Inspection·April 4, 2019

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, observation and record review, the facility failed to ensure the care plans were updated timely for residents with catheters. This affected two residents (Resident #44 and Resident #88) out of two residents reviewed for catheters. The facility census was 148. Findings Include 1. Resident #44 was admitted to the facility on [DATE]. Her admitting diagnoses included urinary tract infection, severe sepsis with septic shock, neuromuscular dysfunction of the bladder, chronic kidney failure and encephalopathy. According to Resident #44's Minimum Data Set 3.0 (MDS) assessment, dated 01/24/19, this resident had moderate cognitive impairment. She needed extensive assistance of staff for bed mobility, transfers, dressing, toilet use and personal hygiene. Review of the bowel and bladder assessment of this MDS showed that the resident did have an indwelling urinary catheter. Review of Resident #44's physician orders revealed on 02/05/19 the physician wrote an order for the resident to have a foley (Urinary drainage tube that is inserted into the bladder) due to a neurogenic bladder. The foley is to be a size 16 FR with a 10 cc balloon to gravity drainage. The foley catheter is to be secured with the foley leg strap. Review of this resident's plan of care dated 01/21/19 revealed the resident was at risk for infection and/or trauma related to use of a foley catheter for a neurogenic bladder. Review of the interventions for this plan of care showed to: Check foley catheter for patency, and/or kinks in tubing every shift; foley catheter care every shift, assess resident for pain/discomfort every shift and to monitor for signs/symptoms of urinary tract infection. There was no intervention listed to secure the foley with a foley leg strap. Interview with the Director of Nursing (DON) on 04/03/19 at 12:35 P.M. revealed that the resident did not have the intervention to secure the resident's catheter with foley leg strap. 2. Resident #88 was admitted to this facility on 01/09/18. His admitting diagnoses included acute kidney failure, chronic kidney disease, Alzheimer's disease, dementia and neuromuscular dysfunction of the bladder. Resident #88's Minimum Data Set 3.0 (MDS) assessment dated [DATE] revealed this resident was cognitively intact. Resident #88 needed extensive assistance of staff for bed mobility, transfers, toilet (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: 365084 Printed: 05/15/2026 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 365084 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/04/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pleasantview Care Center 7377 Ridge Rd Parma, OH 44129 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)