Health inspection·August 15, 2024

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 interviews and records reviewed, the facility failed to ensure a resident who was incontinent of bladder received appropriate treatment and services to prevent urinary tract infections and to restore continence to the extent possible for 1 (Resident #1) of 8 residents reviewed for incontinent care. -The facility failed to replace Resident #1's foley catheter's drainage bag after it was removed by the resident. This failure could place residents at risk for urinary tract infections. The findings included: Record review of Resident #1's admission Record, dated 08/15/24, revealed a [AGE] year-old female who was admitted to the facility on [DATE]. The resident's diagnoses included retention of urine (inability to completely empty the bladder) and obstructive and reflux uropathy (when urine can't flow (either partially or completely) through ureter, bladder, or urethra due to some type of obstruction. Instead of flowing from kidneys to bladder, urine flows backward, or refluxes, into kidneys). Record review of Resident #1's physician orders revealed a urethral indwelling urinary catheter with catheter care on 08/05/24. Record review of Resident #1's admission MDS assessment, dated 08/02/24, revealed a BIMS score of 1, indicating severe cognitive impairment. Further review revealed the resident required partial/moderate assistance with toileting. Record review of Resident #1's undated care plan revealed the resident had a need for an indwelling foley catheter and was at risk for increased UTIs and skin breakdown related to obstructive uropathy. Interventions included providing catheter care and perineal hygiene as indicated. In an interview on 08/15/24 at 12:31 p.m., CNA B said on 08/13/24, she took Resident #1 back to her room after dinner and when they were in the room the resident pulled off her catheter drainage bag. She said she left the resident in the room and notified Nurse A about the catheter bag and as soon as she went back to the resident's room, she found her on the floor. She said she notified Nurse A and they both went to the resident's room. She said Nurse A checked the resident and sent them out to the hospital. She said Nurse A did not put on another catheter bag. She said it took EMS approximately 10 minutes to arrive at the facility. (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: 675321 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 675321 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm at Faith Memorial 811 Garner Rd Pasadena, TX 77502 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)