Failure to Maintain a Safe, Clean, and Comfortable Environment
Penalty
Summary
The facility failed to provide a safe, functional, sanitary, and comfortable environment for residents, staff, and the public in three of five units. Multiple observations and interviews revealed persistent odors of urine and feces in common hallways, resident rooms, and dining areas. Residents and their representatives reported frequent and strong smells of urine and feces, with some stating that the odors were so strong they had to cover their mouths and noses. Additionally, representatives noted issues such as broken blinds, missing lights, and sticky or stained floors in resident rooms and common areas. Direct observations by surveyors documented stained footprints, sticky and stained floors, dried feces in resident rooms, spills left uncleaned for hours, and cracks in floors and walls. Used linens and water pitchers were left in common areas for extended periods, and cleaning was observed to be incomplete, with crumbs and stains remaining under tables and on surfaces. Handrails and baseboards throughout the facility were scratched, chipped, and marked, and some repairs appeared to be temporary or incomplete. The facility's cleaning and maintenance practices were inconsistent, with unclear responsibilities between housekeeping and nursing staff regarding the cleaning of bodily fluids and spills. Staff interviews confirmed confusion about cleaning responsibilities and the frequency of deep cleaning. Housekeeping staff did not always clean under tables or mop common areas, and nursing staff were sometimes responsible for cleaning spills, but there was uncertainty about the cleaning solutions used and the condition of cleaning equipment. Maintenance issues, such as cracked floors and missing lights, were sometimes delayed due to communication problems and staff turnover. The facility's own policy required a sanitary, orderly, and comfortable environment, but observations and interviews indicated that these standards were not consistently met.