Inspection·April 29, 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 medical record review, observation, staff interview, and review of the facility policy, the facility failed to ensure the treatment of a suprapubic catheter was provided per physician order and failed to ensure the documentation of urine output was completed per physician order. This affected two (#20 and #22) of two residents reviewed for urinary catheters. The facility census was 37. Findings include: 1. Review of the medical record for Resident #22 revealed an admission date of 10/10/17. Diagnoses included neuromuscular dysfunction of the bladder, benign prostatic hyperplasia, and dementia. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #22 was moderately cognitively impaired, required substantial assistance from staff with toileting, had an indwelling catheter, and had occasional bowel incontinence. Review of the care plan revised on 03/08/24 revealed Resident #22 required a suprapubic catheter related to urinary retention and a history of meatus erosion. Interventions included for Resident #22 to wear clothing which does not constrict the catheter, avoid obstructions in drainage, position the drainage bag below the bladder, keep system closed as much as possible, catheter care each shift, documentation of output every shift and minimize manipulation of the tubing with catheter care. An additional care plan for Resident #22 included enhanced barrier precautions due to multiple drug resistant organism, interventions included gowns and gloves to be worn during high contact resident care activities including bathing, showering, providing hygiene, changing linens, toilet hygiene and urinary catheter care. Review of the current physician orders in place for Resident #22 revealed orders dated 03/14/24 for the nurse to complete suprapubic catheter care every shift with catheter site cleansed with soap and water, bacitracin ointment applied around catheter insertion site and covered with split gauze while wearing required personal protective equipment and for a graduated cylinder used for urine collection for suprapubic catheter to be changed each week. Observation of suprapubic catheter care on 04/29/24 at 8:12 A.M. by Registered Nurse (RN) #75 revealed hand hygiene completed prior to care, gloves donned, moistened two washcloths with water, both cloths were rung out, soap was applied to one of the washcloths, both washcloths were then placed on top of a towel sitting on the counter of the sink. RN #75 approached Resident #22 who was lying in bed, elevated the height of the bed, removed the covers, lower the pant waist band, and proceeded using the soap covered washcloth, cleansed around the suprapubic insertion site, using a different (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 5 Event ID: 365996 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 365996 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/29/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ohio Living Swan Creek 1650 Swan Creek Lane Toledo, OH 43614 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)