F0695

E

Failure to Properly Store, Clean, and Label Respiratory Equipment and Oxygen Supplies

Milford, Delaware Survey Completed on 11-17-2025

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to provide safe and appropriate respiratory care by not properly storing and maintaining respiratory equipment and supplies for multiple residents. One resident with chronic respiratory failure and an order to use IVAPS nightly had the IVAPS mask left on the bedside table without a protective bag. Another resident with COPD and acute and chronic respiratory failure, ordered to use Bi-PAP at bedtime and as needed, had the Bi-PAP mask sitting on the bedside table without a protective bag, and the external filter on the oxygen concentrator was observed to be completely full of dark gray dust. A third resident admitted with obstructive sleep apnea and congestive heart failure had a Bi-PAP mask and tubing sitting on the nightstand without any protective bagging.

Additional deficiencies were identified with oxygen concentrator maintenance and oxygen tubing labeling. One resident receiving continuous oxygen via nasal cannula had a physician’s order for weekly cleaning of the external filter on the oxygen concentrator, yet observations on consecutive days showed the filter covered with dusty, thick gray particles; the resident reported the nurse had cleaned the filter that morning and that this was not normally done, and an LPN confirmed the filter had been heavily soiled despite being signed off as cleaned previously. Another resident admitted with pneumonia and respiratory failure had a physician’s order to change oxygen tubing weekly and label each component with date and initials, but the oxygen tubing was observed without any label, which was confirmed by an RN. These observations and interviews demonstrate multiple failures to follow orders and facility practices for respiratory equipment storage, cleaning, and labeling.