Failure to Maintain Clean and Homelike Resident Environment
Penalty
Summary
The facility failed to maintain a clean and homelike environment for one resident, as required by its policy and state regulations. Multiple observations over several days revealed that the wall directly behind the resident's bed had approximately 20 black and white gouges in the drywall, varying in length from eight to 22 inches and covering an area about 30 inches wide. These gouges were visible upon entering the room and were not addressed prior to the survey. The resident involved was cognitively intact and had diagnoses including chronic obstructive pulmonary disease and diabetes. The Director of Maintenance was unaware of the condition of the wall and explained that previous headboards with bolts likely caused the damage when the bed was moved. The Director of Nursing confirmed that the drywall should have been free of such damage, but it was not.