Failure to Maintain Clean Wheelchairs and Effective Infection Control
Penalty
Summary
The facility failed to maintain an effective infection prevention and control program, as evidenced by the condition of two residents' wheelchairs, which were observed to be covered with black and brown unknown substances. Both residents were found asleep in their beds during the observation, and their wheelchairs' metal frames and wheels were visibly soiled. The Assistant Director of Nursing (ADON) confirmed that the housekeeping staff were responsible for cleaning the wheelchairs weekly, but this had not been done. The ADON acknowledged that the facility did not provide a comfortable and homelike environment and that the substances on the wheelchairs could be a source of bacterial growth and illness. Housekeeping staff confirmed that the wheelchairs were dirty and should have been kept clean at all times, but due to staffing problems, the scheduled cleaning was missed. The Housekeeper stated that unclean equipment such as wheelchairs could make residents ill and that the facility failed to provide a comfortable homelike environment for the affected residents. The Director of Nursing (DON) also reviewed photos of the wheelchairs and stated that she expected them to be cleaned as scheduled and as needed for soilage. The DON indicated that the housekeeping department was responsible for cleaning wheelchairs weekly and as needed, and that licensed nurses and CNAs were expected to report dirty wheelchairs to housekeeping for follow-up. The Administrator stated that all wheelchairs were expected to be cleaned weekly and as needed, and that providing a clean, comfortable, and homelike environment was the responsibility of all staff. The facility's job description for housekeepers and its policies and procedures for assistive devices and infection control both indicated that maintaining a clean and safe environment was required. However, these policies were not followed, resulting in the deficiency.