Health inspection·August 9, 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 residents with Urinary Incontinence received appropriate treatment and services to prevent Urinary tract infections for 1 (Resident #5) out of 3 residents reviewed for quality of care. 1. The facility failed to ensure Resident #5's indwelling catheter tubing was not laying on the floor and he had a privacy bag on 08/07/2024 . 2. The facility failed to ensure Resident #5's subpubic catheter was properly secured to a leg strap on 08/08/2024 . This failure could place residents at risk of a Urinary Tract Infection and injury. Findings include: Record Review of Resident #5's Face Sheet dated 08/08/2024 revealed he was an [AGE] year-old male, admitted to the facility on [DATE] with a readmission on [DATE]. Record review of Resident #5's history and physical dated 02/01/2022, type 2 diabetes mellitus with unspecified complications, benign prostatic hyperplasia without lower urinary tract symptoms (enlarged prostate). Record review of Resident #5's quarterly MDS assessment dated [DATE], revealed a severe impairment cognition BIMS score of 7. Record review of Resident #5's care plan dated 07/17/2024, revealed Resident #5 had a focus of an indwelling Foley 16fr with a 10cc N/S balloon. Resident #5 had a goal Resident will be/remain free from catheter-related trauma, with interventions to monitor and document intake and output as per facility policy, monitor of discomfort on urination and frequency, monitor/document for pain/discomfort due to catheter, monitor/record/report to MD for s/sx 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. During an observation on 08/07/2024 at 10:04 AM, Resident #5 was sitting on his wheelchair in his bedroom. Resident #5 had catheter tubing rolled up and placed next to his leg side. His catheter bag was not placed in the blue privacy bag, but was hanging on the left side of the wheelchair touching the left wheel of the wheelchair. (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: 675723 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 675723 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/09/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nazareth Living Care Center 1475 Raynolds St El Paso, TX 79903 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)