Failure to Maintain Clean and Homelike Resident Environment
Penalty
Summary
Surveyors identified that the facility failed to provide a safe, clean, comfortable, and homelike environment for its residents, as required. Multiple residents reported that their rooms were not cleaned daily, and that garbage was not always emptied, resulting in unpleasant odors. Observations confirmed these reports, with surveyors noting a urine odor in one resident's room, a dried yellow stain on another resident's bed sheet, and full garbage containers. Residents stated that while they sometimes notified staff about the lack of cleaning, the response was inconsistent and did not ensure regular cleaning as per facility policy. Interviews with facility staff, including a housekeeper, LPN, and CNA, corroborated the residents' accounts. Staff acknowledged that housekeeping did not always clean resident rooms daily, and that nursing staff sometimes had to clean up messes themselves. The housekeeper explained that while daily cleaning should include emptying garbage, sweeping, and wiping down surfaces, this was not always completed. Deep cleaning was reportedly done monthly, but there were instances where rooms were not cleaned for several days. The housekeeper also noted that certain spills, such as body fluids over a certain amount, were not cleaned by housekeeping but left for facility staff, who could not always address them promptly. A review of facility grievance records from May to August revealed 11 grievances related to unclean rooms, with investigations confirming that rooms were not cleaned as required. The facility's housekeeping and laundry services were outsourced, and the district manager stated that daily cleaning should include disinfecting surfaces, sweeping, mopping, and cleaning bathrooms. However, there was no documentation or audit trail to verify that these tasks were consistently performed. The lack of regular cleaning and failure to maintain a homelike environment had the potential to affect all residents in the facility.