Inspection·July 7, 2025

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. Based on record review, staff interview, review of Centers for Disease Control and Prevention (CDC) guidance, and review of the facility policy, the facility failed to ensure Resident #16 who had a indwelling catheter received the appropriate treatment and services related to a urinary tract infection (UTI). This affected one (#16) of six residents reviewed for UTIs. The facility census was 76. Findings include: Review of the medical record for Resident #16 revealed an admission date of 05/01/20 with diagnoses of obstructive and reflux uropathy and type II diabetes mellitus. Resident #16 was admitted to Hospice on 05/25/25. Review of the significant change comprehensive Minimum Data Set (MDS) assessment, dated 05/30/25, revealed Resident #16 had impaired cognition and an indwelling catheter. Review of a urine culture and sensitivity, collected 05/26/25 and reported 05/31/25, revealed Resident #16 had bacterium Acinetobacter baumannii present at greater than 100,000 colony forming units per milliliter. The bacterium was susceptible only to amikacin (an antibiotic). There was nothing in the medical record indicating Resident #16 had symptoms of a UTI and notification to the physician of the results of the urine culture and sensitivity. Review of the current and discontinued physician orders dated 05/31/25 through current revealed no order for amikacin. Interview on 07/07/25 at 1:51 P.M. with Infection Preventionist (IP) #505 confirmed no signs or symptoms were documented in Resident #16's record indicating the purpose of the urinalysis. IP #505 confirmed the identification and testing for a UTI, per McGeer's criteria, required signs and/or symptoms of a UTI must be present before proceeding with a urinalysis. IP #505 confirmed no antibiotics were ordered to treat Resident #16's UTI. Additionally, IP #505 could provide no evidence a physician was notified regarding the results of the urine culture and sensitivity results. Review of facility policy titled Guideline for Infection and Prevention Surveillance Program dated 10/02/19 revealed the facility would have a system for preventing, identifying, reporting, investigating, and controlling infections. Review of the CDC guidance titled NHSN Long-term Care Facility Component Urinary Tract Infection dated January 2025 and found at https://www.cdc.gov/nhsn/ltc/uti/index.html revealed UTI is one of the most common sites of healthcare-associated infections (HAI), accounting up to 20 percent (%) of infections reported by long-term care facilities (LTCFs). There is criteria for catheter-associated symptomatic urinary tract infections (CA-SUTI). This included one or more signs and symptoms and a positive urine culture with no more than two species of microorganisms, at least one of which is a (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: 366042 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 366042 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/07/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Spring Meadows Nursing, A Villa Center 1125 Clarion Ave Holland, OH 43528 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)