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F0584
D

Failure to Provide Homelike Environment Due to Noise and Linen Preferences

Spearfish, South Dakota Survey Completed on 08-28-2025

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 ensure a homelike environment for two residents due to issues with noise levels and the availability of preferred linens. For one resident, staff did not consistently provide a clean washcloth and hand towel on the towel rack for use after handwashing, despite repeated requests from the resident and his spouse. The resident was able to use the handwashing sink independently and preferred cloth towels over paper towels, as was his custom at home. Observations confirmed that a used washcloth remained on the sink countertop for an extended period, and no clean cloth towels were provided, contrary to the facility's policy to maintain clean bed and bath linens. Another resident was exposed to loud, intermittent hissing noises from bulk oxygen tanks placed directly outside the wall of his room. The noise from the tanks' pressure release was significant enough to interrupt conversations, television viewing, and the resident's ability to listen to books on tape. The resident, who had a history of generalized anxiety disorder, PTSD, and other mental health conditions, reported that the noise startled him, increased his anxiety, and disturbed his sleep. Staff interviews revealed a lack of awareness regarding the impact of the noise on the resident, and the tanks had been in that location since before the resident's admission. The facility's policy defined a homelike environment as one with comfortable sound levels and the provision of clean linens. In both cases, the facility did not meet these standards, as the resident's preferences for linens were not accommodated and the noise from the oxygen tanks created an uncomfortable and disruptive environment.

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