Failure to Maintain Clean, Homelike, and Well-Maintained Environment
Penalty
Summary
The facility failed to provide a safe, clean, comfortable, and homelike environment for multiple residents across several units, as required by its own policy and federal regulations. Observations revealed numerous deficiencies in cleanliness and maintenance, including crumbs and soiling on floors, unclean and damaged bathrooms, toilets that were difficult to flush or not functioning, and cracked or loose toilet seats. Residents reported that housekeeping was inconsistent, with rooms sometimes not cleaned, garbage cans overflowing, and a lack of basic supplies such as toilet paper and paper towels. Maintenance issues, such as clogged toilets and broken shower heads, were not addressed in a timely manner, with some repairs taking weeks to complete. Resident council minutes documented ongoing concerns over several months, including unswept floors, dirty windows, insufficient trash bags, un-mopped floors, malfunctioning lights, and persistent plumbing issues. Observations in various rooms and common areas found dust accumulation on ceiling tiles, water damage, peeling baseboards, soiled and discolored flooring, missing or damaged tiles, mildew, and non-functioning light fixtures. Shower rooms were cluttered with stored equipment, further detracting from the homelike environment and limiting usable space for residents. Interviews with housekeeping staff revealed high turnover and heavy workloads, with each housekeeper responsible for cleaning up to 35 rooms. Staff confirmed that some areas, such as the blackened floors, could not be adequately cleaned with routine methods and required more intensive maintenance. The Maintenance Director and Environmental Services staff verified many of the observed deficiencies and acknowledged that some issues, such as lack of storage space and persistent grime, had not been properly addressed. Residents affected by these deficiencies included individuals with intact cognition as well as those with moderate cognitive impairment and complex medical needs.