Failure to Maintain Sanitary Conditions in Shared Shower Room
Penalty
Summary
The facility failed to establish and maintain an effective infection prevention and control program in the 3rd floor community shower room, which is used by up to 30 residents. Observations revealed that both shower stalls had drains clogged with large amounts of hair, a brown substance was present under one shower chair, and the floors were dirty with darkened areas and brown substance droppings in one of the stalls. Staff interviews confirmed that Certified Nursing Assistants (CNAs) were responsible for cleaning shower chairs between resident use, but one CNA reported only using shampoo to clean the chair due to a lack of disinfectant products. Housekeeping (Hsk) staff were responsible for cleaning the shower stalls and floors, but they left for the day by 4:00 PM, leaving cleaning duties to CNAs after that time. Further interviews with nursing and maintenance staff indicated confusion and inconsistency regarding cleaning responsibilities and procedures. The Assistant Director of Nursing (ADON) and Maintenance/Housekeeping Supervisor both described overlapping and unclear duties between CNAs and Hsk staff, particularly regarding the cleaning of feces and hair from drains. Policy documents reviewed stated that floors should be cleaned according to a schedule and that approved cleaning agents should be used in contaminated areas, but no specific policy for CNA responsibilities in cleaning and disinfecting shower rooms was provided. This lack of clear procedures and inadequate cleaning led to unsanitary conditions in the shared shower area.