Health inspection·April 6, 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 observation, interviews and record reviews, the facility failed to provide appropirate treatment and services to prevent urinary tract infections for one resident (Resident #8) of three residents reviewed for catheter care. Resident #8's catheter drainage collection bag was left on the floor. Resident #8 has history of urinary tract infections. This deficient practice could affect residents with catheters and could result in cross contamination of germs and could result in a urinary tract infection (a painful infection of the urinary system, which includes the kidneys, bladder, urethra, and ureters). The findings included: Review of Resident #8's face sheet dated 04/06/2023, revealed resident was initially admitted to the facility on [DATE] and readmitted on [DATE]. Resident #8's diagnoses include sepsis due to methicillin resistant staphylococcus aureus (staph infection that is difficult to treat because of resistance to some antibiotics), stroke, acute respiratory failure, neuromuscular dysfunction of bladder (urinary conditions in people who lack bladder control due to brain, spinal cord or never problem), repeated falls, dementia, cerebral aneurysm, type-2 diabetes, and hypertension (high blood pressure). Review of Resident #8's quarterly MDS assessment dated [DATE] revealed Resident #8 had a BIMS score of 0 which indicated he was severely impaired cognitively. Resident #8 with Indwelling catheter, always incontinent of both urinary and bowel continence. Review of Resident #8's care plan dated 4/6/2023 revealed Focus: resident has Foley Catheter and is at risk for Increased Urinary Tract Infections: Date Initiated: 10/05/2022. Interventions: CATHETER: The resident has 16fr catheter; Position catheter bag and tubing below the level of the bladder and away from entrance room door; Check tubing for kinks each shift; Monitor for signs and symptoms of discomfort on urination and frequency; Monitor/document for pain/discomfort due to catheter; Monitor/record/report to medical doctor for signs or symptoms of UTI: pain, burning, blood tinged urine, cloudiness, no output, deepening of urine color, increased pulse, increased temp, urinary frequency, foul smelling urine, fever, chills, altered mental status, change in behavior, change in eating patterns. Observation on 04/06/2023 at 9:45 a.m., HHSC Investigator walked by an opened door room [ROOM NUMBER] and observed Resident #8 lying in bed with a drainage collection bag lying flat on the floor next (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: 675722 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 675722 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Fort Stockton 501 N Sycamore Fort Stockton, TX 79735 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)