**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on facility policy review, medical record review, and interview the facility failed to develop a comprehensive care plan for 2 of 4 residents (Resident #14 and #251) who required indwelling urinary catheters. The findings include: Review of the undated facility policy titled, Updating and revising Care Plans, .New problems are added to the current care plan even if the change is not considered significant enough for a complete revision . Review of the medical record, revealed Resident #14 was admitted to the facility on [DATE] with diagnoses which included Malignant Neoplasm of Gallbladder, Urinary Retention, and Type 2 Diabetes. Review of the 5-day Minimum Data Set (MDS) dated [DATE], revealed Resident #14 had a Brief Interview for Mental Status (BIMS) score of 11 indicating moderate cognitive impairment. Review of the Physician Orders for Resident #14 dated 5/16/2021, revealed Indwelling urinary catheter; catheter care every shift; document output; 16 F [French] three times a day. Review of the care plan dated 5/19/2021, revealed Resident #14 was care planned for Urinary Retention and Urinary Tract Infection. Continued review revealed the resident was not care planned for an indwelling urinary catheter. Observation on 6/14/2021 at 10:53 AM, in Resident #14's room revealed the resident's catheter bag attached to the left side of the footstool. During an interview conducted on 6/15/2021 at 3:37 PM, Licensed Practical Nurse (LPN) #2 confirmed Resident #14 was not care planned for an indwelling urinary catheter. During an interview conducted on 6/15/2021 at 4:03 PM, the Quality Assurance (QA) Nurse confirmed she did not see a care plan for an indwelling catheter for Resident #14. She stated, when a resident has an indwelling catheter, it should be on the comprehensive care plan. During an interview conducted on 6/16/2021 at 3:38 PM, the Assistant Director of Nursing (ADON) confirmed Resident #14 should've had the indwelling urinary catheter care planned when the catheter was placed. Review of the medical record, revealed Resident #251 was admitted to the facility on [DATE] with diagnoses which included Nontraumatic Chronic Subdural Hemorrhage, Dementia Without Behavioral Disturbance, and Personal History of Transient Ischemic Attack (TIA), and Cerebral Infarction Without Residual Deficits. Review of the admission MDS dated [DATE], revealed Resident #251 had a BIMS score of 7 indicating severe cognitive impairment. Review of Physican Orders for Resident #251 dated 6/12/2021, revealed .indwelling urinary catheter; catheter care every shift, document output 18Fr [French] 15ml [milliliters] bulb for promotion of wound healing . Review of the Care Plan on 6/15/2021 at 3:30 PM, revealed Resident #251 was not care planned for indwelling urinary catheter. Observation on 6/14/2021 at 11:45 AM, in Resident #251's room revealed a catheter bag attached to the bottom of the wheel chair. During an interview conducted on 6/16/2021 at 9:00 AM, the Director of Nursing (DON) confirmed Resident #251 was not care planned for an indwelling urinary catheter according to the Physician Order dated 6/12/2021.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on facility policy review, medical record review, observation, and interview the facility failed to ensure 1 of 23 residents (Resident #1) had clean and groomed fingernails. The findings include: Review of the facility's undated policy titled, Fingernails, Cleaning, and Trimming, revealed .Designated partner will care for patients nails with bathing and PRN [as needed] . Review of the medical record revealed Resident #1 was admitted to the facility on [DATE] with diagnoses which included Unspecified Dementia without behavioral disturbance, Seborrheic Dermatitis, and Candidiasis of skin and nail. Review of the Quarterly Minimum Data Set (MDS) dated [DATE], revealed Resident #1 required extensive assistance of staff for personal hygiene. Review of the comprehensive care plan dated 1/14/2021, revealed Resident #1 was care planned for .keep nails trimmed as pt [patient] tolerates . Review of the Physician Orders dated June 2021 for Resident #1 revealed .Ensure fingernails are kept short and filed due to pt scratching .order began on 3/5/2021 . During an Observation and interview on 6/15/2021 at 10:04 AM revealed Resident #1 sitting in his reclining chair in the spa room. Continued observation revealed the resident's nails were long with brown dried debris under his fingernails on both hands. Continued interview the resident stated he had already taken a shower this morning [6/15/2021]. Continued interview when asked if staff cleaned his nails during his bath he stated no. During an Observation and interview on 6/15/2021 at 10:50 AM revealed Resident #1 sitting in his reclining chair in the dining room. Continued observation revealed the resident's nails remained long with brown dried debris under his fingernails on both hands. Continued interview when asked if he liked his nails that long he looked at his nails and said, you can cut them if you want. During an Observation and interview on 6/15/2021 at 10:55 AM in the presence of Certified Nurse Aide (CNA) #1 revealed Resident #1 sitting in his reclining chair in the dining room. Continued interview with CNA #1 confirmed the resident had brown dried debris underneath his fingernails on both of his hands; CNA #1 looked at the resident's hands and said, they are not clean at the moment. During an Observation and interview on 6/15/2021 at 10:56 AM in the presence of the 2nd floor Unit Manager and CNA #1 revealed Resident #1 sitting in his reclining chair in the dining room. Continued interview with the Unit Manager she stated residents' nails are to be cleaned before meals and with baths. Continued interview the Unit Manager confirmed Resident #1's nails were long and had brown dried debris underneath his fingernails on both hands. The Unit Manager looked Resident #1's hands and stated no, they are not clean, we will get them clean and clipped for him.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on facility policy review, medical record review, observation and interview the facility failed to provide a sanitary environment for 1 (Resident #16) of 2 residents reviewed for enteral feeding per feeding pumps. The findings include: Review of the facility policy titled, 304 Nursing, dated May 2021, revealed, .Reusable items are used for an individual patient if the product remains intact and sanitary. Items which become broken, chipped or unsanitary are replaced as needed . Review of the medical record revealed Resident #16 was admitted to the facility on [DATE] with diagnoses which included Anorexia, Protein-Calorie Malnutrition, Adult Failure to Thrive, Aphasia, and Encounter for Attention to Gastrostomy. Review of the admission Minimum Data Set (MDS) assessment dated [DATE], revealed Resident #16 had a Brief Interview for Mental Status score of 1 which indicated the resident had severe cognitive impairment. During further review revealed the resident required a feeding tube. Review of Physician Order dated 6/8/2021, for Resident #16 revealed, .Osmolite 1.2 Cal [Calorie] (nutritional supplements) liquid; 0.06 gram-1.2 kcal/mL [kilocalorie/milliliter]; amt [amount]: 60ml/hour; gastric tube Every Shift . Observations conducted on 6/14/2021 at 10:45 AM, 11:30 AM, 1:22 PM, 3:18 PM, 4:08 PM, and at 4:25 PM, revealed Resident #16's enteral tube feeding pump pole had a moderate amount of dried tan debris on the pole and the base of the pole. During an interview conducted on 6/14/2021 at 4:25 PM, in Resident #16's room, Licensed Practical Nurse (LPN) #1 confirmed the enteral tube feeding pole had a moderate amount of dried tan debris on the pole and the base of the pole.