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F0584
D

Failure to Maintain Clean and Homelike Environment in Shower and Resident Rooms

Kerrville, Texas Survey Completed on 06-13-2025

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 maintain a safe, clean, comfortable, and homelike environment for residents, as evidenced by several deficiencies observed in both a community shower room and a resident room. During an observation, a shower chair in the 400-hall community shower was found to have a brown substance on the bottom of the seat. Certified Nursing Assistants (CNAs) confirmed that the chair should be cleaned after each use and stated that the hospice CNA was the last to use the shower room. The Licensed Vocational Nurse (LVN) and Assistant Director of Nursing (ADON) acknowledged the presence of the substance and indicated that the expectation was for shower chairs to be cleaned and disinfected after each use. The ADON also stated that such conditions could pose infection control risks. Additionally, the 400-hall shower room was found to be missing a tile, and a resident room was missing a door frame on one side of the bathroom entrance. Staff interviews revealed that these issues had not been reported to the Maintenance Director, and the Housekeeping Manager was unaware of the missing tile and door frame. The facility's policy requires a clean, sanitary, and orderly environment, but these deficiencies were not addressed or reported as required, resulting in a failure to uphold the residents' right to a safe and homelike environment.

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