Failure to Maintain Sanitary and Homelike Environment for Dependent Resident
Penalty
Summary
Facility staff failed to maintain a sanitary, orderly, and homelike environment for a resident with multiple complex medical conditions, including chronic obstructive pulmonary disease, systemic lupus erythematosus, legal blindness, schizophrenia, epilepsy, and a contracture of the left hand. The resident was dependent on staff for daily living activities, had moderately impaired cognitive functioning, and was always incontinent of urine and bowel movements. Observations revealed food remains, utensils, a glass jar with brown residue, an upside-down plate, orange peels, and cut orange on the floor next to the resident's bed, as well as ants present inside the jar and on the floor. Additionally, brown residue, identified as dried fecal matter, was observed on the resident's bedside commode. During interviews, a CNA acknowledged the presence of the debris and ants, and confirmed the importance of maintaining cleanliness to prevent infection. The DON also confirmed that the resident's room was not kept clean or sanitary, and that infection control measures were not maintained. Review of facility policy indicated that residents are to be provided with a safe, clean, comfortable, and homelike environment, which was not upheld in this instance.