Failure to Maintain Odor-Free, Clean Environment for Dependent Resident
Penalty
Summary
The facility failed to maintain a clean, odor-free, and well-kept environment for one of five sampled residents by not ensuring that the resident's room and adjacent hallway were free from foul odors. During an observation, two surveyors detected a strong urine odor in the resident's room and the nearby hallway. Further inspection with a CNA revealed that the resident's bedding, draw sheet, under pad, and pants were wet with urine, and the CNA acknowledged that the odor was due to the resident not being changed in a timely manner. The CNA also stated that residents should be changed every two hours to prevent such issues. The resident involved had cognitive impairment and was dependent on staff for activities of daily living, including toileting and personal hygiene. The facility's own policy required a clean, sanitary, and pleasant-smelling environment, including clean bed linens. The Director of Nursing confirmed the expectation for a home-like, odor-free environment. The failure to provide timely incontinence care resulted in a foul-smelling environment in the resident's room and adjacent hallway, directly contravening facility policy and resident rights.