Health inspection·July 26, 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, interviews and record reviews, the facility failed to provide appropriate treatment and services to prevent urinary tract infections for one resident (Resident #3) of three residents reviewed for catheter care. -Resident #3's catheter drainage collection bag was lying on the floor. This deficient practice could affect residents with catheters and could result in cross contamination of germs and could result in a urinary tract infection (an infection in any part of the urinary system). The findings included: Review of Resident #3's admission Record dated 07/25/2024, revealed an [AGE] year-old male who was admitted to the facility on [DATE]. Resident #3's diagnoses included: obstructive and reflux uropathy (disorder of the urinary tract that occurs due to obstructed urinary flow and can be either structural or functional), and benign prostatic hyperplasia with lower urinary tract symptoms (needing to urinate frequently, a weak urine stream, and leaking or dribbling of urine). Review of Resident #3's quarterly MDS dated [DATE], revealed resident was rarely/never understood. Section H Bladder and Bowel indicated the resident had an indwelling catheter. Review of Resident #3's care plan dated 07/25/2024, reflected in part, (Resident #3) has Suprapubic Catheter: Obstructive and reflux uropathy. Pulling on his suprapubic. Part of the intervention steps reflected, Foley bag off the floor. Observation and interview on 07/25/2024 at 9:10 a.m., revealed the HHS Investigator walked by an open door of room [ROOM NUMBER] and observed Resident #3 lying on a bed with the Foley drainage bag on the floor next to the bed. Resident #3 was observed to be asleep at the time. During an interview on 07/25/2024 at 9:13 a.m., LVN F entered Resident #3's bedroom and observed the drainage bag on the floor. LVN F said the drainage collection bag should have been attached to the bedframe below Resident #3's bladder level. LVN F said the CNAs had just changed Resident #3 about 15-20 minutes ago and didn't reattach the drainage bag back onto the frame of the bed. LVN F said the risk of the bag being on the floor was infection control and a possible spill. LVN F said she did not know why the CNAs did not attach the drainage bag and said she would immediately address it with the CNAs. LVN F said Resident #3 did not have a urinary tract infection. (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 5 Event ID: 676060 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 676060 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ambrosio Guillen Texas State Veterans Home 9650 Kenworthy St El Paso, TX 79924 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)