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Complaint Investigation

Avina Of Weyauwega

Inspection Date: October 7, 2025
Total Violations 1
Facility ID 525315
Location WEYAUWEGA, WI
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Inspection Findings

F-Tag F0690

Quality of Life and Care Deficiencies
Harm Level: Potential for More Than Minimal Harm

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

observation, staff interview, and record review, the facility did not ensure an active physician order was in place for an indwelling catheter for 1 resident (R) (Resident R1) of 3 residents reviewed for catheters. Resident R1 had an indwelling catheter for which staff provided care. Resident R1 did not have an active physician order for the catheter or for catheter care. Findings include:Review of Resident R1's admission Record indicated Resident R1 was admitted to the facility on [DATE REDACTED] and readmitted on [DATE REDACTED] with diagnoses including benign prostatic hyperplasia. Review of Resident R1's care plan, dated 7/28/25, indicated Resident R1 had a urinary catheter. Interventions included to monitor for signs and symptoms of discomfort, leaking, and obstruction. Review of Resident R1's physician orders, dated 10/6/25, revealed no current orders for a urinary catheter or catheter care. During an observation on 10/6/25 at 11:35 AM, Resident R1 was in bed with catheter tubing visible. During an interview on 10/7/25 at 11:16 AM, Licensed Practical Nurse (LPN)1 said LPN1 provided catheter care to Resident R1 earlier but did not check to see if there was a current order in place. LPN1 stated when Resident R1 was readmitted to the facility from the hospital, nursing staff should have clarified if Resident R1 still required a catheter. LPN1 stated LPN1 had not been documenting catheter care on Resident R1's Treatment Administration Record (TAR) since there was not a current catheter order. During an interview on 10/7/25 at 12:42 PM, the Director of Nursing (DON) said nursing staff should look at a resident's physician orders each time they provide care. The DON stated staff are expected to document after care is provided and if there is not a current order, staff should clarify and obtain one.

Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date

these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.

LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE

TITLE

(X6) DATE

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

Facility ID:

If continuation sheet

Event ID:

📋 Inspection Summary

Avina of Weyauwega in WEYAUWEGA, WI inspection on recent inspection.

Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.

What this means: Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. All deficiencies must be corrected within required timeframes and are subject to follow-up verification.

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 WEYAUWEGA, WI, (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 Avina of Weyauwega or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.
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