Widespread Environmental Cleanliness and Maintenance Failures
Penalty
Summary
The facility failed to maintain a clean, safe, and comfortable environment for all 196 residents, as evidenced by multiple observations, interviews, and record reviews. Residents and staff reported and surveyors observed widespread cleanliness issues, including garbage not being emptied daily in resident rooms, accumulation of food waste, and the presence of flies and gnats throughout the facility. Specific instances included garbage cans in resident bathrooms and rooms remaining unemptied for several days, leading to infestations of fruit flies and gnats, and residents expressing dissatisfaction with the frequency and quality of cleaning services. Significant sanitation concerns were documented in shared shower rooms, where surveyors observed soiled and wet paper products, brown-stained towels, suspected fecal matter, and mold or mildew on ceiling tiles and grout. The shower drains were covered in hair and infested with small flying insects. Equipment in the shower rooms was found to be in disrepair, such as a shower head pole that was not properly secured to the wall, and a handheld shower nozzle left dangling without a mounting pole. Staff acknowledged these issues, with housekeepers and CNAs noting the persistent dirtiness, presence of mold or mildew, and lack of proper equipment maintenance. Maintenance staff were unaware of some of the problems, indicating a breakdown in communication and reporting. Additional observations included sticky and debris-laden dining room floors, a shower bed with a drain pan containing foul-smelling, murky liquid with solid brown particles, and further insect infestations in various facility areas, including staff bathrooms. Facility policies and job descriptions provided by the facility require daily cleaning, prompt garbage removal, pest control, and regular maintenance, but these standards were not met. Residents involved had intact cognition and were able to clearly articulate their concerns and dissatisfaction with the environment, and some were dependent on staff for all activities of daily living and mobility.