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F0584
D

Failure to Maintain a Clutter-Free, Homelike Environment for Cognitively Impaired Resident

Lancaster, California Survey Completed on 04-22-2025

Penalty

No penalty information released
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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

A deficiency was identified when the facility failed to ensure that a resident's room was free from clutter, as required to maintain a safe, clean, and homelike environment. During an observation with an LVN, multiple boxes, bags, blankets, and clothing were found cluttering both sides of the room entrance. The items belonged to the resident's roommate. The Director of Nursing confirmed that the resident was cognitively impaired and acknowledged that a reasonable person would not feel comfortable in such a cluttered environment. The resident involved had a history of epilepsy, schizophrenia, and muscle weakness, and was assessed as having severely impaired cognitive functioning. The resident required maximal assistance with lower body dressing and was dependent for eating, personal hygiene, and toilet transfers. The care plan indicated a high risk for falls and injuries, with specific instructions to keep the environment free from obstruction. Despite these documented needs, the room remained cluttered, contrary to the facility's policy and procedure for maintaining a homelike environment.

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