Health inspection·May 23, 2023

F690- 483.25(e)(1)-(3) FCR § 483.25(e)(1) The facility must ensure that resident who is continent of bladder and bowel on admission receives services and assistance to maintain continence unless his or her clinical condition is or becomes such that continence is not possible to maintain. §483.25(e)(2) For a resident with urinary incontinence, based on the resident's comprehensive assessment, the facility must ensure that- (i) A resident who enters the facility without an indwelling catheter is not catheterized unless the resident's clinical condition demonstrates that catheterization was necessary. (ii) A resident who enters the facility with an indwelling catheter or subsequently receives one is assessed for removal of the catheter as soon as possible unless the resident's clinical condition demonstrates that catheterization is necessary; and (iii) A resident who is incontinent of bladder receives appropriate treatment and services to prevent urinary tract infections and to restore continence to the extent possible. T22 CCR § 72315. Nursing Service - Patient Care. (i) Measures shall be implemented to prevent and reduce incontinence for each patient and shall include: (1) Written assessment by a licensed nurse to determine the patient's ability to participate in a bowel and/or bladder management program. This is to be initiated within two weeks after admission of an incontinent patient. (2) An individualized plan, in addition to the patient care plan, for each patient in a bowel and/or bladder management program. A weekly written evaluation in the progress notes by a licensed nurse of the patient's performance in the bowel and/or bladder management program. CCR § 72523. Patient Care Policies and Procedures. (a) Written patient care policies and procedures shall be established and implemented to ensure that patient related goals and facility objectives are achieved. On 4/11/2023, the California Department of Public Health (CDPH) conducted an unannounced visit to the facility for an annual recertification survey. The facility failed to ensure Patient 24 who was admitted to the facility with an indwelling urinary catheter (a catheter drains urine from the bladder into a bag) was assessed for removal of the catheter necessary to restore continence (ability to urinate) since admission on 6/1/2022. This violation placed Patient 24 at risk for catheter-related infection and decreased self-esteem (self-worth) and socialization. A review of Patient 24's Admission Record indicated Patient 24 was admitted to the facility on 6/1/2022 with diagnoses that included benign prostatic hyperplasia (BPH, a condition in men in which the prostate gland is enlarged) and syncope (fainting). A review of Patient 24's Minimum Data Set (MDS, a standardized assessment and care screening tool), dated 12/30/2022, indicated Patient 24 had clear speech, had the ability to understand others and made self-understood. Patient 24 had intact cognition (ability to understand). The MDS indicated Patient 24 required limited assistance (patient highly involved in activity; staff provide guide maneuvering of limbs or other non-weight bearing assistance) with one-person physical assist for transfer, walking, toilet use and personal hygiene. The MDS indicated Patient 24 had an indwelling catheter. During an observation and concurrent interview on 4/11/2023 at 10:04 am, Patient 24 was lying in bed. Patient 24 had an indwelling urinary catheter connected to a collecting bag which Patient 24 hanged on his pants. Patient 24 stated he had been in this facility for about 8 months, and he had urinary catheter since admission. Patient 24 stated the facility staff talked to him about doing bladder training, but it was never done. Patient 24 stated he wanted his urinary catheter removed so he can go home. A review of Patient 24 's Admission Orders dated 6/1/2022 indicated Patient 24 was ordered urinary catheter for obstructive uropathy (a disorder of the urinary tract that occurs due to obstructed urinary flow and can be either structural or functional). A review of Patient 24's Bowel and Bladder Assessment dated 6/4/2022 indicated Patient 24 was admitted on 6/1/2022 with indwelling catheter present on admission for BPH and obstructive uropathy. A review of Patient 24's Care Plan titled "Urinary Catheter", initiated 6/1/2022, indicated Patient 24 had urinary catheter and the interventions included to provide Urology (science and medicine that focuses on surgical and medical diseases of the urinary-tract system) consult and review for possible removal of catheter. Patient 24's care plan for Urinary Catheter was reviewed 9/2022, 12/2022 and 3/2023. A review of Patient 24's Interdisciplinary Team (IDT)/Care Plan Conference Summary, dated 12/14/2022, indicated Patient 24's family member asked staff about the patient's urinary catheter if it would ever be removed. The IDT note for Patient 24 indicated the facility staff would communicate with Patient 24's physician if the patient can get a urologist (urology doctor) for consult. During an interview and concurrent record review on 4/12/2023 at 3:03 pm, Registered Nurse 1 (RN 1) stated Patient 24 had urinary catheter since his admission on 6/1/2022. RN 1 stated there was no Urology notes in Patient 24's medical record, and there was no evidence in Patient 24's medical record indicating Patient 24 received bladder training from the facility staff. RN 1 stated Patient 24's care plan and IDT indicated urology consult, but the care plan and IDT recommendations were not followed through. RN 1 stated if a patient was admitted with a urinary catheter, nurses should check for any physician's order for date of removal of the urinary catheter or Urology consult to determine the need for continued use of urinary catheter. RN 1 stated a patient with urinary catheter was at high risk for urinary tract infection (UTI) which may cause hospitalization, sepsis and death from sepsis. During an interview on 4/12/2023 at 3:46 pm, the facility's Director of Nursing (DON) stated Patient 24 had not seen a Urologist since admission on 6/1/2022. The DON stated the facility “forgot to” follow up with IDT's recommendation to provide a Urology consult to Patient 24. The DON stated Patient 24 should be seen by a Urologist to determine if Patient 24 still needs urinary catheter in place. The DON stated using a urinary catheter placed Patient 24 at risk for UTI, sepsis, decline of health conditions and quality of life. During a telephone interview on 4/12/2023 at 3:51 pm, Nurse Practitioner 1 (NP 1) stated she was working under the supervision of Patient 24's primary physician. NP 1 stated "I was thinking it (urinary catheter) was already removed, my last visit to him (Patient 24) was last month. I have not noticed he (Patient 24) had a foley catheter (urinary catheter). I missed it. We should have a Urology consult to check it out." During an interview on 4/12/2023 at 4:18 pm, Patient 24 stated he transferred from a General Acute Care Hospital (GACH) to the facility with a urinary catheter. Patient 24 stated he was continent before and was able to void himself before his admission to the GACH. Patient 24 inquired when he can have a Urology consult, remove his urinary catheter, and go home. A review of the facility's Policy and Procedure titled "Indwelling Catheter Use-Indications", revised 10/2017, indicated an assessment must be documented to support the use of an indwelling catheter. The assessment should include any reversible causes of incontinence and identifications related to incontinence that may not be reversible, such as bladder tumors or spinal cord disorders. Documentation in the patient's medical record must reflect the attending physician's valid clinical indication to support the use of an indwelling catheter. Documentation for the use of an indwelling urinary catheter must include involvement of the patient or their responsible party and discussion of the risks and benefits of the use, removal of the catheter when criteria or indication for use is no longer present and the right to decline the use of the catheter. The facility failed to ensure Patient 24 who was admitted to the facility with an indwelling urinary catheter was assessed for removal of the catheter necessary to restore continence since admission on 6/1/2022. As a result, this violation placed Patient 24 at risk for catheter-related infection and decreased self-esteem and socialization. This violation jointly, separately, or in any combination, had a direct or immediate relationship to the health, safety, or security of Patient 24.