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F0921
D

Failure to Maintain Clean and Sanitary Shared Medical Equipment and Resident Areas

Plainwell, Michigan Survey Completed on 09-17-2025

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 clean and sanitary conditions for shared medical equipment and resident areas, as evidenced by multiple observations of visibly soiled equipment and unclean resident rooms. One resident was repeatedly observed in a dirty scoot/Broda chair with dried liquid material, ingrained dirt, and body oils on the padding, as well as food debris and smeared substances on the armrests and seat. The resident's room also had visible dirt, debris, and food particles on the floor over several days. Additionally, a shower chair was observed in the hallway and shower room with encrusted dried brown and white material, and the shower room itself had missing tiles, cracked surfaces, and debris on the floor. Other shared equipment, such as a sit-to-stand device, was also found with dirt and dried material on various surfaces. Interviews with staff revealed inconsistent understanding and execution of cleaning responsibilities. CNAs reported that they were responsible for cleaning shower chairs and resident chairs, with a cleaning schedule in place for third shift CNAs. However, there was confusion among housekeeping and maintenance staff regarding who was responsible for cleaning heavily soiled equipment, and no checklist existed for housekeeping duties in the shower rooms. The DON confirmed that shared equipment should be cleaned after each use and when visibly soiled, but observations indicated that this was not consistently done.

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