Failure to Maintain Safe and Homelike Resident Environment Due to Broken and Unsafe Bathroom Equipment
Penalty
Summary
The facility failed to provide a safe, clean, comfortable, and homelike environment for three residents, as evidenced by broken and unsafe bathroom equipment. Two residents were affected by a broken shower faucet handle in their shared bathroom, which had been missing for at least two weeks to over a month. Both residents had to use a shower in another resident's room, and multiple work orders for the repair were placed in the facility's TELS system, but the issue remained unresolved. Staff interviews revealed a lack of awareness about the residents' use of alternative showers and confirmed the maintenance director position was vacant at the time. Another resident was provided with a toileting chair that had a rusty metal support frame and peeling paint, which caused discomfort and concern for the resident. The resident reported that the peeling paint would scrape her skin and could get into her private areas, and that the chair was too small for her needs. Despite complaints to staff, the original chair remained in her bathroom even after she was given a larger, more suitable chair. Staff interviews indicated that no work order had been submitted for the repair or replacement of the unsafe chair, and the condition of the equipment was not known to the nurse interviewed. Record reviews confirmed that the facility's policy required all equipment to be maintained in good working order to ensure resident safety and wellbeing. However, the lack of timely repairs and the continued presence of unsafe equipment in resident bathrooms demonstrated a failure to uphold this policy. The absence of a maintenance director contributed to delays in addressing these issues, as work orders were not completed and staff were unclear about who was responsible for maintenance tasks.