Health inspection·November 8, 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, policy review, and staff interview, it was determined that the facility failed to assess bladder incontinence and provide services to restore bladder function as much as possible for two of 12 sampled residents. (Residents 7, 16) Findings include: Review of the facility policy entitled, Incontinence - Assessment and Management, last reviewed August 14, 2023, revealed that facility staff was to complete a urinary incontinence assessment upon admission and whenever there was a change in a resident's urinary tract function. Staff would complete a quarterly screening and if there was a change in incontinence staff would implement a seven day toileting diary to determine a resident's voiding pattern for assistance in decision making and development of a toileting program. The type of urinary incontinence was to be identified in the care plan with specific interventions. Clinical record review revealed that Resident 7 was admitted to the facility on [DATE], with diagnoses that included parkinsonism and depression. A Bowel and Bladder Program Screener was completed on April 30, 2023, and indicated that the resident was a candidate for a scheduled toileting program. According to the Minimum Data Set (MDS) assessment, dated July 18, 2023, the resident needed assistance from staff for toileting. The assessment further indicated that the resident was incontinent of urine and was not on a toileting program. Review of the current care plan revealed that Resident 7's type of urinary incontinence was not identified and there was no indication that the resident was on a scheduled toileting program. Review of the MDS assessment, dated October 12, 2023, indicated that Resident 7 was incontinent of urine and was not on a scheduled toileting program. There was no documentation in the clinical record to support that the resident's urinary incontinence was assessed by the facility upon admission and upon a change in Resident 7's incontinence to determine if normal bladder function could be restored. There was no documented evidence that a seven day toileting diary was completed upon identification of a change in Resident 7's incontinence status or that a scheduled toileting program had been implemented. Clinical record review revealed that Resident 16 was admitted to the facility with diagnoses that included congestive heart failure and depression. A Bowel and Bladder Program Screener was completed on October 5, 2023, and indicated that the resident was a candidate for a scheduled toileting program. According to the MDS assessment, dated October 12, 2023, the resident needed assistance from staff for toileting, was frequently incontinent of urine, and was not on a toileting program. Review of the current care plan revealed that Resident 16's type of urinary incontinence was not identified and there was no indication that the resident was on a scheduled toileting program. There was no (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: 395927 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 395927 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/08/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stoneridge Poplar Run 450 East Lincoln Avenue Myerstown, PA 17067 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)