F 0550
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or
her rights.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, interview, and record review the facility failed to promote care for residents in a manner and in
an environment that maintained or enhanced each resident's dignity for 1 of 4 (Resident #34) residents
reviewed for dignity in that:
The facility failed to ensure Resident #34's urinary drainage bag had a dignity/privacy cover while out of his
room.
This deficient practice could place residents in the facility at risk for a diminished quality of life, loss of
dignity and self-worth.
Findings:
Record review of facility face sheet dated 5/23/2023 indicated Resident # 34 was admitted on [DATE] with
diagnosis aftercare following digestive system surgery, urinary tract infection, and obstructive uropathy
(blockage of urinary tract).
Record review of Quarterly MDS dated [DATE] indicated Resident # 34 had a BIMS of 11 indicating
moderately impaired cognition and required indwelling urinary catheter.
Record review of care plan with review date of 05/01/2023 indicated Resident # 34 had an indwelling foley
catheter, and approach was to position catheter bag in a privacy bag.
Record review of order summary report dated 5/23/2023 indicated Resident # 34 had an order dated
10/08/2022 to ensure foley catheter bag was in a privacy bag while in bed or wheelchair.
During an observation on 05/22/23 at 11:52 AM Resident # 34 was lying in bed with a foley catheter
attached to bedframe. The catheter drainage bag was without a privacy cover.
During an observation on 05/23/23 at 9:48 AM Resident # 34 was ambulating in the hallway with COTA and
rehab director using a walker. His foley catheter drainage bag was attached to the walker with dark yellow
urine in the bag without a privacy covering.
During an interview on 05/23/23 at 9:59 AM Resident # 34 stated he was not aware his catheter bag had to
be covered but could see how that would be important to protect his privacy. He had nothing further to
comment regarding his catheter.
(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:
676172
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
676172
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
05/24/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Groveton Nursing Home
1020 W 1st St
Groveton, TX 75845
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)
F 0550
Level of Harm - Minimal harm
or potential for actual harm
During an interview on 05/23/23 at 10:25 AM the COTA stated that a residents privacy and dignity was
maintained by not discussing their health openly, closing doors, and pulling privacy curtains. She stated
foley catheter drainage bags should also be covered to maintain resident privacy and dignity. She stated
she had been trained on privacy covering of catheter bags and should have put a cover on the walker
before getting Resident # 34 up to walk. She stated that by not covering it could affect a residents dignity.
Residents Affected - Few
During an interview on 05/23/23 at 2:12 PM the rehab director stated that resident privacy and dignity was
maintained by protecting resident information. She stated that Resident # 34's catheter drainage bag
should have been covered when he was up walking with therapy in the hallway. She stated she had been
trained on dignity and that by not covering the bag it could cause the resident embarrassment. She stated
she would make sure there was a privacy cover for future therapy sessions.
During an interview on 05/23/23 at 2:20 PM LVN B stated that when a resident has a urinary catheter they
are to have a privacy cover over the drainage bag and the nurse was responsible for monitoring that it was
there. She stated when she last checked he had a privacy bag on his bed and wheelchair but was not
aware Resident #34's drainage bag was exposed during therapy. She stated the drainage bag is covered
for dignity and privacy reasons and if it was not covered it could cause resident embarrassment.
During an interview on 05/23/23 at 2:22 PM the DON stated she was responsible for all nursing oversight
and expects that residents with an indwelling catheter to have a privacy cover in place at all times. She
stated all staff had been trained on privacy and dignity. She stated by not covering the drainage bag it could
affect the residents dignity.
During an interview on 05/24/23 at 8:25 AM the administrator stated that she was responsible for ensuring
privacy and dignity for all residents at the facility. She stated all staff are trained on resident rights on hire,
annually, and as needed. She stated the risk of not maintaining a residents dignity could be belittlement.
She stated here expectation was that all residents rights are honored, and dignity maintained.
Record review of the facility's policy titled Resident Rights dated 11/28/2016 indicated, .facility must treat
each resident with respect and dignity and care for each resident in a manner and in an environment that
promotes maintenance or enhancement of his or her quality of life.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
676172
If continuation sheet
Page 2 of 2
