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F0921
E

Failure to Maintain Sanitary and Functional Resident Rooms and Bathrooms

Silver Spring, Maryland Survey Completed on 12-19-2025

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 a safe, functional, sanitary, and comfortable environment for three residents. One resident, who was dependent on staff for all activities of daily living and had diagnoses including spastic quadriplegic cerebral palsy and spinal stenosis, was observed in a room with several dark spots, dried food droppings, and black and brown substances on the walls. The resident reported that the facility did not adequately clean the room or walls. Two other residents, one with unspecified dementia and chronic kidney disease requiring substantial to maximum assistance with personal hygiene, and another with end stage renal disease and a history of falls who was independent with ADLs, experienced ongoing issues with a damaged and leaking commode toilet in their shared bathroom. Both residents reported strong, persistent odors and visible contamination in the bathroom, including black and brown substances on the stool area, stained and discolored floor tiles, and a pervasive smell of urine and human waste. One resident stated the issue had persisted for over two months, leading them to use staff bathrooms instead. Interviews with the Housekeeping Director and Maintenance Director confirmed that the bathroom required significant repairs, including floor and toilet replacement, and that the odor could not be eliminated despite repeated cleaning. Both directors indicated that the administrator was aware of the ongoing plumbing and maintenance issues, which had been present for several months. A private plumber's work order documented repairs to the toilet bowl and recommended further replacement of toilet bolts and pipes.

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