The Bellefontaine Healthcare Center
Inspection Findings
F-Tag F0842
F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some
FORM CMS-2567 (02/99) Previous Versions Obsolete
urine, blood clots, or other materials, preventing urine from flowing out of the body). During an interview on 9/9/2025 at 3:15 PM, LVN 2 stated he worked on 8/15/2025 and 8/17/2025 evening shift. LVN 2 also stated
the amount of urine output should be accurately documented in the MAR which should be in ml, so that the licensed staff would know when to notify the attending physician for any concerns or issues. During a concurrent interview and record review on 9/9/2025 at 3:30 PM with CNA 1, Resident 1's urine output task log dated 8/15/2025 to 8/19/2025 and MAR dated from 8/13/2025 to 8/19/2025 were reviewed. CNA 1 stated the licensed staff log on to Resident 1's MAR was not consistent with the numbers / amount of urine output documented in Resident 1's urine output task log. CNA 1 confirmed she did not remember why she did not put an exact amount of urine emptied in Resident 1's indwelling catheter bag on 8/15/2025. During
an interview on 9/9/2025 at 4:50 PM, LVN 3 stated the charge nurses (CNs- LVN who is in charge during
the shift) are responsible in documenting urine output in the resident's MAR and the CNAs documents the urine output on the urine output task log. LVN 3 also stated at the end of the shift, the CNs are responsible for communicating with the CNAs how much urine output Resident 1 had. LVN 3 further stated the urine output entered in the MAR should be the total amount on that shift including the amount in the CNAs urine output task log and should be documented in ml and not how many times the resident urinated. LVN 3 also stated the amount of urine entered in the MAR and urine output task log should be accurate to know if Resident 1 had adequate urine output and to know the resident's hydration status. During an interview on 9/9/2025 at 5:13 PM, the Director of Nursing (DON) stated the CNAs should have communicated with the CNs on how much urine output Resident 1 had and LVNs/ CNs should have documented in the resident's MAR the urine output in ml not the frequency to accurately monitor any changes in the resident's urine output and get assessed for signs of dehydration. During a review of the facility's undated policy and procedure (P&P) titled, Charting and Documentation, revised 07/2017, the P&P indicated, all services provided to the resident, .shall be documented in the resident's medical record. The P&P also indicated that
the medical record should facilitate communication between the Inter Disciplinary Team (IDT, comprised of team members from different disciplines working together, with a common purpose, to set goals, make decisions, and share resources and responsibilities) regarding the resident's condition and response to care. The P&P further indicated that documentation in the medical record will be objective (not opinionated or speculative), complete, and accurate.
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THE BELLEFONTAINE HEALTHCARE CENTER in PASADENA, CA inspection on recent inspection.
Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.
Frequently Asked Questions
- What is an F-tag violation?
- F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
- Were these violations corrected?
- Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
- How often do nursing home inspections happen?
- CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
- What should families do about these violations?
- Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in PASADENA, CA, (5) Report new concerns to state authorities.
- Where can I see the full inspection report?
- Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from THE BELLEFONTAINE HEALTHCARE CENTER or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.