Failure to Maintain Clean Curtains and Intact Room Fixtures for Multiple Residents
Penalty
Summary
The deficiency involves the facility’s failure to maintain a safe, clean, comfortable, and homelike physical environment for multiple cognitively intact residents. During a tour, surveyors observed that two male residents’ rooms had privacy curtains with large stains and dried debris. Both residents reported that the curtains had been dirty and unchanged for some time and that they disliked their appearance. In one of these rooms, surveyors also observed a stained ceiling tile, exposed pipes, and a bathroom light fixture missing its cover, and the resident stated that these conditions had been present and unchanged. In another room shared by two additional male residents, surveyors observed ceiling tiles with dried debris and privacy curtains hanging off their hooks. One of these residents reported that the curtains and ceiling stains had been in that condition for some time. All four residents involved had BIMS scores of 15, indicating they were cognitively intact and able to make their needs known. The environmental issues identified included dirty and damaged privacy curtains, missing light covers, stained ceiling tiles, and exposed pipes. Staff interviews revealed inconsistent understanding and implementation of responsibilities for identifying and addressing these environmental problems. A CNA stated housekeeping was responsible for ensuring curtains and rooms were clean. The housekeeper reported that rooms were cleaned daily but was unsure whether they should notify anyone when curtains needed changing, while acknowledging that several residents’ curtains were visibly soiled. The ADON and assistant administrator stated that curtains should be clean, changed when dirty, and checked regularly, and that lights should have covers. The maintenance director and other staff described processes for daily checks and monthly surveillance of rooms, as well as policies and job descriptions requiring regular inspections and maintenance of resident rooms, but the observed conditions showed these processes were not effectively carried out for the affected residents’ rooms.
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