sheet revealed Resident #3 has an order with a start date of 01/28/2025 for indwelling urinary catheter due to obstructive uropathy for the catheter's draining bag to be changed on the 15th and 28th of each month. Record review of Resident #3's admission MDS dated [DATE] revealed the resident is cognitively impaired. For bladder, urinary continence is not rated because the resident has a catheter, and bowel is rated as always incontinent for bowel. Review of Resident #3's Care Plans revealed the resident requires an indwelling catheter related to diagnoses of Obstructive Uropathy. Interventions include- Always cover indwelling urinary draining bag. Observe the catheter and change the catheter or bag as indicated or as needed. Be alert for signs of infection including increased temperature, abdominal or flank pain, changes in quantity and quality of urine, hematuria, and disorientation of residents. Interview on 02/10/25 at 02:11 PM with Staff E, CNA stated she been working for the facility for almost 9 years and receive in services on catheter care once a month with supervisor. Staff E, CNA states the steps she take to perform catheter care are getting the supplies, washing your hands, introduce self to resident, getting the water, soap, basin, washcloth and towel. I would clean the resident, empty the water, get new water, rinse and dry. Staff E, CNA stated she washed her hands prior to surveyor observing care. 105172 Page 2 of 6 105172 02/10/2025 Fountain Manor Health & Rehabilitation Center 390 NE 135th St North Miami, FL 33161

F 0690 Level of Harm - Minimal harm or potential for actual harm Interview on 02/10/25 at 02:31 PM, Staff C, RN revealed she normally ask to observe indwelling urinary catheter care with CNAs to make sure they are doing the procedure correctly. The steps she would take to perform care would be to gather the supplies, wash her hands, glove and gown up. I would knock on the residents door, get the water, soap and towel. I would clean the resident, remove the water, get new water, rinse and dry. Residents Affected - Some Interview on 02/10/25 at 02:31 PM, Staff F, RN revealed when performing catheter care she washes her hands, apply gown and gloves, gather supplies which consist of warm water, soap, a basin, washcloths and towels. She cleans the perineum area first then the catheter using different washcloths. Staff F, RN explained she normally ask to observe catheter care with CNAs to supervise and educate. Interview on 02/10/25 at 02:20 PM with Staff D, CNA revealed stated she has been working in the facility for almost 3 years and never received in-services on catheter care. The steps she to perform catheter care are: Empty bag, clean bag and put protector on bed, gather the supplies, wash your hands, put on glove and gown, introduce self, get water, soap, towel, remove water, get new water, rinse and dry off resident. Review of the facility policy and procedure regarding catheter care 09/2014, states the staff should wash and dry hands thoroughly. For a female resident: Use a washcloth with warm water and soap to cleanse the labia. Use one area of the washcloth for each downward, cleansing stroke. Change the position of the washcloth with each downward stroke. Next, change the position of the washcloth and cleanse around the urethral meatus. Do not allow the washcloth to drag on the resident's skin or bed linen. With a clean washcloth, rinse with warm water using the above technique. For a male resident male: Use a washcloth with warm water and soap to cleanse around the meatus. Cleanse the glans using circular strokes from the meatus outward. Change the position of the washcloth with each cleansing stroke. With a clean washcloth, rinse with warm water using the above technique. Return foreskin to normal position. 105172 Page 3 of 6 105172 02/10/2025 Fountain Manor Health & Rehabilitation Center 390 NE 135th St North Miami, FL 33161

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** During an interview on 2/10/25 at 2:40 PM; the Infection Preventionist (ICP) stated, I have been ICP for two years. I in-service staff weekly on infection control protocols and as needed depending on if I see incorrect practices performed. The last in-service for catheter care was November and December of last year. We in-service staff on ways to prevent Urinary Tract Infections (UTI) through proper catheter care and hydration care .Certified Nursing Assistants are to wash their hands before and during incontinence care when going from a dirty to clean surface. Staff should be washing hands with soap and water in the sink in the bathroom, not in a basin. Staff should use the soap provided by the facility when cleaning the perineal area. When emptying the urinary drainage bag, The port is to be cleaned with an alcohol pad, not sanitizing wipes. Residents Affected - Some On 2/10/25 at 1:45 PM, The Director of Nursing (DON) stated, Protocols we have in place to help prevent UTIs are keeping residents, performing routine labs for all residents which include a urine analysis and practice routine peri-care. The CNAs are to clean resident's perineal area every shift with soap and water using the fragrant free soap provided by the facility and report any abnormalities to the nurse. Fragrant soaps can irritate the perineal area and lead to an infection. We also change the indwelling catheter and drainage bags bi-monthly. When a resident is admitted with an indwelling urinary catheter, we verify if there is a pertinent diagnosis. If there is no pertinent diagnosis, we receive an order from the doctor to remove it. Based on observations, record review and interviews the facility failed to reduce the risk of Urinary Tract Infections for two (Residents #2 and Resident #3) out of two residents sampled for indwelling urinary catheter care, as evidenced by staffs' failure to implement infection prevention and control precautions during perineal care for Resident #2 and Resident #3 with indwelling urinary catheter. The findings included: On 02/10/25 at 11:09 AM, during observation of Resident #2's indwelling urinary catheter care performed by Staff D, Certified Nursing Assistant (CNA) and Staff C, Registered Nurse (RN), it was noted that Staff C, RN did not perform handwashing before the procedure started. Staff D,CNA drained the catheter bag and cleansed the tip of the catheter bag with [Germicidal Disinfectant Wipes]. Staff D, CNA washed her hands at the bedside with the residents soap [brand body wash] that was personally selected by Staff D, CNA to be used. Staff D, CNA cleaned the outer perineum area first, then the inside labia and lastly the catheter in a top to bottom motion. Review of the medical records for Resident #2 revealed the resident was admitted to the facility on [DATE]. Clinical diagnoses included but not limited to: Urinary Tract Infection (UTI) and Overactive Bladder. Review of Resident #2's Physician's Orders Sheet revealed an order with a start date of 12/30/2022 for indwelling urinary catheter related to (r/t) diagnosis (dx) Obstructive Uropathy and catheter care every shift and as needed (PRN). Resident #3 During observation on 02/10/25 at 12:05 PM, Staff E, CNA and Staff F, RN providing indwelling 105172 Page 4 of 6 105172 02/10/2025 Fountain Manor Health & Rehabilitation Center 390 NE 135th St North Miami, FL 33161

