Nexus At Mascoutah

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

physician on speaker phone. V16 and V17 both stated if an indwelling urinary catheter is ordered to be flushed with water it should be sterile water. Surveyor asked V17 if the facility should have clarified Resident R2's instructions given by Resident R2's urologist V14, dated 8/4/25, to increase Resident R2's catheter flushes to every 8 hours and to apply topical antibiotic. V17 replied it is always good to clarify.On 8/20/25 at 2:23 PM V1 Administrator provided surveyor with the facility's Physician Orders policy and stated the facility does not have a policy on consultant physicians.The facility's Physician Orders policy, dated 6/2015, documented General: Drugs will be administered only upon a clean, complete, and signed order of a person lawfully authorized to prescribe. Verbal orders will be received only by licensed nurses or pharmacists and confirmed in writing by the physician. Responsible Party: Nursing. Policy: Elements of the Medication Order:1. Medication orders specify the following: a. Name of medication, b. Strength of medication, c.

Dosage, d. Time or frequency of administration, e. Route of administration, f. Quantity or duration, g.

Diagnosis or indication for, h. Medication allergy, I. Any dose or order that appears inappropriate considering the resident's age, condition, or diagnosis is verified with the attending physician. It continues, Documentation of the Medication Order: 1. Each medication order is documented in the resident's medical

record with the date and signature of the person receiving the order. The order is recorded on the physician order sheet in (EMR) and the MAR and TAR. 2. The following steps are initiated to complete documentation: a. Clarify the order, b. Enter the orders with administration schedule in (EMR) and transmit to pharmacy.The facility's Catheter Irrigation: Indwelling policy, dated 6/2015, documented General: Catheter irrigation is done to ensure tube patency and remove clots or sediment from the catheter or bladder. Responsible Party: RN, LPN. Procedure: 1. Obtain order from physician/nurse practitioner as to the type of solution and frequency of irrigation. 2. Wash hands. 3. Explain procedure to the resident. 4. Provide privacy. 5. Open irrigation set by grasping end flap and peeling back. 6. Place irrigation set in convenient position. Maintain sterility of drainage system. Use only sterile solution or water for irrigation. Type of solution should be specified in the order.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

08/25/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Nexus at Mascoutah

901 North Tenth Street Mascoutah, IL 62258

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0690 Level of Harm - Actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

the isolation door supply caddy. Neither V6 nor V9 donned gowns at any time during this observation. V9 cleansed Resident R5's penis, scrotum, and inner thighs but did not cleanse Resident R5's indwelling catheter tubing. V6 and V9 rolled Resident R5 onto his right side without repositioning the catheter bag or tubing causing the urine to back flow in the tubing. Resident R5's 8/25 TAR documented (indwelling urinary) catheter care every shift as need although it was not documented as completed every shift on 8/7/25, 8/8/25, nor 8/15/25. Resident R5's catheter output record, print date of 8/20/25, did not document Resident R5's urine output was monitored every shift on 7/22/25, 7/23/25, 7/27/25, 7/28/25, 7/29/25, 8/2/25, 8/3/25, 8/4/25, 8/5/25, 8/7/25, 8/8/25, 8/10/25, 8/12/25, 8/13/25, 8/15/25, 8/16/25, nor 8/17/25. Resident R5's fluid intake records for July and August of 2025 do not document Resident R5's intake was recorded every shift as ordered on 7/17/25, 7/19/25, 7/23/25, 7/26/25, 7/27/25, 7/31/25, 8/1/25, 8/2/25, 8/3/25, 8/6/25, 8/7/25, 8/10/25, 8/12/25, nor 8/15/25.On 8/20/25 at 11:07 AM V2, DON, and V15, ADON were interviewed. V2 stated she would expect the CNAs to don (put on) gowns and cleanse the indwelling catheter tubing while providing catheter care. V15 stated she expects the CNAs to reposition the urinary catheter tubing and bag during turning and repositioning to prevent the urine from back flowing. V2 stated she and the other nurses did not view Resident R2's urologist's instructions on 8/4/25 as physician orders therefore they were not clarified nor implemented. V15 stated she did not view them as orders either. V15 stated she would expect the CNAs and nurses to complete and document catheter care and I&Os as ordered.The facility's (Indwelling) Catheter Care policy, dated 4/2019, documented Policy: Daily and PRN catheter care will be done to promote comfort and cleanliness. Equipment: The following equipment and supplies will be necessary when giving catheter care: 1. Basin with warm water and soap/or pre-moistened disposable cloths. 2. Personal protective equipment (i.e. gowns, gloves, etc.) as necessary.

1. 3. Towel and washcloth. 4. Protective bed pad. Procedure: 1. Wash your hands before beginning the

procedure. 2. Assemble all equipment and supplies that will be necessary to perform the procedure. 3.

Knock before entering the room. 4. Arrange the supplies so they can be easily reached. 5. Identify yourself.

Explain procedure to resident. It continues, 11. Cleanse area of catheter insertion site, using soap and water or pre-moistened wipes. 12. Wash catheter itself by holding on to catheter at insertion site, wash with one stroke downward, using same procedure for rinsing. The facility's Intake and Output policy, dated 6/2015, documented General: Intake and/or output are monitored accurately to ensure adequate fluid balance for residents. Responsible Party: all nursing staff. Guideline: 1. All staff can record the intake or output in the resident record. 2. Intake is recorded for residents with the following: a. Fluid restriction, b. IV therapy, c. Tube feedings, d. Order. 3. Output is recorded for residents with the following: a. (indwelling) catheter, b. Suprapubic catheters c. Order.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

08/25/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Nexus at Mascoutah

901 North Tenth Street Mascoutah, IL 62258

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

Federal health inspectors cited Nexus at Mascoutah in MASCOUTAH, IL for a deficiency under regulatory tag F-F0880 during a complaint investigation conducted on 2025-08-25.

Category: Infection Control Deficiencies

The facility was found deficient in the following area: Provide and implement an infection prevention and control program.

Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 3 deficiencies cited during this inspection of Nexus at Mascoutah.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-08-26.