Failure to Secure Shower Room and Hazardous Chemicals
Penalty
Summary
The facility failed to ensure that the environment remained free from accident hazards by not keeping the shower room door on one hallway closed and locked as required. During an observation, the shower room door was found propped open with no staff or residents nearby, and various potentially hazardous items such as no-rinse cleanser, shampoo, body wash, and shaving cream were accessible on top of a clothes barrel. Staff interviews confirmed that the expectation was for the shower room door to be locked at all times, and that staff had been in-serviced on this requirement, though the last in-service date could not be recalled. The CNA involved admitted to leaving the door unlocked and acknowledged the risks associated with residents accessing the chemicals inside. Further interviews with the DON and Administrator confirmed that all shower doors were expected to be closed and locked at all times to prevent residents from entering unsupervised, potentially ingesting chemicals, or being unable to call for help if they fell. The Administrator also stated that there was no formal protocol in place for accidents and hazards. A review of the Safety Data Sheet for one of the cleansers indicated that ingestion could be harmful, and the facility was unable to provide Safety Data Sheets for other chemicals present in the shower room.