Inspection·September 27, 2023

F 0583 Keep residents' personal and medical records private and confidential. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide personal privacy of personal care for 1 of 3 residents (R#3), reviewed for privacy. Residents Affected - Few R#3's catheter bag containing urine did not have a privacy bag and was visible to staff, residents (R#5), and visitors. R#5 was the roommate to R#1. The deficiency could create psychosocial harm to residents with an indwelling catheter and deny the residents privacy and dignity. The findings included: Record review of Resident #3's EMR and face sheet, dated 09/27/23, revealed an admission date of 08/02/20 with diagnoses that included: Hemiplegia (paralysis of one side of the body) and hemiparesis (muscle weakness to one side of the body), traumatic brain injury, generalized anxiety disorder, and epilepsy (seizure disorder).The resident was a female age [AGE]. The RP was listed as a family member. Record review of R#3's MDS assessment dated [DATE] revealed a BIMS score of 10 (moderately impaired in cognition). Bladder was listed as indwelling catheter. Record review of R#3's physician orders dated 8/09/23 revealed: to drain and record urine output every shift; and catheter care every shift [shifts were 6:00 AM-2:00 PM, 2:00 PM-10 PM, and 10:00 PM-6:00 AM] Record review of R#3's TAR for the month of September 2023 revealed that every shift (day, evening, and night) provided catheter care. Record review of Resident #5's EMR and face sheet, dated 09/26/23, revealed an admission date of 08/21/21 with diagnoses that included: dementia, Parkinson's disease, and HTN (hyper tension). The resident was a female age [AGE]. The RP was listed as a family member. Record review of R#5's MDS dated 08/2023 revealed a BIMS score of 14 (no impairment of cognition). Observation and interview on 09/26/23 at 2:30 PM , R #3 was in bed, alert and oriented; catheter present without a privacy bag. Catheter was not covered; urine visible to roommate and outside the room; room door was opened. Roommate (R#5) was present in the room. The Resident (R#3) stated, she had a Foley indwelling catheter and wanted her room door open because she feared having a seizure. R#3 (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: 675678 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 675678 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Care Choice of Boerne 200 E Ryan St Boerne, TX 78006 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)