Widespread Environmental Deficiencies and Pest Infestation
Penalty
Summary
The facility failed to maintain a clean, comfortable, and homelike environment for its residents, as evidenced by multiple observations of unsanitary conditions, pest infestations, and delayed removal of soiled items. Surveyors observed heavily soiled ice machines with black and white substances, rust buildup, and water leaks on several floors. Food carts with leftover, uncovered food from previous meals were left unattended, and resident rooms contained food debris, soiled linens, and broken furniture. Bathrooms were found with debris, broken fixtures, and in one instance, a cockroach was observed crawling on the wall during incontinence care. Staff confirmed the presence of cockroaches and described the protocol for reporting pest sightings, which included documentation in a pest control log and notification of the Maintenance Director. Pest logs revealed ongoing documentation of cockroach sightings in resident rooms and common areas dating back several months. Residents and staff consistently reported and observed cockroach infestations throughout the facility, including in bedrooms, bathrooms, closets, and on personal belongings. Surveyors directly observed swarming live cockroaches and dead cockroaches on sticky traps in resident closets, with personal items such as blankets and clothing exposed to the pests. Multiple residents expressed distress about the presence of cockroaches, describing them crawling on their faces and beds, and reported taking measures such as blocking beds with towels to prevent contact. Staff also reported wrapping their personal belongings in plastic bags to protect them from cockroaches. Despite ongoing pest control efforts, the infestation persisted, with sightings documented on all resident floors and in various locations, including on a clean linen cart and near medication carts. In addition to pest issues, the facility failed to promptly clean up resident excrement and address strong odors. Surveyors noted a strong odor of feces in a hallway, and upon investigation, found that a resident's bedside commode had not been cleaned after an episode of incontinence and vomiting overnight. The roommate reported the odor to staff, but the issue was not resolved in a timely manner, and the responsible LPN acknowledged being aware of the situation but did not ensure it was addressed. Damaged and chipped furniture, cracked countertops, and exposed wallboard were also observed, contributing to an environment that was not clean or homelike. Residents and staff confirmed that these conditions had been ongoing and were not adequately addressed.