Failure to Maintain Hot Water Supply for Residents
Penalty
Summary
The facility failed to maintain a functioning hot water heater for a period of 16 days, resulting in the lack of hot water for 21 residents on the south hallway. Multiple residents reported being unable to wash their hands or faces with hot water, and some stated they had not received a shower in over a week. Observations confirmed that the hot water in resident bathrooms and the shower room was cold to the touch after running for several minutes. Staff interviews revealed that residents were not consistently provided with alternative means, such as warm wet washcloths, to maintain personal hygiene during this period. The breakdown of the hot water heater began when the pilot light repeatedly went out, and attempts to repair it were unsuccessful. The facility ordered a replacement, but the wrong type was delivered, causing further delays. Internal communications documented the timeline of the breakdown, the ordering process, and the challenges in obtaining the correct replacement unit. During this time, staff had to use other areas of the facility to provide showers and attempted to use basins and rags with hot water, though this was not consistently implemented for all residents. The facility did not have a specific policy for responding to a hot water heater failure and did not activate its emergency water supply process, as the water supply itself was not lost. The Emergency Operations Plan referenced an emergency water supply process but did not provide guidance for a loss of hot water. As a result, residents on the affected hallway experienced prolonged periods without access to hot water for basic hygiene needs.