Health inspection·March 5, 2020

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 observation, record review and interview the facility failed to ensure Resident #3's indwelling Foley catheter (a thin sterile tube inserted into the bladder to drain urine) bag was emptied properly to prevent potential complications for the resident. This affected one resident (#3) of one resident reviewed for catheters. Findings include: Review of the medical record for Resident #3 revealed an admission date of 11/24/19 with diagnoses including chronic respiratory failure, chronic kidney disease, neuromuscular dysfunction of the bladder, benign prostatic hyperplasia with lower tract symptoms and spinal stenosis. Review of the care plan, dated 11/25/19 revealed Resident #3 required alternate means of urinary elimination of a Foley catheter due to neurogenic bladder, benign prostatic hyperplasia with lower urinary tract symptoms, urinary tract infection and sepsis. Interventions included catheter care every shift and as needed, monitor catheter patency every shift, position drainage bag below the level of the bladder and keeping the bag and tubing off the floor always. There was nothing in the care plan regarding emptying the catheter drainage bag. Review of physician's orders for March 2020 revealed Resident #3 had an order for an indwelling Foley catheter to continuous drainage and catheter care every shift. There were no physician orders regarding emptying the Foley catheter drainage bag. Observation on 03/02/20 at 11:29 A.M. revealed Resident #3's indwelling Foley catheter drainage bag laying on the floor while Resident #3 was in bed. Resident #3's catheter drainage bag was all the way full of urine and the urine was backing up into the catheter tubing. His drainage bag was leaking out the bottom of the catheter bag and the bag was laying in a puddle of urine. Interview and observation with the Director of Nursing on 03/02/20 at 11:32 A.M. verified the indwelling Foley catheter bag was overfull causing the urine to back up into the catheter tubing as well as leak out of the bottom of the catheter bag. She verified the catheter bag should have been emptied and not had this amount of urine in the bag. The Director of Nursing emptied the urinary catheter bag and measured the urine content and she revealed the urinary output measured 3000 cubic centimeters (cc). Review of manufacturer guidelines, SteriGear the Fig Leaf with a model number of 10270 revealed Resident #3's urinary drainage bag had a capacity of 2000 milliliters. The guidelines revealed to hang the bag utilizing the hanger or rope and do not place the bag on the floor. The guidelines also (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: 366326 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 366326 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/05/2020 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Geneva Center for Rehabilitation and Nursing 1140 South Broadway Geneva, OH 44041 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)