Health inspection·March 20, 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 closed medical record review, review of a resident communication log, review of visiting healthcare service orders, review of a customer alert form, hospital notes, policy review, medication instructions, and death certificate, and interview with family and facility staff the facility failed to ensure comprehensive monitoring and timely identification of a change in condition for Resident #94, who was incontinent of bladder with a diagnosis of Stage 3 chronic kidney disease. In addition, the facility failed to ensure Resident #94 received timely, necessary and appropriate treatment and services of a urinary tract infection (UTI). This resulted in Immediate Jeopardy, actual harm, and subsequent death beginning on [DATE] when Resident #94's daughter requested a urinalysis to be performed due to changes in the resident's cognition that was not completed by the facility. Resident #94's daughter again requested on [DATE] a urinalysis be performed as Resident #94 had increased confusion including visual hallucinations and two falls on [DATE]. On [DATE] the nurse practitioner (NP) was in the facility and ordered a urinalysis with culture and sensitivity for Resident #94, however, did not assess the resident. On [DATE] the physician ordered additional laboratory testing (a basic metabolic panel (BMP) and complete blood count (CBC). The urinalysis order was not entered into the computer system until [DATE]. The lab collected the BMP and CBC on [DATE] at 8:25 A.M., however the urine was not collected for the urinalysis. The urine specimen was finally collected and sent to the hospital lab on [DATE] for testing. On [DATE] the culture results were received indicating that the resident had Escherichia coli (E. Coli) (bacterial infection). The E. Coli infection had antibiotic susceptibility and was sensitive to Trimethoprim/Sulfa (antibiotic). The resident was started on Bactrim (antibiotic medication) orally. On [DATE] Resident #94's daughter requested the resident be transferred to the hospital due to her confusion. The resident was admitted to the hospital on [DATE] with diagnoses including sepsis secondary to UTI and met sepsis criteria. On [DATE] the resident expired at the hospital. The resident's death certificate dated [DATE] revealed the resident 's immediate cause of death was acute renal failure due to acute cystitis with an onset of days. This affected one resident (#94) of three residents reviewed for infections. The current census was 92. On [DATE] at 9:05 A.M., the Administrator and Director of Nursing (DON) were notified Immediate Jeopardy began on [DATE] when Resident #94 had a change in condition including confusion with visual hallucinations and increased episodes of falling, whereas the resident's family requested urinalysis twice due to the resident's change in condition, and the facility failed to complete the requested testing and failed to notify the medical provider of the family's concerns. In addition, the resident's urinalysis with culture and sensitivity was not collected timely, therefore delaying treatment for the UTI. Resident #94 was transferred and admitted to the hospital on [DATE] per the family's request due to increased confusion. The resident expired at the hospital on [DATE] due to acute renal failure due to acute cystitis. (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 11 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 03/20/2025 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)