Failure to Maintain Clean, Safe, and Homelike Environment
Penalty
Summary
Surveyors identified that the facility failed to maintain a safe, clean, comfortable, and homelike environment for residents across four of six resident units. Observations revealed multiple instances of uncleanliness and disrepair, including scraped and crumbling walls, holes with exposed wires, dirty and soiled linens left on floors, stained and unclean furniture, and accumulation of trash and debris in resident rooms and common areas. There were also strong and persistent unpleasant odors, particularly of urine, in various hallways, dining areas, and resident rooms. Specific examples included soiled briefs and towels left on floors, dirty tables and chairs in dining areas, and stained or missing furnishings in resident rooms. Interviews with residents and staff confirmed these findings. One resident reported that their room was consistently messy, housekeeping staff did not routinely wipe down surfaces, and they often had to clean their own room. Staff interviews revealed confusion and overlap in responsibilities between nursing and housekeeping staff regarding cleaning, trash removal, and reporting of environmental issues. Staff described that soiled items should not be left on floors and that environmental concerns were to be reported through a work order system, but observations indicated these processes were not consistently followed. The facility's own policy required staff to ensure a safe, clean, and comfortable environment for residents, but the observed conditions and staff interviews demonstrated a failure to adhere to these standards. The issues were widespread, affecting multiple units and both resident rooms and common areas, and included both cleanliness and maintenance deficiencies. These failures directly impacted the living conditions and dignity of the residents.