Health inspection·January 29, 2024

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 policy review, observation, interview and record review, the facility failed to ensure proper perineal care to residents with a history of and current Urinary Tract Infection (UTI) for 1 of 3 sampled residents observed during perineal care, Resident #3. The finding included: The policy titled perineal care, dated 11/01/2018, documented, in part: the purposes of this procedure are to provide cleanliness and comfort to the resident, to prevent infections and skin irritations, and to observe the resident's skin condition .; the following equipment and supplies will be necessary when performing this procedure: wash basin, towels, washcloth, soap (or other authorized cleansing agent) .; and steps in the procedure: #9 for a female resident: a) wet washcloth and apply soap or skin cleansing agent. Review of the in-house UTI [Urinary Tract Infection] list, dated from October 2023 to present (January 29, 2024), evidenced there were 25 cases of facility acquired UTIs during this time. Review of record for education / in-services, dated August 2023, revealed education / in-services was provided regarding pericare / Foley catheter care. Record review for Resident #3 revealed the resident was admitted to the facility on [DATE], with diagnoses that included: Septicemia (blood poisoning by bacteria), and Urinary Tract Infection (UTI) in the last 30 days. The admission Minimum Data Set (MDS) assessment, reference date, 01/04/24, indicated a Brief Interview for Mental Status (BIMS) score of 12, indicating Resident #3 was moderately cognitively impaired. This MDS recorded no mood/behavior issue; the functional abilities and goals for toilet hygiene as dependent for admission performance; and shower / bathing was self-substantial assistance for admission performance. Additional record review revealed a urinalysis dated 01/26/24 was positive for UTI. Review of the Physician orders revealed an order dated 01/28/24 for Bactrim DS (Sulfamethoxazole-Trimethoprim) 800-160 mg 1 tablet by mouth twice a day for UTI. Review of care plan, dated 01/29/24, recorded, that Resident #3 had urinary incontinence (loss of bladder control), Cystitis (inflammation of the bladder), and UTI. This care plan recorded Resident #3 had received Macrobid (antibiotic) from 01/16/24 through 01/20/24 and Bactrim DS (antibiotic) was ordered from 01/28/24 through 02/01/24 for a UTI. Review of progress note dated 01/28/24 written at 10:10 PM documented Resident #3 started the Page 1 of 2 105687 105687 01/29/2024 Solaris Healthcare Parkway 800 SE Central Pkwy Stuart, FL 34994

F 0690 antibiotic for UTI. Level of Harm - Minimal harm or potential for actual harm On 01/29/24 at 11:51 AM, an interview was held with the Staff Developer who voiced that the facility conducted a peri care Inservice in August 2023, and they're planning a skills fair for the last week of [DATE]. The skill fair will include providing peri care, and the facility has a male and female mannequin for the skill fair. Residents Affected - Few On 01/29/24 at 12:06 PM, peri care observation was conducted with Staff A and Staff B, Certified Nursing Assistants (CNA). Both CNAs were observed with gloves on in the bathroom. Staff A collected warm water in a basin for the peri care. Subsequently, both CNAs proceeded to go towards Resident #3's bed. Staff A placed the basin on the bedside table. Staff A also placed several small washcloths and a big towel directly on the bedside table without a barrier. Staff A proceeded to draw the curtain and closed it for privacy. Staff A removed the pillow and linens from the bed, obtained a clean sheet to cover Resident #3's upper body, and moved the bedside table closer to the bed. After completing these tasks, and with the same gloves, Staff A obtained a small washcloth from the bedside table, wet it in the water that had no soap, and she proceeded to provide the peri care. On 01/29/24 at 12:14 PM after the peri-care, an interview was held with Resident #3. When asked how she had contracted the UTI (bladder infection), the resident said she didn't know. She then voiced that she gets UTIs all the time and has been getting UTI's once or twice a year. On 01/29/24 at 12:41 PM, another interview was held with the Staff Developer and the Director of Nursing (DON) regarding the peri care observation. The surveyor notified them of the findings, and both acknowledged the findings. 105687 Page 2 of 2