Inspection·November 2, 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 observation, interviews, record review and policy review, the facility failed to provide straps for anchoring catheter tubing for 3 of 3 sampled residents observed for catheter use (Resident #5, #16 and #21). The findings included: A review of the facility's policy titled Catheter Care which was renewed and updated on 08/03/23 revealed leg bags will be attached to the resident's thigh or calf making sure to have slack on the tubing to minimize pressure and tension. Ensure straps are snug but not tight. 1) Record review revealed Resident #5 was admitted to the facility on [DATE]. The resident's diagnoses included Neuromuscular dysfunction of the bladder, Metabolic encephalopathy, and Overactive bladder. Her Brief Interview for Mental Status (BIMS) score was 2, per the Medicare 5-day Minimum Data Set (MDS) with an assessment reference date (ARD) of 10/13/23. This indicated the resident was severely cognitively impaired. On 10/02/23 the resident was transferred to the hospital for urine retention and a Foley catheter was inserted prior to the transfer. A urinary tract infection was identified in the hospital, and she was placed on an antibiotic. She returned to the facility on [DATE] with a Foley catheter in place. A trial removal of the Foley catheter was done on 10/17/23 but was reinserted on 10/18/23. On 10/31/23 at 11:50 AM, catheter care was observed for Resident #5. Staff B, certified nursing assistant, performed the care. After the care was done, Staff B proceeded to reapply the brief without providing any type of strap or anchor for the tubing. 2) Record review revealed Resident #16 was admitted to the facility on [DATE]. Her diagnoses included Neurogenic Bladder, Hemiplegia, Paraplegia, and Multiple sclerosis. Her BIMS score was 15 according to the quarterly MDS with an ARD of 08/30/23. This indicated the resident was cognitively intact. On 10/31/23 at 1:00 PM an interview was conducted with the resident who stated she does not have a strap or anchor on her catheter tubing. 3) Record review revealed Resident #21 was admitted to the facility on [DATE]. Her diagnoses included Obstructive and Reflux Uropathy, Acute Kidney Failure, and Neurogenic Bladder. Her BIMS score was 7, per the quarterly MDS with an ARD of 07/31/23. This indicated the resident had severe cognitive impairment. An interview and observation of Resident #21 was conducted on 10/31/23 at 12:54 PM. The resident did not have a strap to anchor the tubing for the leg bag. Staff C, a (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 7 Event ID: 105827 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 105827 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Finnish-American Village 1800 South Drive Lake Worth, FL 33461 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)