Failure to Provide Adequate Clean Towels and Linens for Resident Care
Penalty
Summary
The facility failed to provide an adequate supply of clean towels and linens in good condition for resident care, as evidenced by multiple observations, interviews, and record reviews. Residents reported having to purchase their own towels due to shortages, and staff confirmed that there were not enough towels and linens available to meet the needs of all residents. On several occasions, staff resorted to using sheets, pillowcases, or even diapers to clean residents when towels and washcloths were unavailable. The laundry staff acknowledged delivering significantly fewer towels than required, and described cutting up bath towels to create makeshift washcloths, which were observed to be tattered, frayed, and stained. Clean linens and blankets were also observed to have persistent stains, including feces, pus, and blood, which could not be removed despite laundering. Residents affected by this deficiency included individuals with significant care needs, such as those who were always incontinent of urine and bowel, required maximal assistance for hygiene, and had multiple comorbidities including morbid obesity, diabetes, contractures, and mobility limitations. These residents were dependent on staff for all aspects of personal care, including bathing, toileting, and hygiene. The lack of adequate linens and towels directly impacted their ability to maintain personal cleanliness and dignity, as they were sometimes unable to wash their faces or be properly cleaned after incontinence episodes. Staff interviews revealed that the shortage of towels and linens was a recurrent and well-known problem, with CNAs frequently having to search other units or purchase their own wipes to provide care. Laundry staff reported being unable to discard stained or damaged linens due to insufficient supply, and did not have access to new linens stored in a locked supply closet. Nursing and administrative staff were aware of the issue, with some indicating that they had provided instructions for reporting shortages, but the problem persisted due to lack of communication and inadequate replenishment of supplies.