Failure to Maintain Clean and Sanitary Resident Equipment
Penalty
Summary
Staff failed to maintain clean and sanitary resident equipment for a resident with multiple complex medical diagnoses, including metabolic encephalopathy, mood affective disorder, heart transplant, cardiomyopathy, and frontotemporal neurocognitive disease. The resident, who utilized a wheelchair, had previously sustained a skin tear to the left eyelid after hitting his face on a bedrail, leading staff to place white cloth bandage padding on the bedrails as an intervention. During observations, surveyors noted that the white padding on the right side of the bedrail had a visible rust-colored stain, and the wheelchair had white cloth bandage wraps with a large patch of brown substance on the right side of the frame. The wheelchair cushion also had black and brown smears. Interviews with an LPN and the DON confirmed the presence of these stains and that nursing staff were responsible for cleaning resident equipment as needed. Facility policy required maintaining a clean, sanitary, and orderly environment, but this was not followed in this instance.