Based on interview and record review, the facility failed to meet the medical needs of one sampled resident (Resident #1) out of four sampled residents, who admitted to the facility on [DATE] from the hospital with an indwelling foley catheter (a tube placed to drain the bladder). On 07/09/26, the resident's Urologist (medical doctor and surgeon specializing in diagnosing and treating conditions of the urinary tract) removed the indwelling foley catheter and ordered the resident to be monitored for urinary retention. The facility failed to document any monitoring for post void retention (PVR - urinary output) per policy and as ordered. …
F690 citations in Missouri
Incontinence and catheter care · Quality of Life and Care Deficiencies
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
Data as of , released by CMS on October 8, 2026. Source: CMS Provider Data Catalog.
Against expectation — 2025
Missouri cites F690 less often than its own record predicts
0.86 times the national share — cited less often here than elsewhere.
Of every deficiency written in Missouri in 2025, this is the portion that was F690.
Each state is measured against its own expected share, not against other states.
In the surveyor’s words
What Missouri surveyors wrote
F690 findings written in Missouri, one from each severity band recorded here, most serious first.
Severity is as the surveyor wrote it. Some findings had already been corrected before the survey.
Based on interview and record review, the facility failed to provide appropriate treatment and services consistent with acceptable standards of practice to prevent and treat urinary tract infections (UTIs) when the facility failed to ensure one resident (Resident #6), went to his/her follow up urology appointments as scheduled and failed to ensure his/her urinary catheter (a sterile tube inserted into the bladder to drain urine) was changed as ordered either at the urology clinic or by facility staff. The resident missed three scheduled appointments. The resident was diagnosed with a UTI which the medical director said could be a result of lack urinary catheter changes. …
Based on observation, interview and record review, the facility failed to provide appropriate catheter care for two residents (Residents # 77 and #82) of four sampled residents with catheters when facility staff placed the catheter bag on the low bed and the urinary catheter bag lay on the fall mat on the floor increasing the residents' risk for infection. The facility census was 79. Review of the facility policy from the Infection Control Manual Volume 1, updated March 2026, showed for patients with urinary catheters, staff were to keep drainage bags off the floor, but below the level of the patient's bladder.1. …
The short window
Recent years
| Year | Share of Missouri citations | vs expected |
|---|---|---|
| 2023 | 1.27% | 0.78× |
| 2024 | 1.09% | 0.73× |
| 2025 | 1.17% | 0.86× |
Shares of citations, not counts: earlier years hold fewer inspections.
What else Missouri surveyors cite →
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