Health inspection·November 13, 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 observation, record review, and interview, the facility failed to ensure proper indwelling urinary catheter care and services for 1 of 3 sampled residents, as evidenced by the failure to assess for and or attempt to discontinue the indwelling urinary catheter for Resident #1. The findings included: Review of the record revealed Resident #1 was admitted to the facility on [DATE], after hospitalization for back surgery. Review of the hospital record revealed the indwelling urinary catheter was placed at the time of the surgery. The hospital discharge instructions lacked any documentation related to the indwelling urinary catheter. The hospital record lacked any documented attempt at removal of the device. Review of the transfer form dated 09/04/24 from the hospital documented Resident #1 had a Foley catheter (indwelling urinary catheter) in place but lacked any indication for use and lacked information as to if the hospital made an attempt to remove the device. Review of the admission Minimum Data Set (MDS) assessment dated [DATE] documented the resident was cognitively intact with a Brief Interview for Mental Status (BIMS) score of 15, on a 0 to 15 scale, indicating intact cognition. This MDS also documented the resident had an indwelling urinary catheter for neurogenic bladder, as did an order dated 09/06/24. The admission nursing assessment dated [DATE] documented Resident #1 was admitted with the indwelling urinary catheter. Review of all nursing and physician progress notes, along with all physician orders, lacked any documented assessment to remove the indwelling urinary catheter, or rationale as to why it needed to remain. The record also lacked a documented voiding trial, a process where the urinary catheter would be removed to allow the resident to urinate. The progress notes and orders also lacked any need for a urinary consult. Review of the record revealed an order for a surgical follow-up appointment scheduled for 09/26/24 at the physician's office. A progress note dated 09/26/24 at 2:15 PM documented Resident #1 was transported to the hospital following a doctor's appointment. Review of the post-operative progress note from the Resident's follow-up appointment documented, in part, that Resident #1 still had the Foley catheter in place. This note revealed Resident #1 told the nursing staff and doctors at the SNF (skilled nursing facility) that the catheter was meant to be removed and that she had not had any voiding trial. This note documented the Foley catheter was to be removed two to three days after admission to the facility. (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: 106091 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 106091 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/13/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Luxe at Wellington Rehabilitation Center The 10330 Nuvista Avenue Wellington, FL 33414 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)