Inspection·June 13, 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record review, the facility failed to ensure that a resident who was continent of bladder and bowel on admission received services and assistance to maintain continence unless his or her clinical condition was or became such that continence was not possible to maintain, and that a resident who was incontinent, received appropriate treatment and services to restore continence to the extent possible, for two (Residents #5 and #6) of six residents sampled. Specifically, these residents were placed in briefs and were not offered other means of toileting. Failure to maintain continence or attempt to improve incontinence, when possible, could lead to functional loss and impaired dignity. The findings include: During an interview with Director of Rehabilitation (DOR) B on 6/12/2023 at 4:42 p.m., she stated Occupational Therapy assessed residents upon admission, while the Certified Nursing Assistants (CNAs) assessed the residents' toileting functioning levels. Therapists promoted dignity and the resident trying to use the bathroom. They did not encourage the use of incontinence pads. The goal was to get the residents to use the toilet, however, if it was not safe for the staff, then therapy would encourage a bedside commode or bedpan for the resident's use. Therapy worked with residents to find the most dignified way for them to use the bathroom. On 6/13/2023 at 12:42 p.m., Resident #5 was observed in his room with his personal Case Manager. The resident stated he was aware of his rights in the facility. When asked about toileting, he stated he could go to the bathroom on his own. If he had an accident in his brief, staff would come in and help him get cleaned up. He confirmed that he was wearing a brief at the time of the interview and stated he preferred to use the toilet or the urinal. No urinal was observed in the resident's room or bathroom. He stated he could walk to the bathroom with the use of his walker. A walker was observed within his reach. An interview was also conducted with the resident's Case Manager who was in the resident's room at the time. She stated she had concerns that the facility was causing Resident #5 to become incontinent by forcing him to wear incontinence briefs. She stated upon admission, he was fully continent and his episodes of incontinence had begun to increase. In the past, she had spoken with DOR B regarding Resident #5 having a urinal in his room to promote and maintain urinary continence; however, someone kept removing it. She addressed this again on 6/12/2023 with DOR B who provided the resident with another urinal at that time; however, when the Case Manager arrived on the morning of 6/13/2023, the urinal had been removed from the resident's room again. A record review revealed that Resident #5 was admitted into the facility on 4/8/2023. His diagnoses included unspecified fracture of left femur - subsequent encounter for closed fracture with routine healing; unspecified dementia; atrial fibrillation; fecal impaction and peripheral vascular disease. (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 3 Event ID: 105468 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 105468 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ponce Therapy Care Center and Rehab, The 1999 Old Moultrie Road Saint Augustine, FL 32086 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)