Failure to Maintain Clean, Comfortable, and Home-like Environment
Penalty
Summary
Facility staff failed to consistently maintain a clean, comfortable, and home-like environment for residents, as evidenced by multiple observations during a recertification survey. Specific deficiencies included a clothing armoire door hanging off in a resident room, accumulation of trash such as empty bottles, snack packs, and tissues under a resident's bed on multiple days, a broken toilet paper dispenser, and a non-functioning light bulb in a shared bathroom. Additional issues noted were the absence of privacy curtains in a resident room, a loose faucet that could not be turned off, a missing drawer in a resident's dresser, and stains on the wall behind a commode. These conditions were confirmed by a GNA during the surveyor's rounds. Interviews with facility staff revealed that maintenance concerns are reported via binders on each unit, with urgent issues communicated directly to the Maintenance Director. However, staff do not determine what constitutes an urgent issue and simply document all concerns in the binder. The Maintenance Director stated that room audits are conducted based on identified issues, with a goal of auditing one room daily and every resident's room quarterly. Maintenance issues are addressed by the maintenance assistant, and staff use both binders and an electronic system (TELS) to report problems. Despite these processes, the observed deficiencies indicate lapses in maintaining a safe and comfortable environment.