Health inspection·January 26, 2023

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. Based on record review and interview, the facility failed to obtain physician's orders and a diagnosis for a urinary catheter for one (Resident #12) of two residents sampled for a review of urinary catheters, from a total of 19 residents in the sample. The findings include: A review of the facility's Resident Matrix, printed on 1/23/23, revealed that Resident #12 had an indwelling urinary catheter. A record review was conducted for Resident #12, revealing an admission date of 10/26/22. The resident's diagnoses included cardiomyopathy, interstitial pulmonary disease, heart failure, hypertension, and atherosclerotic heart disease. A review of the resident's active Physician's Order Sheets for January 2023, revealed no diagnosis or physician's orders for a urinary catheter or catheter care. (Photographic evidence obtained) A review of the resident's care plan, dated 11/15/22, revealed that Resident #12 was admitted with an indwelling urinary catheter. He received extensive assistance to meet his toileting needs with interventions that included administration of medications as ordered; monitor catheter every shift for blockage, leakage, if present document and notify doctor; monitor for signs and symptoms of discomfort during urination and frequency. Monitor/document for pain/discomfort due to catheter. Perform catheter care every shift and position catheter bag and tubing below the level of the bladder and away from entrance room door. (Photographic evidence obtained) An interview was conducted with the Director of Nursing (DON) on 1/26/23 at 10:31 a.m. She stated the facility's protocol for catheter care should be based on a physician's order and diagnosis. She stated, Orders should state when a resident's catheter should be changed and how long the catheter should be place. She was asked to identify the diagnosis for Resident #12's catheter placement. She stated I don't see one. She was asked to find the physician's order for Resident #12's catheter. She stated there was no diagnosis or order for the resident's catheter in the electronic medical record. The DON reviewed the hard (paper) chart, and was unable to find a physician's order for a urinary catheter in either the hard chart or the hospice care plan. She stated, I see what your saying. She agreed that there was no diagnosis in the hard chart. The DON was asked how the nurse would know what to do with the catheter if there was no order. She replied, They wouldn't. The facility's policy for Foley (urinary catheter) Catheters (revised 8/19/2015), did not reference obtaining a physican's order or a diagnosis for the use of a urinary catheter. (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 5 Event ID: 105210 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105210 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE W Frank Wells Nursing Home 210 N 2nd St MacClenny, FL 32063 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)