Failure to Maintain Safe, Clean, and Homelike Environment Due to Water, Linen, and Supply Shortages
Penalty
Summary
The facility failed to provide a safe, clean, comfortable, and homelike environment for its residents, as evidenced by multiple deficiencies identified during an onsite investigation. Surveyors found that water temperatures in resident rooms and bathing areas were consistently below the facility's policy requirement of at least 105 degrees Fahrenheit, with temperatures often ranging from 70.6 to 97.7 degrees Fahrenheit even after running the water for several minutes. Staff, residents, and family members confirmed that the lack of hot water had persisted for weeks to months, impacting the ability to provide showers and basic hygiene. Facility logs and temperature records corroborated ongoing issues with the hot water supply, and mechanical inspection revealed that only one of two boilers was operational, with the other being very old. In addition to water temperature issues, the facility was found to have an inadequate supply of clean bath linens, such as towels and washcloths, for resident use. Observations of supply rooms on multiple units revealed insufficient quantities of these items, and interviews with staff and residents' families confirmed that this shortage had been an ongoing problem for years. Staff reported that laundry deliveries often arrived after showers had already started, further exacerbating the issue and leaving residents without necessary linens for personal care. The investigation also uncovered that garbage bags were not being provided in resident room trash cans, a recent change that staff and residents' families reported had been ongoing for at least a week to over a month. Observations confirmed the absence of garbage bags in multiple resident rooms, and staff interviews indicated that the facility had been running out of these supplies. Facility policy required housekeeping to maintain supplies and keep equipment stocked, but this was not being met, as confirmed by the newly hired Laundry/Housekeeping Supervisor and other staff members.