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F0584
D

Failure to Maintain Cleanliness and Resident Privacy

Baltimore, Maryland 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

Facility staff failed to maintain a safe, clean, and homelike environment for residents, as evidenced by multiple observations of unclean floors, bathrooms, and shower rooms. Surveyors observed trash, toilet paper, cigarette ashes, and brown substances scattered on floors in various areas, including the resident smoking exit, stairwells, and elevators. The elevator floor was so sticky that a surveyor's shoes stuck to it, and trash such as a paper straw wrapper adhered to their footwear. The stairwell contained trash, leaves, a used glove, and a brown substance on the wall. Resident bathrooms and shower rooms were found with trash, soiled linens, personal hygiene items left out, and visibly soiled floors. Janitor carts with dirty mop water and mobility equipment such as wheelchairs and geri-chairs were stored in shower rooms, sometimes blocking access to shower stalls. In addition to cleanliness issues, the facility failed to ensure privacy for residents using shared bathrooms. On the third floor, a bathroom connected a room housing four male residents to a room with two female residents. Both bathroom doors were left open, allowing unsupervised access between the male and female rooms. This lack of privacy was confirmed during the surveyor's walkthrough and acknowledged by facility leadership. The open access between rooms compromised the privacy and dignity of residents, particularly as the female residents were unable to access the bathroom independently. Interviews with staff, including the Environmental Services (EVS) Director and the Nursing Home Administrator (NHA), confirmed the observations of uncleanliness and privacy concerns. The EVS Director described the cleaning schedule and staff responsibilities, but acknowledged the surveyor's findings when shown images of the facility's condition. The NHA also acknowledged concerns about the state of the shower rooms, which were observed to have soiled floors, trash, and improperly stored equipment. These deficiencies were corroborated by multiple staff interviews and direct observations by the survey team.

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