Failure to Maintain Safe Equipment and Environment for Residents
Penalty
Summary
The facility failed to maintain essential equipment in safe working condition in several areas, as observed during surveyor inspections. In the kitchen, the light bulb inside the freezer used to store milk was found to be non-functional. Staff members, including the Dietary Aide and Dietary Director, were unaware of the issue, and the broken bulb had not been reported or addressed. Facility policy required that equipment be kept in optimal working condition and that staff notify supervisors and maintenance when repairs are needed, but this process was not followed. In the resident care areas, two residents were affected by unsafe equipment conditions. One resident, with a history of dementia, cerebral palsy, and high fall risk, was found with a bed controller that had exposed wires at its base. Multiple staff, including a CNA, Maintenance Supervisor, and DON, confirmed the presence of exposed wires and acknowledged that maintenance should have been notified immediately. The facility's policies emphasized the importance of maintaining equipment in good repair and ensuring a safe environment, but the required notifications and repairs were not made in a timely manner. Another resident, who had hemiplegia, aphasia, and was also at high risk for falls, was found to have wall sockets at the head of the bed that were cracked and missing covers. Staff interviews confirmed that these hazards had not been reported to maintenance as required. Facility policies outlined the responsibility of staff to identify and report hazards and for maintenance to keep the environment safe and homelike, but these procedures were not followed, resulting in unsafe conditions for the residents.