Failure to Maintain Safe, Clean, and Homelike Environment
Penalty
Summary
The facility failed to maintain a safe, clean, and homelike environment on the north unit, affecting multiple residents. During an initial tour, surveyors observed brown splatters on the walls of the north unit. Two residents with diagnoses including type II diabetes, hypertension, thyrotoxicosis, and muscle weakness reported that they felt the facility was not well taken care of and was dirty. Further observation with an LPN confirmed a broken floor tile in the hallway with half of the tile missing and baseboards coming loose. A subsequent tour with the Administrator and DON revealed missing and loose floorboards, additional wall splatters, three vents with rust, and a missing half of a floor tile that was identified as a potential tripping hazard. In a shared room of two other residents with diagnoses including epilepsy, hypo-osmolality and hyponatremia, schizoaffective disorder, and type II diabetes, surveyors observed that the footboard trim on one resident’s bed had come off, leaving an approximately two-inch gap that the resident had unsuccessfully tried to repair with tape. The grout around the toilet in the room was dirty and brown, the toilet itself moved, and the sharps container in the room was overflowing. These conditions were confirmed by both a CNA and an LPN, who acknowledged the gap in the bed footboard trim, the dirty grout, the overflowing sharps container, and the unstable toilet. The facility’s own Safe and Homelike Environment policy required a safe, clean, comfortable, and homelike environment and a physical layout that does not pose a safety risk, which was not met in these observations.
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