Bayview Manor

F-F880.

Findings include:

Review of the policy titled, Resident Rights, revised on 10/01/24, states: Employees shall treat all residents with kindness, respect and dignity. 3. Our facility will make every effort to assist each resident in exercising his/her rights to assure that the resident is always treated with respect, kindness, and dignity.

Review of Resident R33's face sheet revealed she was admitted to the facility on [DATE REDACTED] with diagnosis including, but not limited to, Cerebral Palsy, neuromuscular dysfunction of bladder, retention of urine, and lack of coordination.

Review of Resident R33's Quarterly Minimum Data Set (MDS) Assessment, with an Assessment Reference Date (ARD) of 12/04/24 revealed Resident R33 had a Brief Interview of Mental Status (BIMS) score of 10 of 15, indicating that the resident has a moderate cognitive impairment. Resident 33 is always incontinent of bowel and bladder and has an indwelling catheter.

Review of Resident R33's Care Plan with a start date of 08/21/24, revealed Resident R33 prefers some activities out of room as well as all things Catholic. It also includes, Resident R33 has a suprapubic catheter related to urinary retention and neurogenic bladder. Interventions include: The resident has a (16Fr) indwelling catheter, position catheter bag and tubing below the level of the bladder and away from entrance room door, check tubing for kinks

during rounds each shift initiated on 08/12/24.

Review of Resident R33's Progress Note dated 11/05/24 revealed, Resident is s/p antibiotic therapy, completed Keflex r/t urinary tract infection (UTI) on 11/02/24. No adverse reactions noted at this time. RR e/u w/o any distress noted. No concerns or complaints at this time. Resident resting in bed with call light in reach. Plan of care ongoing.

During an observation on 01/06/25 at 12:00 PM, Resident R33 was in bed watching television. Her foley bag was full of urine and lying on the floor. There was no privacy cover over the foley catheter bag.

During an observation on 01/07/25 at 4:30 PM, Resident R33 was sitting in her wheelchair in her room watching television. Her foley catheter bag was on the floor behind her wheelchair with no privacy covering.

During an interview on 01/07/25 at 4:44 PM, with the Unit Manager (UM), revealed Resident R33's catheter bag was

on the floor behind her wheelchair and did not have a privacy covering. UM stated the privacy catheter bag wasn't present and she is aware that the catheter bag should not be on the floor because that could cause infection, and the covering is a dignity issue for the patient. The UM stated that she will take care of this matter now.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 7 of 8 425067 Department of Health & Human Services Printed: 09/11/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 425067 B. Wing 01/08/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Resorts at Beaufort 11 Todd Drive Beaufort, SC 29901

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 0880 During an interview on 01/08/25 at 9:21AM, with the Director of Nursing (DON), stated that staff uses stat locks in place on residents to keep catheter tubing from kinking. DON stated that her staff visually observes Level of Harm - Minimal harm or the foley catheters to see whether it is kinking as well. She stated that the foley catheter bag should never be potential for actual harm on the floor and should have a privacy bag covering to protect the patient and prevent infection. The DON states she has never witnessed the foley bag being on the floor in Resident R33's room. Residents Affected - Few

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 8 of 8 425067