Failure to Maintain Consistent Hot Water Supply on Two Halls
Penalty
Summary
The deficiency involves the facility’s failure to maintain hot water temperatures at acceptable levels for residents on the Middle North and North Back halls. On one occasion, hot water was left running in Mechanical Room Five, which resulted in no hot water being available on those halls. A maintenance assistant responded, turned off the faucet, and confirmed that the hot water tank temperature returned to an acceptable range, with spot checks in two resident rooms and the nourishment room also within acceptable limits. However, there was no subsequent monitoring of water temperatures over the following days to ensure that hot water was consistently maintained. In the days that followed, staff and family reports indicated that there was no hot water on the affected halls for multiple days. The DON became aware of the initial hot water outage after CNAs reported the issue, and a group message was sent to management. Later, a resident’s family member reported that the resident’s shower could not be completed because there was no hot water and stated that staff had told them the hot water had been out for three days, including over a weekend. Nursing staff, including an LPN and a CNA who worked during this period, confirmed that there was no hot water on the Middle North and North Back halls on at least one of those days. Despite these conditions, review of the maintenance work order log for the period in question showed no evidence that staff had submitted any work orders regarding hot water concerns. A central supply staff member, who was present on some of the days when hot water was reportedly unavailable, stated that staff did not inform her of the problem until later, when the DON contacted her after receiving the family complaint. When she then investigated, she was told there had been no hot water for three days. Subsequent review of plumbing vendor documents confirmed that one hot water tank serving the affected halls was inoperable and another required a new gas valve, contributing to the lack of hot water for the identified residents on those halls.
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