Failure to Maintain Sanitary Respiratory Equipment
Penalty
Summary
The facility failed to maintain respiratory equipment in a sanitary manner for four residents who required nebulizer treatments or oxygen therapy. Facility policies required staff to clean nebulizer equipment after each use, disassemble and air-dry components, and change and date tubing and masks every 14 days. However, observations and record reviews revealed that nebulizer cups, masks, and tubing were not dated, and there was no documentation of routine changing or cleaning of these items as required. In several cases, nebulizer equipment was found assembled and moist after use, indicating it had not been properly disassembled and air-dried. For one resident with scheduled nebulizer treatments for shortness of breath, the equipment was found on the floor, attached to the compressor, and undated, with no documentation of tubing or mask changes despite multiple treatments administered. Another resident receiving frequent nebulizer treatments for COPD had equipment resting on paper towels, with visible moisture inside the cup and no dates on the tubing, cup, or mask. The MARs for both residents lacked documentation of required cleaning or equipment changes. Two additional residents using oxygen therapy also had deficiencies in equipment maintenance. One resident receiving oxygen via nasal cannula had undated tubing, and staff were unclear on the required frequency for changing it. Another resident's oxygen tubing was found in direct contact with the floor, undated, and not in use at the time of observation. In all cases, the facility failed to follow its own policies and physician orders regarding the cleaning, changing, and dating of respiratory equipment.