Failure to Maintain a Safe, Clean, and Homelike Environment
Penalty
Summary
The facility failed to provide a clean, comfortable, and homelike environment for residents on one unit, as evidenced by multiple maintenance and cleanliness issues observed during surveyor tours and confirmed by resident interviews. Specific deficiencies included loose and duct-taped keypads, missing bathroom light panels with exposed bulbs, broken heating panels, unpainted and water-damaged walls, peeling wallpaper, cracked and stained ceiling tiles, missing molding, frayed and ripped curtains, and missing or makeshift room number displays. Additional issues were found in common areas, such as an unlocked electrical panel with exposed wires, missing molding, water-damaged countertops, cabinets held together with zip ties, and a rotting exterior door with visible holes. Resident rooms also had problems such as dirty air conditioner filters, water damage, and damaged wheelchairs. Residents reported ongoing problems, including broken beds held together with duct tape, clogged sinks, and maintenance issues that had persisted since admission. Staff interviews revealed that maintenance relied on a notebook system for reporting issues, which was inconsistently used and primarily addressed staff-related concerns rather than resident needs. Both the Director and Regional Director of Maintenance acknowledged the poor condition of the unit and the inadequacy of the current reporting and tracking system. The Administrator confirmed expectations for a safe and homelike environment and recognized the need for improved processes and staff awareness regarding environmental standards.