Failure to Maintain Safe Equipment and Promptly Report Defects
Penalty
Summary
The facility failed to maintain mechanical, electrical, and patient care equipment in safe operating condition, specifically neglecting to ensure that resident beds were functioning properly. One resident was injured when his bed moved while care was being provided, resulting in the resident striking his head against a nightstand and sustaining two lacerations. Staff statements revealed that the bed's wheel lock had been defective for months, and the malfunction had not been reported to maintenance or management despite being known to nursing staff. The facility's preventive maintenance policy and logs did not include requirements for checking the function of bed wheels or brakes, focusing instead on other aspects of bed safety. Additionally, the report documents that a staff member had to use his foot to hold open a broken oven door in the kitchen due to a broken spring, which made it difficult to remove food safely. The broken equipment was confirmed by the regional dietary manager. These deficiencies indicate that the facility did not ensure all essential equipment was kept in safe working order, and staff did not promptly report defective equipment, potentially exposing residents to harm.