F 0684
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Level of Harm - Minimal harm
or potential for actual harm
Based on clinical record review and observation, it was determined that the facility failed to ensure that
physician's orders were implemented for one of 37 sampled residents. (Resident 5)
Residents Affected - Few
Findings include:
Clinical record review revealed that Resident 5 had diagnoses that included acute cystitis without hematuria
(bladder infection without bleeding), Alzheimer's disease, and chronic kidney disease. On April 23, 2024,
the physician ordered for staff to apply a Darco Flat (specialty shoe) to Resident 5's right leg, a roam alert
bracelet to Resident 5's right ankle, and a chair alarm. Observations on April 30, 2024, from 12:59 p.m.
through 2:00 p.m., and again on May 1, 2024, from 11:58 a.m. through 1:10 p.m., revealed Resident 5 in his
wheel chair in the dining room area without a Darco Flat, roam alert bracelet, or chair alarm in place.
28 Pa. Code 211.12(d)(1)(5) Nursing services.
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:
395476
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
395476
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
05/02/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Northampton County-Gracedale
Gracedale Avenue
Nazareth, PA 18064
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 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 facility policy review, clinical record review, and observation, it was determined that the facility
failed to ensure that adequate catheter care was provided for one of four sampled residents with an
indwelling urinary catheter. (Resident 5)
Findings included:
Review of the facility policy entitled, Urinary Catheter Care, last reviewed April 11, 2024, revealed that a
urinary drainage bag was to be positioned lower than the bladder at all times to prevent the urine in the
tubing and drainage bag from flowing back into the bladder. Staff was also to ensure the catheter tubing
and drainage bag was kept off the floor.
Clinical record review revealed that Resident 5 had diagnoses that included acute cystitis without hematuria
(bladder infection without bleeding), Alzheimer's disease, chronic kidney disease, and urine retention. On
April 23, 2024, the physician ordered for the resident to have a foley catheter every shift. On April 30, 2024,
from 1:04 p.m. to 2:00 p.m., Resident 5 was observed in his wheelchair with his catheter drainage bag
hanging on the armrest of his wheel chair, which was above the level of his bladder. On May 1, 2023, from
8:52 a.m. to 10:06 a.m., Resident 5 was observed in bed with his catheter on the mattress, which was not
below the level of his bladder. Observation on the same day, from 11:58 a.m. to 12:10 p.m., revealed
Resident 5 in his wheel chair with his catheter bag directly on the floor. At 12:10 p.m., a registered nurse
(RN1) put Resident 5's catheter bag on his lap, above the level of his bladder. Resident 5's catheter bag
remained on his lap until 12:30 p.m., when he placed it on the dining room table. At 12:44 p.m., Resident 5
removed his catheter from the table and held it in his hands, which was above the level of his bladder.
Resident 5 continued to hold his catheter in his hands until 12:54 p.m., when a nurse aide (NA1) placed it
on his wheel chair armrest, which was above the level of his bladder.
28 Pa. Code 211.12(d)(1)(5) Nursing services.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395476
If continuation sheet
Page 2 of 2
