Health inspection·May 23, 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 observations, interviews, and record reviews, the facility failed to ensure a resident who was incontinent of bladder received appropriate treatment and services to prevent urinary tract infections for 2 (Residents #1 and Resident #2) of 5 reviewed for indwelling catheters. The facility failed to ensure Resident #1 and Resident #2's indwelling catheters were treated using proper hand hygiene techniques to prevent urinary tract infections. The failure could place residents with indwelling catheters at risk for urinary tract infections. Findings included: Review of Resident #1's admission Record on 05/11/2023, revealed she was a [AGE] year-old-female admitted to the facility on [DATE] with diagnosis of: hemiplegia (paralysis of one side of the body), lack of coordination, muscle weakness, and Dysuria (the sensation of pain and/or burning, stinging, or itching of the urethra or urethral meatus associated with urination) Review of Resident #1's quarterly MDS assessment dated [DATE] indicated she had a Brief Interview Mental Status of 00 indicated resident had severe impairment. Required total assistance of two staff members to provide total care. Section H (Bowel and Bladder) indicated Resident #1 had a indwelling catheter. Review of Resident #1's care plan dated 11/04/2014 indicated in part: Focus: the resident has a urinary catheter and is at risk for increased urinary tract infections. Goal: the resident will show no signs/symptoms of urinary infection through review date. Interventions: Provide incontinence care every 2 hours and monitor for redness. Review of Resident #1's physician order dated 06/28/2022 on 05/17/2023 revealed the following: Catheter care - wash with soap and water every shift. Observation and interview on 05/15/2023 at 03:40 PM revealed during catheter care with Resident #1, CNA A washed and gloved, removed brief, cleaned labia, bilateral folds and changed gloves. CNA A failed to sanitize hands during each task, only changed and applied gloves one time after cleaning the vagina and moving to the buttock. Removed gloves after completion of task then touched sheets and Page 1 of 3 455555 455555 05/23/2023 Avir at Graham 1224 Corvadura St Graham, TX 76450

F 0690 Level of Harm - Minimal harm or potential for actual harm quilt bringing them up to the resident's chest without sanitizing hands. After observation CNA A said, she did not sanitize her hands because she left her hand sanitizer in another room and did not think about needing it for the care. CNA A said she was taught to sanitize her hands after removing gloves and unsure why she did not sanitize her hands. She said she normally has a bottle of sanitizer in her pocket. CNA A said the training at the facility for catheter care is covered by in-servicing Residents Affected - Few During an interview on 05/15/2023 at 4:00 PM, LVN C said, she would expect the aides to provide proper hand sanitization during catheter care. She said, she checks the drain bag for volume and for signs and symptoms of urinary tract infections. LVN C said some of the signs and symptoms include fever, pain, sediment and odors. During an interview with ADON on 05/15/2023 at 4:00 PM, she said, the aides are taught how to provide catheter care during check offs and should have known that they should sanitize hands each time they remove their gloves. She said in-service with all staff will begin now (right after notifying failure to provide proper hand sanitation 05/15/2023 a6 4:00 PM). She said, she would expect the aides or anyone to provide proper catheter care and use proper hand sanitize techniques. Resident #2 Review of Resident #1's admission Record on 05/11/2023, revealed she was an [AGE] year-old-female admitted to the facility on [DATE] with diagnosis of: neuromuscular dysfunction of bladder (unable to control bladder), hemiplegia, lack of coordination, and muscle weakness. Review of Resident #2's significant change MDS dated [DATE] revealed she had a BIMS of 00 indicating she was severely cognitively impaired. Section H (Bowel and Bladder) indicated Resident #2 had a indwelling catheter Review of Resident #2's Care Plan dated 05/05/2023 revealed the following: Focus: the resident has a urinary catheter related to neurogenic bladder. Goal: the resident will not show signs/symptoms of urinary infection. Interventions: Provide incontinence care every shift. Review of Resident #2's physician order report dated 05/05/2023 revealed - Catheter care - wash with soap and water every shift. During observation and interview on 05/16/2023 at 4:40 AM, CNA B provided catheter care for Resident#2. At the beginning of observation she did not wash hands or sanitize immediately prior to catheter care. She put on gloves removed residents brief begin cleaning both sides of the groin, disposed wipes, then wiped across the pubic ( three principal bones composing either half of the pelvis) and labia area of the vagina. Then CNA B removed her gloves and failed to sanitize after cleaning the groin, pubic area and labia. Then CNA B put on gloves and used alcohol wipe to clean the indwelling catheter tube and sanitized after cleaning the indwelling catheter tube. She rolled the resident to her left side, cleaned her buttock with wipes from front to back change gloves and did not sanitize her hands. She then put her gloves back on, and put on a new brief. She did not sanitize her hands after removing her gloves or putting Resident#2's brief back on. After removing the brief, provide 455555 Page 2 of 3 455555 05/23/2023 Avir at Graham 1224 Corvadura St Graham, TX 76450

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few catheter care, cleaning her buttock and then pull covers up she sanitize her hands one time when she cleaned the catheter tube. Right after catheter care observation CNA B said, she was nervous and did not know she was supposed to sanitize her hands between glove changes. CNA B was asked if she attended the in-service provided by the facility, she said, she has not at this time because she works night shift and will when her shift ends. She said she was trained in CNA school how to provide urinary catheter care. CNA B said the training at the facility for catheter care was covered by in-servicing and she has not had the most recent in-servicing due to her working nights shift. During an interview on 05/16/2023 at 4:40 PM LVN D said she expected the aides to provide proper hand sanitization during catheter care. She said she checks the drain bag for volume and for signs and symptoms of urinary tract infections. LVN D said some of the signs and symptoms include fever, pain, sediment and odors. LVN D said the training at the facility for catheter care is covered by in-servicing and she has not received in-servicing for catheter yet. During an interview on 05/17/2023 at 02:24 PM with the Administrator and ADON, they said their expectations for residents with urinary catheters was for them to be checked by the nurse and the aides for placement, drainage and signs and symptoms of urinary tract infection. Review of facility policy undated titled, Hand Washing hygiene on 05/17/2023 at 1:00 PM revealed: 1. All personnel and shall follow the handwashing /hand hygiene to help prevent the spread of infection to other staff and residents. .5. Hand hygiene must be performed prior to donning and after doffing gloves. 6. Hand hygiene is the final step after removing and disposing of personnel protective equipment. 455555 Page 3 of 3