Health 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. Page 1 of 3 105468 105468 06/13/2023 Ponce Therapy Care Center and Rehab, The 1999 Old Moultrie Road Saint Augustine, FL 32086

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few A review of the admission Minimum Data Set (MDS) assessment, dated 4/15/2023, revealed that Resident #5's Brief Interview for Mental Status (BIMS) score was 15/15, indicating intact cognition. He was totally dependent on staff for transfers and locomotion on and off the nursing unit. He required extensive assistance with personal hygiene, toilet use, dressing and bed mobility, with supervision required for eating. At the time of the assessment, he was documented as occasionally incontinent of bladder and frequently incontinent of bowel. A review of Resident #5's Care Plan, revealed focus areas including Falls and ADL (Activities of Daily Living) Self-Care Performance Deficit. Toileting and/or incontinence was not among the focus areas addressed in the resident's Care Plan. On 6/13/2023 at 1:11 p.m., Resident #6 was observed sitting in her room. She stated she was in the facility for short-term rehabilitation. When asked about toileting, she stated she was continent. The facility required her to wear incontinent briefs because they didn't want her to put any pressure on her foot. She didn't want to wear the brief and preferred to use the bedside commode. She was asked if she had been offered a bedpan for use. She stated no. She stated she was agreeable to using a bedpan. The facility staff had not offered any alternate toileting means; she had been wearing the incontinence briefs since her admission. A record review revealed that Resident #6 was admitted to the facility on [DATE]. Her diagnoses included effusion right knee; cerebral infarction; acute kidney failure; atrial fibrillation and a need for assistance with personal care. At the time of the survey the resident's MDS assessment had not been completed. A review of the Baseline Care Plan, initiated on 6/10/2023, revealed the following: FOCUS: Resident has urinary incontinence GOAL: Resident will not develop complications associated with urinary incontinence. INTERVENTIONS/TASKS: Resident has or is at risk for urinary incontinence. Check every 2-3 hours and/or as required for incontinence. Provide incontinence care as needed. If the resident has some control, check with resident every 2-3 hours for need to toilet. Encourage to ask for assistance in advance of need and not wait until need to urinate is urgent. During an interview with DOR B on 6/13/2023 at 2:23 p.m., she stated there was never a reason a resident should not be permitted to use the bathroom. She added that the resident's safety would be taken into consideration. Regarding Resident #5, she stated he was currently receiving therapy. He was starting to progress with moderate assistance and recently started walking a distance of 35 feet. She confirmed she had been speaking with his Case Manager regarding his progress and toileting concerns. She denied knowledge of reasons that would prohibit Resident #5 from having a urinal or being assisted to the bathroom. She stated the nursing department provided residents with urinals and they were stored in the central supply room. Regarding Resident #6, DOR B stated she was a readmission. The resident required total assistance from staff at this time with use of a mechanical lift. She stated the use of the incontinence brief was a recommendation based on safety; however, alternatives should be offered. She added the recommendation was always to offer an alternative to voiding on the sheets or in a brief. The bedpan was an option for use. There was nothing preventing the resident from using the bedpan. She should not be forced to wear a brief. During an interview with Registered Nurse (RN) A on 6/13/2023 at 2:40 p.m., she stated she was familiar with Resident #5. She referred to him as incontinent; however, she was unsure if he was able to alert staff when he had to use the bathroom. She stated on 6/12/2023 she spoke with his Case 105468 Page 2 of 3 105468 06/13/2023 Ponce Therapy Care Center and Rehab, The 1999 Old Moultrie Road Saint Augustine, FL 32086

F 0690 Level of Harm - Minimal harm or potential for actual harm Manager about him using the urinal. The facility was addressing that request. She confirmed that nursing did provide the urinals. When advised about the urinal being removed from Resident #5's room, she stated she was not aware that it had been removed again. She stated she would speak with the CNAs about it. She was somewhat familiar with Resident #6. If Resident #6 activated her call light and asked to use the bathroom, she should have been permitted to use the bedpan. Residents Affected - Few A review of the facility's policy for Standards and Guidelines Perineal/Incontinence Care Manual: Nursing Date Implemented: 3/1/2021: Dated 3/1/2021 revealed: Guidelines: #5 The facility must ensure that a resident who is continent of bladder and bowel on admission receives services and assistance to maintain continence unless his or her clinical condition is or becomes such that continence is not possible to maintain. . 105468 Page 3 of 3