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some urinary catheter care for Resident #3; Staff E, CNA and Staff F, RN did not perform hand hygiene before the procedure started. Staff gathered supplies that contained the facility's approved soap, a basin with warm water, wash cloths and towels. Staff E, CNA cleansed the outside of the perineum area first, then pushed back the foreskin and cleaned the tip of the penis in a circular motion, next Staff E, CNA cleaned the catheter in a top to bottom motion without folding or changing washcloths. Staff E, CNA changed gloves, washed hands and dried the resident's perineum area. Review of the medical records for Resident #3 revealed the resident was admitted to the facility on [DATE]. Clinical diagnoses included but not limited to UTIs. Review of the Physician's Orders Sheet revealed Resident #3 has an order with a start date of 01/28/2025 for indwelling urinary catheter due to obstructive uropathy for the catheter's draining bag to be changed on the 15th and 28th of each month. Review of Resident #3's Care Plans revealed the resident requires an indwelling catheter related to diagnoses of Obstructive Uropathy. Interventions include- Always cover indwelling urinary draining bag. Observe the catheter and change the catheter or bag as indicated or as needed. Be alert for signs of infection including increased temperature, abdominal or flank pain, changes in quantity and quality of urine, hematuria, and disorientation of residents. Interview on 02/10/25 at 02:11 PM with Staff E, CNA stated she been working for the facility for almost 9 years and receive in services on catheter care once a month with supervisor. Staff E, CNA states the steps she take to perform catheter care are getting the supplies, washing your hands, introduce self to resident, getting the water, soap, basin, washcloth and towel. I would clean the resident, empty the water, get new water, rinse and dry. Staff E, CNA stated she washed her hands prior to surveyor observing care. Interview on 02/10/25 at 02:31 PM, Staff C, RN revealed she normally ask to observe indwelling urinary catheter care with CNAs to make sure they are doing the procedure correctly. The steps she would take to perform care would be to gather the supplies, wash her hands, glove and gown up. I would knock on the residents door, get the water, soap and towel. I would clean the resident, remove the water, get new water, rinse and dry. Interview on 02/10/25 at 02:31 PM, Staff F, RN revealed when performing catheter care she washes her hands, apply gown and gloves, gather supplies which consist of warm water, soap, a basin, washcloths and towels. She cleans the perineum area first then the catheter using different washcloths. Staff F, RN explained she normally ask to observe catheter care with CNAs to supervise and educate. Interview on 02/10/25 at 02:20 PM with Staff D, CNA revealed stated she has been working in the facility for almost 3 years and never received in-services on catheter care. The steps she to perform catheter care are: Empty bag, clean bag and put protector on bed, gather the supplies, wash your hands, put on glove and gown, introduce self, get water, soap, towel, remove water, get new water, rinse and dry off resident. Review of the facility's policy and procedure regarding catheter care 09/2014, states the staff should wash and dry hands thoroughly. For a female resident: Use a washcloth with warm water and soap to cleanse the labia. Use one area of the washcloth for each downward, cleansing stroke. Change the position of the washcloth with each downward stroke. Next, change the position of the washcloth and cleanse around the urethral meatus. Do not allow the washcloth to drag on the resident's skin or bed 105172 Page 5 of 6 105172 02/10/2025 Fountain Manor Health & Rehabilitation Center 390 NE 135th St North Miami, FL 33161

F 0880 Level of Harm - Minimal harm or potential for actual harm linen. With a clean washcloth, rinse with warm water using the above technique. For a male resident male: Use a washcloth with warm water and soap to cleanse around the meatus. Cleanse the glans using circular strokes from the meatus outward. Change the position of the washcloth with each cleansing stroke. With a clean washcloth, rinse with warm water using the above technique. Return foreskin to normal position. Residents Affected - Some 105172 Page 6 of 6