§483.10(i) Safe Environment.
The resident has a right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
The facility must provide-
§483.10(i)(1) A safe, clean, comfortable, and homelike environment, allowing the resident to use his or her personal belongings to the extent possible.
(i) This includes ensuring that the resident can receive care and services safely and that the physical layout of the facility maximizes resident independence and does not pose a safety risk.
(ii) The facility shall exercise reasonable care for the protection of the resident's property from loss or theft.
§483.10(i)(2) Housekeeping and maintenance services necessary to maintain a sanitary, orderly, and comfortable interior;
§483.10(i)(3) Clean bed and bath linens that are in good condition;
§483.10(i)(4) Private closet space in each resident room, as specified in §483.90 (e)(2)(iv);
§483.10(i)(5) Adequate and comfortable lighting levels in all areas;
§483.10(i)(6) Comfortable and safe temperature levels. Facilities initially certified after October 1, 1990 must maintain a temperature range of 71 to 81°F; and
§483.10(i)(7) For the maintenance of comfortable sound levels.
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Observations:
Based on observations and staff interviews, it was determined that the facility failed to ensure that residents had a clean and homelike environment on the South and North halls of the facility.
Findings include:
Observations on January 22, 2024, at 9:11 a.m. revealed that the floors in the hallway on the south side of the building contained what appeared to be scattered dirt/debris and three moderate size clumps of brown dust entering into Corridor B, and black marking, reported to be floor glue, in various locations on the vinyl flooring in the hallway. Varying amounts of dust and debris were noted on the carpeting in corridor A. Wallpaper on Corridor A on the South hall was noted to be peeling from the wall and had tape attempting to hold it in place, as well as peeling wallpaper above the kiosk in the hallway that had a brown, clumpy substance noted on the wall. Rooms 114, 111, and 220 had transition strips in the doorways that had pieces missing from them. The shower in the North hall had a pink substance noted in and around the grout in the bottom of the shower stall where the wall and floor meet.
Interview with the Environmental Services Director on January 22, 2025, at 1:31 p.m. confirmed that housekeeping staff is responsible for cleaning resident rooms and common areas in the facility daily. He confirmed that there was a presence of varying amounts of dirt and debris on the floor in the hallways on the South halls of the building; there was glue on the vinyl flooring in the hallway that they were having difficulty removing; there was a brown, unknown substance was on the wall; the South side halls appeared dirty and not homelike; and the pink substance in the shower should not be there and does get removed weekly with bleach.
Interview with the Maintenance Director on January 22, 2025, at 1:40 p.m. confirmed that the identified rooms had transition strips that were broken, the vinyl flooring had floor glue on it that they were having difficulty removing, and the wallpaper was peeling, making the facility appear dirty and unkempt.
28 Pa. Code 201.29(j) Resident Rights.
28 Pa. Code 207.2(a) Administrator's Responsibility.
| | Plan of Correction - To be completed: 02/19/2025
In preparation and/or execution of this plan of correction does not constitute admission or agreement by the provider of the truth of the facts alleged or conclusions set forth in the statement of deficiencies. The plan of correction is prepared and/or executed solely because it is required by the provisions of federal and state law.
F584
All items identified during visit have been addressed. Environmental rounds are on-going weekly in order to identify any further issues to be addressed in a timely manner.
Education provided by administrator to the maintenance director and environmental services director F584 with a focus on ensuring that residents have a clean and homelike environment.
Environmental audits will be completed by administrator/designee weekly X2 weeks and then monthly x2 months.
Results of audits will be reviewed at the facility's Quality Assurance Performance Improvement (QAPI) meetings.
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