F0584

E

Failure to Maintain Functioning Toilets and Sinks in Resident Rooms

Luling, Texas Survey Completed on 01-20-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to provide a safe, clean, comfortable, and homelike environment by not maintaining functioning toilets and sinks in multiple resident rooms. Four residents were identified as being affected by non-functioning or inconsistently functioning bathroom fixtures. Surveyors’ observations confirmed that toilets did not flush and sinks produced no water or only low-pressure water in these residents’ rooms. Residents reported that these problems had been ongoing for weeks to months, and that they frequently had to rely on alternative locations, such as shower rooms or communal bathrooms, to perform basic hygiene tasks like handwashing, showering, and toothbrushing.

One resident with paraplegia, depression, and generalized anxiety disorder, and with a BIMS score indicating no cognitive impairment, reported having no water in his sink or a working toilet for six weeks. He stated that he had to remove the toilet tank lid and pour a gallon of water into the tank to flush, despite his paraplegia, and expressed unhappiness about the lack of working bathroom fixtures in his room. Observation confirmed that his toilet did not flush and no water came from his sink. Another resident with a history of atherosclerotic heart disease, difficulty walking, anxiety, major depressive disorder, dementia, and PTSD reported that his water sometimes worked and sometimes did not, and that this had been occurring for a few months. He stated that the toilet took a long time to fill and could not always be flushed, that he considered the situation unsanitary and a health hazard, and that he had to go to another hall to shower, wash his hands, and could not brush his teeth in his own bathroom. Observation confirmed his toilet did not flush and his sink produced no water.

A third resident with cerebral infarction, need for assistance with personal care, unsteadiness on feet, and generalized anxiety disorder, and with a BIMS score indicating no cognitive impairment, stated that his only issue at the facility was his bathroom. He reported that his toilet did not flush, his sink produced no water or only non-hot water, and that he had to use the shower room to brush his teeth, wash his hands, or use the bathroom. He stated that his bathroom often smelled foul because urine or feces remained in the unflushed toilet, and that staff only flushed the toilet once a day, with gallons of water kept in the room for flushing by pouring into the tank. Observation confirmed that his sink did not work and his toilet did not flush. A fourth resident with Alzheimer’s disease, Parkinson’s disease, muscle weakness, difficulty walking, and major depressive disorder, and with a BIMS score indicating moderate cognitive impairment, reported having no hot water in the sink and a full toilet. Observation revealed a toilet full of fecal matter and urine with a foul odor, and a later observation the same day showed the toilet still unflushed and the odor persisting.

Interviews with staff and administration showed inconsistent awareness, training, and practices regarding the plumbing issues and interim measures. The maintenance director stated that the facility needed replumbing, that only certain rooms were affected, and that water bottles were being used to flush toilets by pouring water into the tank when residents requested assistance or when staff rounded. Some CNAs and nurses reported that they were told to use water jugs to flush toilets and to check toilets during rounds, and that the problem had been ongoing from about a week to up to two months, depending on the staff member’s account. However, an agency CNA and an agency LVN reported they had not been trained or specifically informed about flushing toilets with water bottles or performing toilet-flushing rounds. The administrator acknowledged that water pressure on the affected hall was inconsistent, that water bottles were placed in rooms for flushing, and that staff were told to check toilets during rounds, but also stated he was unsure whether in-services had been completed on offering alternatives for toothbrushing and handwashing. Record review showed no in-services on rounding to ensure toilets were flushed or on offering alternatives for hygiene, and no grievances related to bathroom concerns, despite multiple resident reports of ongoing problems.

Facility policies on environmental services and resident rights indicated expectations for maintaining a standard of excellence in housekeeping and for treating residents with dignity and respect, including a dignified existence. Nonetheless, the documented observations and interviews demonstrated that several residents lived with non-functioning toilets and sinks for extended periods, relied on staff or themselves to manually flush toilets with water jugs, and experienced foul odors and lack of in-room access to running water for basic hygiene. These conditions and the inconsistent staff training and response led to the cited deficiency for failing to maintain sanitary, orderly, and comfortable interior conditions and to honor residents’ rights to a safe, clean, comfortable, and homelike environment.