Inspection·September 14, 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 interview, observation, and record review, the facility failed to perform proper technique with catheter care for Resident #24 and failed to utilize a urinary catheter anchor for 3 of 14 residents identified with urinary catheters, Residents #24, #19, and #55. The findings included: 1. The facility's policy titled Urinary Catheter Indication and Maintenance (Urethral and Supra-pubic), revised 6/9/17, has a section titled Maintenance/Care of Indwelling Urinary Catheters that has 6 steps. Step 5 states: Minimize the pull of catheter tubing by securing catheter to resident's body. 2. A procedure manual document from www.nursegroups.com, titled Indwelling Catheter Care, has numbered steps describing indwelling catheter care. Step 10 instructs: Perform perineal care with washcloths, soap, and warm water. Remember to clean front-to-back on female residents and under the foreskin of uncircumcised males. 3. On 09/13/23 at 9:35 AM, an observation was made of Staff A, a Certified Nursing Assistant (CNA), performing perineal care with catheter care on Resident #24. The CNA had all her equipment laid out on a barrier pad. The CNA washed her hands and put on gloves. The CNA filled a wash basin 1/2 full of warm water. The CNA repositioned the resident and removed his brief. The CNA used the warm water with disposable wash cloths and liquid soap to clean the tubing of the catheter from the urinary meatus outward. The CNA then used the same water and a clean disposable washcloth to provide perineal care. The CNA washed around the scrotum and the body of the penis up to the glans. The CNA then retracted the foreskin to wash the glans in a circular motion up to the meatus. The CNA took a disposable washcloth and wet it in the soapy water. The CNA squeezed the water over the penis. The CNA then used a dry towel to pat dry the resident's penis and scrotum. The CNA emptied the basin in the toilet, removed her gloves and put on new gloves. The CNA then refilled the basin with warm water, and washed the resident's buttocks from front to back. The CNA patted the resident dry and placed a new brief on the resident. The CNA did not place any device to secure the catheter tubing to the resident's body as documented in the catheter care policy. When asked about washing her hands between glove changes, Staff A admitted she did not wash her hands when she changed the water in the basin, and put on new gloves. 4. On 09/13/23 at 11:40 AM, after observing Resident #24 without an anchoring device for his catheter tubing, this surveyor used the facility matrix to determine all residents with an indwelling (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 4 Event ID: 106038 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 106038 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Alexander "sandy" Nininger State Veterans Nursing 8401 W Cypress Dr Pembroke Pines, FL 33025 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)