Princeton Place Did Not Always Comply With Care Plans for Residents Who Were Diagnosed With Urinary Tract Infections

Why OIG Did This Review

A Centers for Medicare & Medicaid Services-sponsored study identified conditions, including urinary tract infections (UTIs), that are associated with potentially avoidable hospitalizations of nursing home residents.

We selected for review Princeton Place Skilled Nursing and Rehabilitation Center (Princeton Place), located in Ruston, Louisiana, based on a review of nursing home quality measures, including a high average UTI rate among residents.

Our objective was to determine whether Princeton Place provided services to its Medicaid-eligible residents diagnosed with UTIs in accordance with their care plans, as required by Federal regulations.

How OIG Did This Review

We reviewed medical records for 52 stays by 29 Medicaid-eligible residents who were assessed with UTIs from January 5, 2014, through October 21, 2015.

What OIG Found

Princeton Place did not always provide services to Medicaid-eligible residents diagnosed with UTIs in accordance with their care plans, as required by Federal regulations. Specifically, Princeton Place staff did not always document that they monitored the residents' urine appearance at the frequencies specified in their care plans. Princeton Place did not have policies and procedures to ensure that its staff provided services in accordance with its residents' care plans. As a result of Princeton Place not following residents' care plans, the residents were at increased risk for contracting UTIs and for incurring complications from UTIs, including requiring hospitalization.

What OIG Recommends

We recommend that Princeton Place develop and implement policies and procedures requiring that:

• its nursing staff follow and document compliance with the residents' care plans and
• supervisors conduct reviews to ensure that the nursing staff follows the residents' care plans.

Princeton Place agreed with our recommendations and described corrective actions it had implemented, including revised policies and staff training.