Health inspection·February 18, 2025

F 0690 Level of Harm - Immediate jeopardy to resident health or safety 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 observation, medical record review, policy review, national library glove use review guidance and interview, the facility failed to ensure a resident with an indwelling urinary catheter was provided appropriate care and services. This affected one resident (#2) of three residents reviewed for indwelling catheter use. The facility identified six residents with indwelling urinary catheters. The census was 93. Findings include: Medical record review revealed Resident #2 was admitted on [DATE] with diagnoses including nontraumatic intracerebral hemorrhage, dementia, aphasia, congestive heart failure, urinary tract infection, hydroureteronephrosis, bladder outlet obstruction, pyelonephritis, ureteral stent, use of an indwelling urinary catheter, and Kennedy ulcer (a rapidly developing skin wound that appears in some people during their final weeks of life). Review of the quarterly Minimum Data Set 3.0 assessment dated [DATE] revealed Resident #2 was severely impaired for daily decision-making, had no behavioral or rejection of care, bilateral impaired upper and lower extremity functional range of motion limitation, was dependent on staff for self-care, was always incontinent of urine and did not have an indwelling urinary catheter. Review of the hospital Infectious Diseases Progress Note dated 02/06/25 and hospitalist Inpatient Progress Note dated 02/06/25 revealed diagnoses included Escherichia coli (e. coli) cystitis with chronic retained right ureteral stent with greater than 100,000 col/mL urine culture for e. coli (a gram-negative bacteria commonly found in the lower intestine). Further review of the hospital records revealed a Discharge summary dated [DATE] revealed the resident was admitted to the hospital on [DATE] with diagnoses including a urinary tract infection requiring treatment with antibiotics and discharged back to the facility on [DATE]. Review of the electronic Physician Orders dated 02/10/25 revealed the resident was ordered a 16 french indwelling catheter to straight drain. Review of the undated Baseline care plan revealed pain approaches included the following: encourage resident to report any pain; note pain by utilizing intensity, location and pain type; note verbal (vocal) complaints of pain and non verbal restless, grimacing, withdrawal; and to medicate for pain per order and indication by the resident verbal or non verbal. Coccyx wound approaches included to monitor for pain. On 02/18/25 between 10:42 A.M. and 11:03 A.M., observation of Resident #2's indwelling catheter (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 2 Event ID: 366429 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 366429 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Altercare Zanesville Inc. 4200 Harrington Drive Zanesville, OH 43701 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)