Widespread Environmental and Maintenance Deficiencies
Penalty
Summary
Surveyors identified multiple deficiencies related to the facility's failure to maintain a safe, clean, comfortable, and homelike environment for residents. Observations revealed widespread issues throughout resident rooms, restrooms, common areas, and shower rooms, including heavy dust and debris on exhaust fans, holes in walls, missing or broken fixtures such as light covers, soap and paper towel dispensers, towel bars, and window blinds. Numerous rooms had evidence of water damage, black mold-like areas on ceilings and walls, peeling paint, and discolored or missing floor tiles. Several plumbing fixtures, such as toilets and faucets, were loose, leaking, or not functioning properly, and some heating/ventilation units lacked covers or had broken vent covers. Residents reported that some of these issues, such as missing paper towel holders, broken soap dispensers, and malfunctioning lights, had persisted for extended periods despite being reported to staff. Interviews with residents indicated dissatisfaction with the facility's response to maintenance concerns, with some residents stating they had reported issues multiple times without resolution. In several cases, residents described having to clean up after other residents due to inadequate housekeeping, such as cleaning fecal matter or urine themselves. Observations also noted strong odors of urine and stale smells in some rooms, sticky floors, and visible stains on bedding and furniture. In common areas, such as dining and shower rooms, surveyors found dried food spills, fecal matter, rust stains, and chipped paint, further indicating lapses in cleanliness and maintenance. Facility staff interviews revealed that while a work order system was in place for reporting and addressing maintenance issues, there were inconsistencies in how and where work orders were submitted and collected. Maintenance staff reported that repairs were typically completed within a week of receiving a work order, but daily rounds by department heads to identify issues were not always completed due to emergencies or staffing shortages. Housekeeping staff stated that rooms were cleaned daily, but nursing staff were also expected to address cleanliness between housekeeping visits. Despite these processes, the observations and resident interviews demonstrated ongoing and unresolved deficiencies in the facility's environment.