F0584

D

Failure to Maintain Clean and Sanitary Resident Room Environment

Wharton, Texas Survey Completed on 02-06-2026

Penalty

Fine: $11,444

Summary

Surveyors identified a failure to maintain a safe, clean, comfortable, and homelike environment for one resident whose room contained extensive dried biological material and wall markings. The resident, an older adult with Alzheimer's disease, heart failure, bipolar disorder, GERD, and COPD, had a documented behavior care plan noting a problem of spitting on the floors and walls, with interventions focused on anticipating needs, providing positive interaction, and discussing and reinforcing why the behavior was inappropriate. During an observation, the resident's dresser and adjacent walls were found covered in dried, thick streaks of mucus in brown, red, and pink colors over an area of approximately 5 feet by 5 feet, and the wall next to the bed had multicolored crayon and/or pen scribbles about 2 feet by 1 foot in size.

A CNA reported hearing the resident spit on the walls and stated that nurses and nurse managers were aware of this behavior. The Environmental Supervisor stated that the resident spit so much that staff sometimes had to clean the room twice daily and that if the material stayed too long it became difficult to clean, while also stating the room had been cleaned the previous night. The ADON indicated she did not believe housekeeping was removing the mucus from the walls daily because there was so much present. The facility’s general housekeeping policy stated that each occupied resident room is to be cleaned and put in order daily and as needed, and that sufficient housekeeping and maintenance personnel, equipment, and supplies are to be provided to maintain a safe, clean, orderly, and attractive interior. Despite this policy and awareness of the resident’s spitting behavior, surveyors observed the room in an unsanitary and unpleasant condition, constituting the deficiency.