Failure to Maintain Sanitary Respiratory Equipment
Penalty
Summary
The facility failed to ensure sanitary storage, labeling, and cleaning of respiratory equipment for three residents who required respiratory services. For one resident with COPD and chronic respiratory failure, oxygen tubing was repeatedly observed undated and improperly stored, including being left uncovered in a wheelchair and resting on the floor, with nasal cannula prongs in contact with an unclean soaker pad. There was no documented order for weekly oxygen tubing changes for this resident, and staff interviews revealed inconsistent knowledge and practices regarding equipment maintenance and storage expectations. Another resident with pneumonia was found with an undated nebulizer left on the bedside table with visible condensation in the medication cup, which had not been rinsed since the previous night. A third resident with dementia had oxygen tubing and a nebulizer both dated nearly two months prior, with no evidence in the treatment administration record of weekly changes as claimed by staff. Interviews with CNAs and nursing staff indicated a lack of clarity and responsibility regarding the maintenance and dating of respiratory equipment. Additionally, the facility did not have a respiratory care policy available upon request.