Failure to Maintain Safe Environment: Improper Fall Mat Placement and Unaddressed Flooring Hazards
Penalty
Summary
The facility failed to ensure that fall mats were properly placed for a resident with impaired mobility and a history of falls. According to the care plan, floor mats were to be placed on both sides of the resident's bed following a previous fall. However, during observation, one mat was found standing against the wall instead of on the floor, and staff confirmed it had not been returned after a transfer, rendering it ineffective in preventing injury. Additionally, the facility did not identify or address loose and water-damaged flooring in three hallways. Observations revealed multiple areas where the flooring was bubbling up and separating at the seams, creating tripping hazards under hand railings and near resident rooms. The Director of Environmental Services confirmed the presence of these hazards, and the Administrator acknowledged that hallways should be free of such risks to ensure the safety of residents, staff, and visitors.