Soiled Privacy Curtains Not Timely Cleaned or Replaced
Penalty
Summary
The deficiency involves the facility’s failure to provide a safe, clean, comfortable, and homelike environment by not ensuring that privacy curtains for three residents were free of stains. For Resident #1, a male with a history of cerebral infarction and resulting hemiplegia/hemiparesis and moderate cognitive impairment (BIMS 12), surveyors observed housekeeping staff on a ladder replacing the middle privacy curtain in his room. Resident #1 reported that the curtain had been dirty for approximately two to three weeks, stating that a CNA had splattered bowel movement on the curtain while changing his roommate, attempted to wipe it off, but the stain remained and no one made an effort to clean it afterward. He also reported that a similar incident had occurred previously, that his family member had reported it, and that his family did not want to sit near the curtain during visits. For Resident #2, a female with paroxysmal atrial fibrillation, muscle weakness, and a cognitive communication deficit but no cognitive impairment (BIMS 14), observation revealed several brown splattered dots on the privacy curtain between her and her roommate. Resident #2 stated she did not know what was on the curtain, wished it could be washed, and was unsure if the curtain had ever been washed since she had been in the room. For Resident #3, a male with post-polio syndrome, major depressive disorder, and a need for assistance with personal care, and no cognitive impairment (BIMS 15), observation showed brown streaks and spots on the middle privacy curtain in his room. Resident #3 stated he did not think the curtain was laundered very often and believed the stains were food. Staff interviews revealed inconsistent understanding and implementation of procedures for handling soiled privacy curtains. CNAs and nursing staff reported that when curtains were soiled, they were to submit a work order in the TELS system and notify maintenance or housekeeping, and that nursing staff could not remove curtains themselves. Some staff, including an LVN and an RN, were unsure about the routine frequency for laundering curtains. The housekeeping supervisor and maintenance staff stated that privacy curtains were laundered on a monthly deep-cleaning rotation and as needed via TELS work orders, with increased urgency if bodily fluids or bowel movement were noted. Review of TELS work order logs showed multiple requests over several weeks for curtains in Resident #1’s room and another room to be changed or washed due to large dark or feces-like stains, including repeated notes that the curtain had a large stain that looked like feces for well over two weeks, and specific entries indicating the curtain had bowel movement or “poop” on it. The facility’s physical environment policy stated that TELS was used to track and document maintenance and regular tasks to keep the facility in good working order for resident and staff safety.
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