Health inspection·September 6, 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 observation, interview, and record review, the facility failed to ensure a resident who was incontinent of bladder receives appropriate treatment and services to prevent urinary tract infections and to restore continence to the extent possible for 1 of 1 resident (Resident #1) reviewed for incontinence care, in that: Resident #1 was provided with inadequate incontinence care by CNA A and CNA B. This failure could place residents who required incontinence care at risk for the development of new or worsening urinary tract infections. The findings included: Record review of Resident #1's face sheet, dated 9/5/24 revealed an [AGE] year-old male admitted to the facility on [DATE] with diagnoses that included type 2 diabetes (a long-term condition in which the body has trouble controlling blood sugar and using it for energy), dementia without behavioral disturbance (impaired ability to remember, think, or make decisions that interferes with doing everyday activities), heart disease, hyperlipidemia (high fat levels in the blood), and hypothyroidism (abnormally low activity of the thyroid gland resulting in slowing of metabolic changes in adults). Record review of Resident #1's most recent MDS quarterly assessment, dated 7/30/24 revealed the resident was severely cognitively impaired for daily decision-making skills and was always incontinent of bowel and bladder. Record review of Resident #1's comprehensive care plan with initiation date 8/12/24 revealed the resident was at risk for abdominal discomfort related to constipation with interventions that included to provide incontinence checks every two hours and as needed. Observation on 9/5/24 at 3:04 p.m. during incontinence care revealed CNA A retracted the foreskin from Resident #1's penis and wiped the tip of the penis with one wipe in a back-and-forth motion. CNA A continued with incontinence care but did not clean the shaft of the penis to Resident #1. During a joint interview on 9/5/24 at 3:16 p.m., CNA B, who assisted CNA A with incontinence care to Resident #1 stated she noticed CNA A did not properly provide incontinence care to Resident #1 because CNA A used several passes with one wipe to clean Resident #1's penis. CNA B stated, CNA A should have used one wipe in a clockwise motion and then tossed it out and then should have taken another wipe to continue cleaning the tip of the penis counterclockwise and then toss the wipe. CNA B Page 1 of 2 675452 675452 09/06/2024 Avir at Converse 7700 Mesquite Pass Converse, TX 78109

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few stated, you should not wipe the area in a circular motion or rubbing motion. CNA A stated, initially she was not aware she had wiped Resident #1's penis with multiple passes using one wipe until the interview with the State Surveyor. CNA A stated she had been taught to wipe the area once and then toss the wipe. CNA A stated, it seems that when you wipe in a circle it's like wiping the dirt around and not away. CNA A could neither confirm nor deny she had not wiped the shaft of Resident #1's penis. CNA A revealed, improper incontinence care could lead to the resident developing an infection. During an interview on 9/5/23 at 3:32 p.m., the Staffing Coordinator revealed she had been responsible for providing the training to the CNAs including incontinence care. The Staffing Coordinator stated she and the former DON and the ADON helped with training and competencies. The Staffing Coordinator stated she was also a CNA and revealed when CNA A cleaned Resident #1's penis she should have cleaned the shaft of the penis and use one pass per wipe in an outward motion to clean the area correctly and not cause skin breakdown. The Staffing Coordinator stated, wiping back and forth with the same wipe does not actually clean the area, you are only moving the soiled area back and forth. The Staffing Coordinator stated, improper incontinence care could result in the resident having pain, odor or a urinary tract infection. During an interview on 9/5/23 at 3:50 p.m., the ADON stated, when providing incontinence care to a male resident, the shaft of the penis must be cleaned and should be wiped once in a circular motion then toss the wipe. The ADON further stated, the area should not be wiped multiple times with the same wipe because you are just spreading germs, you're not really cleaning anything. The ADON stated, improper incontinence care could result in the resident developing an infection. Record review of the facility policy and procedure titled, Perineal Care, undated, revealed in part, .PURPOSE .To cleanse the perineum .To prevent infection and odor .EQUIPMENT .Disposable wipes or Washcloths .PROCEDURE .PERINEAL CARE .10. Male perineal care .Gently wash pubis and penis. If uncircumcised, pull back foreskin and wash gently and return foreskin to normal position . 675452 Page 2 of 2