Health inspection·January 19, 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 observations, interviews, and record review, the facility failed to ensure a resident who was incontinent of bladder received appropriate treatment and services to prevent urinary tract infections for 1 of 1 resident (Residents #49) reviewed for indwelling catheters. -The facility failed to ensure Resident #49's Foley catheter (F/C) (tubing inserted into the bladder to drain urine) was placed below the bladder during incontinent care. These failures could place residents at risk for discomfort and urinary tract infections. Findings included: Record review of Resident #49's face sheet revealed an [AGE] year-old male was admitted to the facility on [DATE]. His diagnoses were, dementia ( impaired ability to remember, think, or make decisions that interferes with doing everyday activities), with other behavioral disturbance, age-related cognitive decline, anxiety disorder, unspecified, benign prostatic hyperplasia (enlarged prostate gland) with lower urinary tract symptom, major depressive disorder ( a mental health condition that causes a persistently low or depressed mood and a loss of interest in activities that once brought joy), neuromuscular dysfunction of bladder ( A hollow organ in the lower abdomen that stores urine) and retention of urine. Record review of Resident #49's quarterly MDS assessment, dated 11/04/2023, revealed a BIMS score of 09 out of 15, which indicated the resident's cognition was moderately impaired. Resident #49's functional status revealed he required total assistance with one to two staff for bed mobility, transfer, dressing, and personal hygiene. Resident #49 was always incontinent of bowel and continent of bladder using a suprapubic catheter ( a medical device that helps drain urine from your bladder) Record review of Resident #49's care plan dated 11/07/2023 revealed the resident had ADL (activity of daily living) self-care performance deficit: Intervention included: the resident needed total assist with one to two person assistance with personal hygiene. It also revealed the resident had a suprapubic catheter related to neuromuscular dysfunction bladder and was at risk for increased urinary tract infections. Interventions included: Monitor/record/ report to MD (medical doctor) for signs and symptoms of UTI, pain, burning, blood tinted urine, cloudiness, and no output. Record review of Resident #49's care plan of on 1/19/2024 revealed he was treated for a UTI (Urinary Tract Infection) with antibiotic treatment (ABT) on following dates with their completed dates. Page 1 of 3 676229 676229 01/19/2024 Trucare Living Centers-Columbus 1511 Montezuma Street Columbus, TX 78934

F 0690 ABT for UTI 8/5/23 completed on 8/10/23. Level of Harm - Minimal harm or potential for actual harm ABT for UTI 8/20/23 completed on 8/27/23. ABT for UTI 10/25/23 at hospital. Residents Affected - Few Observation during incontinent care on 01/19/24 at 10:53 AM with CNA A and CNA B revealed, Resident #49 was lying in bed with a suprapubic catheter. During incontinent care, CNA A placed the suprapubic catheter bag, with 225 cc of urine, ion the bed throughout the procedure. CNA A used wet wipes and did not clean around Resident # 49's buttocks. In an interview with CNA A on 1/19/24 at 11:10 AM, she stated she forgot to wipe the buttocks and should not have placed the catheter on the bed. She stated it was wrong because it could cause an infection. She stated she had training on infection control and forgot to place the catheter below the resident's bladder. In an interview with the DON on 01/19/24 at 3:30 PM, she stated CNA A was one of the facility's lead aides that monitored other staff during orientation with incontinent care. The DON said the catheter bag should not be place on the bed, it would result with urine in the bag flowing back in Resident #49's bladder and cause urinary tract infection. DON said C.NA A knew she should clean around the buttocks before placing a cleaned brief. DON said he would be performing more in-services for incontinent care. In an interview on 01/19/2024 at 3:35 PM, the Administrator stated his expectation was that the catheters were always placed below the bladder to prevent infection. Record review for CNA A's skilled checkoff list for incontinent care and F/C care revealed, she had an in-service on 11/14/2023 done by the DON. The policy requested for incontinent/catheter care did not address placement of the catheter bag with urine during incontinent care. The C.NA A competency checked dated 11/14/23: Perineal Care . Male: Cleanse pubic area across, wipe the rectal area and buttocks thoroughly . extending over the buttocks . changing area of wipe with each stroke. Wipe across sacrum. 676229 Page 2 of 3 676229 01/19/2024 Trucare Living Centers-Columbus 1511 Montezuma Street Columbus, TX 78934

F 0814 Dispose of garbage and refuse properly. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview and record review, the facility must dispose of garbage and refuse properly for 1 of 1 dumpster reviewed for garbage disposal. Residents Affected - Few -The facility failed to ensure the dumpster lids and doors were secured. This failure could place residents at risk of infection from improperly disposed garbage. Findings included: Observation on 01-17-24 at 9:10 am, revealed the facility's dumpster area, which was in the lot behind the dietary department had a commercial -size dumpster ¾ full of garbage and the door was wide open. Interview on 01-17-23 at 9:20 am, with the Food Service Manager, she stated that the dumpster doors always must be closed to keep vermin, pests, and insects out of the dumpster and from entering the facility. Record review of facility's, revised 9/16/ 2016 Sanitation Policy Interpretation and Implementation revealed . 2.All garbage and rubbish must be kept covered. 5. Garbage and rubbish containing food wastes will be stored in a manner that is inaccessible to vermin . 7. Outside Dumpster provided by garbage pick up service will be kept closed and free with surrounding litter. 676229 Page 3 of 3