Failure to Maintain Clean and Sanitary Resident Room Environment
Penalty
Summary
The facility failed to maintain a clean and sanitary environment in one occupied resident room, as evidenced by multiple observations of dried brown and beige substances on various surfaces. Specifically, surveyors observed these substances on the walls underneath the television, near the heating and air conditioning unit, behind the bed, in the corner of the room, on the headboard of the bed, and on the base and wheels of the enteral feeding pole. The facility's policy on housekeeping and routine cleaning, dated 1/10/2025, requires regular cleaning of surfaces, including enteral pump poles and walls, to remove visible soils. The affected resident had significant medical conditions, including hemiplegia, dysphagia, aphasia, COPD, diabetes, and used a PEG tube. The resident was also noted to be severely cognitively impaired, with a BIMS score of 2. During an interview and observation, the DON confirmed that the areas should be clean and free of dried substances, and was unable to identify the nature of the substances present, but acknowledged they should not be there.