Advanced Care of St. Joseph: Catheter Care Failures - MO
The observation happened at 2:55 p.m. on August 27 at Advanced Care of St. Joseph, during a complaint inspection. CNA A emptied 850 milliliters from a catheter bag into a graduate, dumped it, then emptied another 750 milliliters and dumped that in the toilet. Then came the cleaning. The CNA wiped the catheter port with a wet wipe and stopped there. No alcohol prep pad. The port, which connects directly to a tube running into a resident's bladder, was left without the disinfection step designed to keep bacteria out.
Urinary catheters are among the most common sources of healthcare-associated infection. Bacteria introduced at the port have a direct path inward.
The Director of Nursing had been asked about catheter care the day before. She was clear: nursing staff are to clean away from the urinary insertion site, away from the body, when cleaning the tubing. The Assistant Director of Nursing, interviewed the morning of the inspection, said catheter bags should be emptied every time catheter care is performed, or as needed.
What the inspector saw did not match either description.
The Director of Nursing also addressed the facility's broader staffing situation during her August 26 interview. Weekends had been a struggle, she said, with last-minute call-ins creating gaps. The facility had responded by putting a clinical person on call in rotation. She said she would not expect a resident to wait over an hour for a call light to be answered, and she would expect a full catheter bag to be emptied when full, not held until the end of a shift.
Those are reasonable expectations. They are also, based on what the inspector documented, expectations that were not being met in at least this instance.
The violation was cited under F0690, which covers catheter care and urinary tract infection prevention. CMS rated the harm level as minimal harm or potential for actual harm, with few residents affected. That rating reflects what inspectors could document, not necessarily what had been happening on shifts when no one was watching.
Catheter care is not complicated. The steps exist precisely because the risk is high and the margin for error is low. A wet wipe is not a substitute for an alcohol prep pad at a catheter port. The distinction is not technical nuance. It is the difference between cleaning a surface and disinfecting one.
Advanced Care of St. Joseph's own leadership knew the correct procedure. The DON described it accurately. The ADON described it accurately. Somewhere between those interviews and the afternoon shift, the standard did not hold.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Advanced Care of St Joseph from 2025-08-27 including all violations, facility responses, and corrective action plans.
Additional Resources
Data source: This article is based on inspection data downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases inspection reports in bulk; we publish the findings as documented by state surveyors in the official Form CMS-2567 Statement of Deficiencies.
Plan of correction: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to state survey agencies and those responses may not be reflected in CMS data at the time of publication. The absence of a plan of correction in our data does not mean one was not filed. Readers who want information about corrective steps taken are encouraged to contact the facility directly or their state survey agency.
Corrections may have occurred: Inspection reports reflect conditions observed on the date of the survey. Facilities may have implemented corrections, staffing changes, additional training, or other remediation since the report was issued. We report what CMS provides and encourage readers to seek current information from the facility.
Editorial process: Inspection findings are extracted from CMS source documents and synthesized using AI, reviewed for factual accuracy against the original report by our editorial team.
Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: October 2, 2026 · Our methodology
ADVANCED CARE OF ST JOSEPH in SAINT JOSEPH, MO was cited for violations during a health inspection on August 27, 2025.
The observation happened at 2:55 p.m.
Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. Review the full report below for specific details and facility response.