Nonfunctional Toilet and Odorous Bathroom Undermine Homelike Environment
Penalty
Summary
The deficiency involves the facility’s failure to provide a safe, clean, comfortable, and homelike environment for a cognitively intact resident whose bathroom toilet was not functional, requiring use of a bedside commode (BSC) instead of the toilet. The resident, admitted with polymyalgia rheumatica, asthma, COPD, and chronic respiratory failure, reported that the toilet in her room had not worked since she moved into the room and that she was unable to use it. Surveyors observed the bathroom shared between two rooms, noting a toilet completely covered with a tied plastic bag and an uncovered BSC placed across from the sink. The bathroom had a strong urine odor similar to ammonia. The resident stated she had reported the toilet problem to the prior Director of Maintenance, who told her it was fine, and that she had also informed the administrator, but the toilet still had not been fixed. She reported feeling useless, not cared about, and unimportant due to the ongoing toilet issue. Staff interviews and observations further documented the ongoing nature of the problem and its impact on the environment. A CNA confirmed that the resident usually used the bathroom or a BSC placed by the bed and acknowledged the strong urine smell in the bathroom, stating the BSC lacked a lid and that a functioning toilet and absence of strong odor would be more homelike. Another CNA stated that toilets in the facility frequently became clogged due to residents flushing excessive toilet paper or paper towels, confirmed that the resident was alert, oriented, and able to use the toilet, and noted that BSCs without lids can cause rooms to smell. The Director of Maintenance stated the resident’s toilet was clogged due to excessive wipes being flushed and that a plumber had been called to unclog it, but during observation the toilet remained bagged, with an “Out of Order” sign, a strong urine odor, discoloration on the floor likely from urine, and visible feces in the toilet bowl. Additional staff interviews corroborated that the toilet had been nonfunctional over time and that the bathroom environment was not acceptable. An LVN stated the toilet had been broken when the resident first moved into the room, that the prior maintenance director had said it was working again, and that a plumber had come a few days earlier to fix it, but the bathroom still had a bad odor. The Social Services Director reported that when the resident moved into the room it was discovered the toilet was not working, that it was later reported to have acted up again, and that she had noticed the plastic bag over the toilet during rounds; she stated the bathroom should not smell like that and emphasized the importance of a working toilet for the resident’s independence. The administrator acknowledged that the toilet had a weak flush with a blockage, that he was unsure if it was the resident’s preference to use the toilet, that the odor persisted despite housekeeping cleaning, and that the plumber had indicated the piping would need to be replaced. Facility policies on Resident Rights and Safe and Homelike Environment required a safe, clean, comfortable, homelike, and sanitary environment, including resident rooms and bathrooms, and minimizing odors, which were not met in this situation.
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