F 0684
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
closed resident record reviews, hospital discharge instructions, and staff interview, the facility failed to
ensure care for nephrostomy tubes was provided in a timely manner. This affected one resident (#77) of
one reviewed for hospitalizations. The facility census was 77.Findings include:Closed record review for
Resident #77 revealed the resident was admitted to the facility on [DATE] and had diagnoses which
included malignant neoplasm of the bladder, hematuria, acute kidney failure, and hydronephrosis with
ureteropelvic junction obstruction.Review of the admission Minimum Data Set (MDS) assessment, dated
05/19/25, revealed the resident was assessed to have intact cognition. The resident was assessed to have
an indwelling catheter device. Review of the hospital discharge instructions, dated [DATE], revealed
instructions for how to care for nephrostomy tubes. Instructions for care of the skin where the tubes exited
the body included cleansing the skin surrounding the area where the tubes exited the body using a
washcloth or cotton swab with cleanser or soap and water, rinsing the area with water if soap was used,
allowing the area to air dry or patting dry gently, then applying one sterile four by four split gauze pad
around the tube. Apply a second gauze pad over the first one to cover the tube, tape over the pads with
paper tape and pinch the tape around the tube, and lastly tape the tube to the skin below the dressing for
support. Review of the physician's orders for the resident revealed no order was put into place for care of
the skin surrounding the area where nephrostomy tubes exited the body until 05/20/25. Interview with the
Director of Nursing on 07/30/25 at 8:45 A.M. confirmed there had not been orders implemented for the care
of the skin surrounding the area where nephrostomy tubes exited Resident #77's body until 05/20/25.
Residents Affected - Few
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 2
Event ID:
365643
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
365643
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/31/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Portsmouth Health and Rehab
727 Eighth Street
Portsmouth, OH 45662
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)
F 0883
Develop and implement policies and procedures for flu and pneumonia vaccinations.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
resident record reviews, staff interview, and review of facility policy, the facility failed to ensure resident
influenza and pneumococcal vaccinations were offered and administered in a timely and appropriate
manner. This affected two residents (#14 and #15) out of the five residents reviewed for immunizations. The
facility census was 77.Findings include:1. Record review for Resident #14 revealed the resident was
admitted to the facility on [DATE] and had diagnoses which included cerebral infarction, acute kidney
failure, and mood disorder. Review of the annual Minimum Data Set (MDS) assessment, dated 06/02/25,
revealed the resident was assessed to not be up to date on the pneumococcal vaccination due to the
vaccination not being offered. Review of the facility immunization record for the resident revealed no
pneumococcal vaccine was documented to have been previously administered. 2. Record review for
Resident #15 revealed the resident was admitted to the facility on [DATE] and had diagnoses which
included hypertension, hyperlipidemia, and diabetes mellitus. Review of the annual MDS assessment,
dated 05/09/25, revealed the resident was assessed to not be up to date on the influenza vaccination due
to the vaccination not being offered. Review of the facility immunization record for the resident revealed no
influenza vaccine was documented to be administered since 09/27/23. Interview with the Director of
Nursing on 07/31/25 at 10:20 A.M. confirmed Resident #14 was not up to date on the pneumococcal
vaccine and Resident #15 was not up to date on the influenza vaccine. Review of the facility policy titled
Vaccination of Residents, revised 10/2019, revealed refusals of vaccinations shall be documented in the
resident's medical record. If the resident receives a vaccine, it shall be documented in the resident's
medical record. Review of the facility policy titled Influenza Vaccine, revised 03/2022, revealed between
October 1st and March 31st each year the influenza vaccine shall be offered to residents and employees
unless the vaccine is medically contraindicated, or the resident or employee has already been immunized.
For those who receive the vaccine, the vaccination will be documented in the resident's/employee's medical
record. Review of the facility policy titled Pneumococcal Vaccine, revised 10/2023, revealed prior to or upon
admission residents are assessed for eligibility to receive the pneumococcal vaccine series. For each
resident who receives the vaccine, the vaccination is documented in the resident's medical record.
Administration of the pneumococcal vaccines are made in accordance with current Centers for Disease
Control (CDC) recommendations at the time of the vaccination.
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365643
If continuation sheet
Page 2 of 2
