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, staff interview, and medical record review, the facility failed to ensure urinary catheter bags
were covered to maintain resident dignity. This affected one (#49) of two residents reviewed for urinary
catheters. The census was 56.
Findings include:
Review of the medical record for Resident #49 revealed an admission date of 08/09/23. Diagnoses included
severe intellectual disabilities, acute kidney failure, retention of urine, chronic obstructive pyelonephritis,
unspecified hydronephrosis, and benign prostatic hyperplasia with lower urinary tract symptoms.
Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #49 was
assessed with moderately impaired cognition.
Observation on 01/02/24 at 8:23 A.M. revealed Resident #49 was sitting in the common dining room
awaiting breakfast and his urinary catheter (Foley) bag was not covered.
Interview with State Tested Nurse Aide (STNA) #135 and STNA #140 verified Resident #49's urinary
privacy bag was not covered in the common dining area.
This deficiency represents an incidental finding investigated under Complaint Number OH00149334.
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:
366237
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
366237
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/04/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Wadsworth Pointe
540 Great Oaks Trail
Wadsworth, OH 44281
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 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
observation, medical record review, staff interview, review of a facility policy, and review of the Centers for
Disease Control and Prevention (CDC) website, the facility failed to ensure urinary catheters were
maintained in a manner to prevent infection. This affected one (#49) of two residents reviewed for urinary
catheters. The census was 56.
Residents Affected - Few
Findings include:
Review of the medical record for Resident #49 revealed an admission date of 08/09/23. Diagnoses included
severe intellectual disabilities, acute kidney failure, retention of urine, chronic obstructive pyelonephritis,
unspecified hydronephrosis, and benign prostatic hyperplasia with lower urinary tract symptoms.
Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #49 was
assessed with moderately impaired cognition and used a manual wheelchair for mobility around the facility.
Review of the plan of care dated 08/16/23, last reviewed 12/04/23, revealed Resident #49 required an
external catheter and nephron tube due to acute kidney failure and urinary retention.
Review of a progress note dated 10/11/23 revealed Resident #49's a urinary catheter (Foley) that was
intact and draining clear yellow. The resident also had a right nephrostomy tube with a dressing that was
clean, dry, intact, and draining clear yellow.
Observation on 01/02/24 at 8:23 A.M. revealed Resident #49 sitting in the dining room awaiting breakfast.
The resident's Foley catheter bag was hooked on the cross bar under his manual wheelchair and there was
not enough space for the Foley catheter bag to be up off the floor. Further observation revealed
approximately one-third of the Foley bag was resting directly on the floor uncovered.
Interview with State Tested Nurse Aide (STNA) #135 and STNA #140 at 8:35 A.M. on 01/02/24 stated
Resident #49 could transfer himself and also could reach where the Foley bag was hooked on the
wheelchair. STNA #135 and STNA #140 verified Resident #49's Foley bag was resting on the floor
uncovered, and the resident dragged the bag around the facility under the wheelchair and in and out of the
elevator when the resident to different floors of the facility.
Review of the infection control policy, dated 08/19/20, revealed employees are to support resident safety by
adhering to all policies and procedures related to infection prevention.
Review of the CDC website at, https://www.cdc.gov/infectioncontrol/guidelines/cauti/index.html, last
reviewed 11/05/15, and titled, Catheter-Associated Urinary Tract Infections (CAUTI), revealed under proper
techniques for urinary catheter maintenance to keep the collecting bag below the level of the bladder at all
times. Do not rest the bag on the floor.
This deficiency represents non-compliance investigated under Complaint Number OH00149334.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
366237
If continuation sheet
Page 2 of 2
