Health inspection·October 17, 2019

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews, the facility did not ensure the urinary catheter devices were maintained in a manner to decrease chance of infection. This affected two (Residents #21 and #46) of 10 residents observed who required urinary catheters. The facility census was 66 residents. Residents Affected - Few Findings include: 1. Medical record review for Resident #21 revealed initial admission into the facility was on 05/31/10. Th resident's medical diagnoses included the principal diagnosis of multiple sclerosis and additional diagnoses of neuromuscular dysfunction of the bladder, overactive bladder, hypertension, depression, and anemia. The comprehensive Minimum Data Set (MDS 3.0) assessment, dated 07/18/19, revealed this resident had a brief interview for mental status (BIMS) score of 15 of a possible 15, indicating intact cognition. The comprehensive assessment dated [DATE] documented Resident #21 had an indwelling urinary catheter for a neurogenic bladder due to multiple sclerosis. A plastic blue face cover for the bag covered the face of the drainage bag only. On 10/15/19 at 12:45 P.M., Resident #21 was observed sitting in the dining room during the meal service and a urinary catheter and urine collection bag was attached to the wheelchair. At the time of the observation the urinary collection bag and portion of the catheter tubing was observed on the floor as it hung from the chair and resident. On 10/15/19 at 1:00 P.M., Resident #21 was observed in the dining room and facing the open area of the room. The surveyor observed the resident in a wheelchair with the catheter bag attached to the wheelchair. At the time of the observation the urine collection bag hung in a position that the bottom of the bag was touching the floor along with the catheter tubing which was secured to the resident's left leg as the catheter was positioned along the resident's leg. Observations were made from 1:00 P.M. through 1:30 P.M., and dDuring this time various staff members including the nursing staff and nurse aide staff walked by the resident and talked to the resident. None of the staff members had noticed or attempted to raise the catheter bag and tubing and secure it in a position to prevent it from touching or dragging on the floor and thereby prevent possible urinary tract infection. On 10/15/19 at 1:35 P.M., after observing the resident wheeling herself down to her room and the catheter tubing and bag dragging on the floor, Resident #21 verified the catheter bag and catheter tubing was on the floor and this had occurred often. Page 1 of 2 366062 366062 10/17/2019 Caprice Health Care Center 9184 Market St North Lima, OH 44452

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During interview on 10/15/19 at 1:50 P.M., Registered Nurse (RN) #505 verified the findings of the tubing and catheter bag on the floor while observing Resident #21 in her room. 2. Resident #46 was admitted to the facility on [DATE] with diagnoses of acute kidney failure and chronic kidney disease. The resident had an indwelling catheter and urinary drainage bag in place due to obstructive uropathy. On 10/15/19 at 1:48 P.M. an observation was made of Resident #46 who had a urinary catheter and catheter bag dragging on the floor while in the television room on the 200 unit. At the time of the observation, State Tested Nursing Aide #510 verified the findings of the catheter bag and tubing being on the floor. Review of the nursing notes from 06/30/19 through 10/15/19 and care plan revealed no evidence of interventions to keep the urinary bag and catheter tubing off the floor for Residents #21 and #46 Review of the document titled, Policy for Foley Catheter Care (undated) revealed it did not address the area of infection control as it related to ensuring the urinary catheter tubing and collection bag remaining off the floor to minimize the possiblity of a urinary tract infection. These findings were shared with the Administrator and Director of Nursing on 10/16/19 at 7:45 A.M. 366062 Page 2 of 2