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F0690
D

Failure to Provide and Document Foley Catheter Care Every Shift

Glendora, California Survey Completed on 03-07-2025

Penalty

Fine: $100,16033 days payment denial
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

Staff failed to perform and document foley catheter care every shift as ordered by the physician for a resident with neuromuscular dysfunction of the bladder. The resident was admitted with an indwelling catheter and had care plans and physician orders specifying that catheter care should be provided every shift. Review of the Treatment Administration Record (TAR) revealed multiple blank entries on specific dates, indicating that catheter care was not performed or documented as required. Interviews with the treatment nurse confirmed that blank spaces on the TAR meant catheter care was not completed, and the Director of Nursing stated that staff are expected to monitor the catheter for patency, placement, and sediment every shift. The facility's policy also required documentation of catheter care in the medical record. The failure to provide and document catheter care as ordered constituted the deficiency.

Plan Of Correction

F690: Bowel/Bladder Incontinence, Catheter, UTI CORRECTIVE ACTION On 3/10/25, licensed nurse assessed Resident 27 and no complication from Foley catheter use was noted and Foley catheter care was performed.

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