Health inspection·November 30, 2023

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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review, facility policy review, and staff interviews, it was determined that the facility failed to ensure residents received appropriate treatment and services to prevent urinary tract infections and complications related to the use of a catheter (thin tube that can be inserted through the urethra and into the bladder, allowing urine to drain) by catheterizing more times than required and improper placement of a foley catheter, for one of three residents reviewed for use of a catheter (Resident 1). Findings Include: Review of facility policy, titled Catheterization, Intermittent, Female Resident, revised October 2010, revealed, Verify that there is a physician's order for this procedure. Review of Resident 1's clinical record revealed diagnoses that included obstructive and reflux uropathy (disorder where urine cannot flow through the urinary tract due to an obstruction) and retention of urine (condition where one is unable to empty urine from the bladder, which can cause urine to back up into the kidneys and damage them). Review of Resident 1's physician orders revealed an order for a foley catheter with 10 cc [cubic centimeter] balloon and drainage bag to gravity, may change as needed for leakage, dislodgement or occlusion (blockage), effective September 22, 2023. Review of Resident 1's nursing progress notes dated October 28, 2023, at 11:03 PM, revealed that no urine output was noted on evening shift so a bladder scan was done, which revealed 900 ml (milliliters) of urine in the bladder. The Foley Catheter was removed. A straight catheterization was done (soft, thin tube used to pass urine from the body that is inserted through the urethra and into the bladder, and removed after urination). 850 ml was drained. The nurse removed the straight catheter and inserted a new foley catheter at that time. Review of Resident 1's nursing progress notes dated October 29, 2023, at 6:03 AM, revealed, in part, No urine output noted for this shift as of this time. Review of Resident 1's nursing progress notes dated October 29, 2023, at 1:49 PM, revealed in part, Resident noted to have no urine output throughout this shift. Bladder scanned at 89 cc at 1315. At approximately 1340, resident's daughter approached writer, stating that resident was experiencing chills and was shaking. Upon assessment, resident noted to be increasingly pale. Vital signs were abnormal, BP [Blood Pressure]: 86/76, Temp: 101.6, Pulse: 132, O2 [Oxygen saturation]: 98% ra [room (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: 395016 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 395016 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hanover Hall for Nursing and Rehabilitation 267 Frederick Street Hanover, PA 17331 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)