Failure to Maintain Homelike Environment and Adequate Dining Service
Penalty
Summary
The facility failed to maintain a safe, clean, and homelike environment for its residents, as evidenced by multiple observations and interviews. One resident with moderate cognitive impairment, a history of stroke, aphasia, hemiplegia, and schizophrenia was found in a room that was not swept daily, with trash on the floor and a bedside table with screws protruding from the surface. The condition persisted over two days, and the housekeeping supervisor acknowledged that the screws were not homelike and that the table was an older, unused piece of furniture. Housekeeping staff were expected to clean rooms daily, but staffing shortages were noted. Another resident, who was cognitively intact and had diagnoses including diabetes, hypertension, and hemiplegia, had two dirty plates with dried food left on the air conditioning unit in their room for at least two days. The resident reported that the plates were from previous meals, and the housekeeping supervisor stated that staff should remove such items or notify nursing. The supervisor also noted that trash should be removed in the morning and rooms checked again before staff leave, but acknowledged recent short staffing. Additionally, the facility did not provide a sufficient number of regular dining plates, resulting in residents being served meals on Styrofoam plates wrapped in plastic. Multiple residents reported dissatisfaction with the use of Styrofoam, stating that it made food cold and unappetizing, and that plates were often removed before they finished eating so they could be washed for the next meal. Observations confirmed that regular plates were in short supply, with staff switching to Styrofoam when plates ran out. The dietary manager and staff confirmed the ongoing shortage, and the administrator provided documentation of a recent order for a small number of plates, but could not locate records of previous orders.