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F0584
D

Failure to Maintain Cleanliness and Safe Equipment in Resident Rooms

Chapel Hill, North Carolina Survey Completed on 06-19-2025

Penalty

No penalty information released
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to maintain a safe, clean, and homelike environment for its residents, as evidenced by multiple observations and staff interviews. In one instance, a large brown semi-solid puddle of dried fluid, identified as tube feeding, was found trailing towards the window in a resident's room, with the floor remaining sticky and a brown dried substance present on the bedside television monitor and its controls. These conditions persisted over several days, despite regular housekeeping routines. Housekeeping staff reported that they were not permitted to clean up bodily fluids and only addressed spills such as water, juice, or food, while the Director of Housekeeping confirmed that tube feeding spills were difficult to clean once dried and noted that the spill had been left over the weekend. The brown substance on the television monitor was not previously identified or cleaned by staff. In another instance, the bed control for a resident's bed was observed with the outer insulation casing stripped away, leaving three individual wires exposed and resting on the resident's pillow while the resident was in bed. The Maintenance Director stated that bed controls were checked monthly and that staff were expected to report any issues for repair. Documentation showed that the bed controls had been inspected the previous month, with checks for proper operation and for any cracked or frayed wires. However, the exposed wiring was not identified or addressed prior to the surveyor's observation.

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