Inspection·April 4, 2024

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, resident and staff interview, and medical record review, the facility failed to maintain resident dignity of by not covering a urinary catheter collection bag. This affected one (#8) of one residents reviewed for dignity. The facility census was 36. Findings include: Review of the medical record for Resident #8 revealed an admission date of 04/17/20 with diagnoses of obstructive uropathy and reflux uropathy, hematuria (blood in the urine), and urinary retention. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] for Resident #8 revealed the resident required an indwelling catheter. Review of the physician orders for April 2024 for Resident #8 revealed the resident was ordered an indwelling urinary (Foley) catheter with instructions to change as needed to maintain patency and catheter care every shift and as needed. Review of the care plan revised January 2024 for Resident #8 revealed the resident was care planned for an indwelling urinary catheter with an intervention to position the catheter bag and tubing below the level of the bladder and away from entrance room door. Observation on 04/01/24 at 11:41 A.M. and 2:36 P.M. of Resident #8 revealed her Foley catheter was not covered and was visible from the hallway. Interview on 04/02/24 at 9:23 A.M. with Resident #8 stated it bothered her if someone saw the urinary catheter bag. Interview on 04/02/24 at 9:53 A.M. with State Tested Nurse Aide (STNA) #236 stated the policy for residents with urinary catheters was to turn the collection bag backwards toward the door. Observation on 04/03/24 at 7:38 A.M. of Resident #8 revealed her Foley catheter was not covered and visible from the hallway. Interview on 04/03/24 at 7:40 A.M. with Registered Nurse (RN) #260 verified the Foley catheter for Resident #8 was visible from the hallway and the facility's policy was to cover Foley catheters. 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 8 Event ID: 365575 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 365575 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/04/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE St Catherine's C C of Fostoria 25 Christopher Dr Fostoria, OH 44830 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)