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F0921
D

Facility Fails to Maintain Sanitary and Functional Storage Areas

Rochester, Pennsylvania Survey Completed on 01-28-2025

Penalty

Fine: $286,709
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to maintain a clean, sanitary, and functional environment in both the laundry room storage area and the large main storage area located on the lower level. During an observation, two large puddles of water were found on the floor of the laundry storage area, with the right corner of the room roped off with caution tape. This area was being used to store resident supplies, including uncovered pillows and boxes of briefs, as well as floor cleaning supplies and trash can liners. Maintenance Employee E3 confirmed the presence of the water, attributing it to a roof leak located under the front parking lot. In the large main storage area, four large buckets were observed collecting water dripping from the ceiling. This area was used to store numerous wheelchairs, bed frames, mattresses, and trash isolation bins. Maintenance Employee E3 confirmed that the drips were coming from the main water supply pipes entering the building. The facility's failure to ensure a clean, sanitary, and functional environment in these areas was acknowledged by the maintenance staff.

Plan Of Correction

1. Maintenance identified the source of the leak as an external leak from the ceiling. Housekeeping storage area leak has been mitigated, and ceiling waterproofing measures have been implemented and area cleaned. 2. Education for EVS and maintenance staff on maintaining a safe/homelike environment will be conducted by EVS manager or designee. 3. Audits of ceiling leaks will be conducted weekly x 3 weeks then monthly x 3 months. 4. Results of audits/education will be submitted to QA for internal monitoring.

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