§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 observation and resident and staff interviews, it was determined that the facility failed to provide a clean, comfortable, and homelike environment on two of two nursing units reviewed (Upper and Lower Nursing Units; Residents 13, 14, 18, 19, 2, 20, 21, 22, 23, 24, 25, 28, 29, 30, and 31).
Findings include:
Observation of the Upper Nursing Unit on January 24, 2024, revealed the following from 10:00 to 11:15 AM:
The cove base in Resident 13's room was coming off the wall, marred, and dirty with spillage spots all along. The floor on both sides of the transition strip was dirty with sticky spots.
Just inside Resident 14's room, there was an empty nebulizer treatment on the floor.
In the hallway between Resident Rooms 11 and 12, there was trash all over the floor, the hand sanitizer attached to the wall leaked and there was hand sanitizer on the cove base and floor.
There were brown sticky spots on the floor in Resident 18's room under her television. An interview with Resident 18 at this time revealed that those spots had been on the floor for several days.
Resident 19's trash was overflowing in her room, there was trash all around the trashcan on the floor. The baseboard heating unit had the end piece missing.
The baseboard heating unit in Resident 2's room end piece was coming off and there were sharp edges exposed on the metal piece. Observation of Resident 2's bathroom revealed there were 5 dirty gloves on the floor, the trash was overflowing and there was a dirty brief hanging half in the trash can and half out of the trashcan.
The floor across from the Nurses' Station to the dining room was dirty with multiple sticky spots, and trash all along the wall with dust balls.
Resident 20 and 21's bathroom trash can was overflowing and there were dirty gloves on the floor. There was trash on the floor throughout their room with spillage spots and trash under both of their beds.
There was a wall fly light trap on the wall outside the bathroom in Residents 22 and 23's room with dead bugs in it, the power cord was hanging down and the prongs were broken. There was a large accumulation of dirt and dust on the edges of all the walls.
Residents 24 and 25's room had multiple spillage spots on the floor, and food smashed in several areas. The bathroom trash was overflowing onto the floor.
Resident 28 and 29's bathroom wall was marred, with paint peeling off.
The wall on the North Hall between the shower room and Room 19 revealed a large section of the wallpaper was ripped and taped together.
Resident 30 and 31's bathroom had a white dusty film all along the cove base and floor, the cove base was coming off the wall, and the wall light glass was not attached. The trash can did not have a trash bag in it and it was full of trash and soiled depends. An interview with Resident 31 revealed staff frequently does not put a trash bag in the trash can. She stated housekeeping does not clean her room every day and when they do, they do not sweep, just mop the floor quickly. Resident 31 indicated that she has voiced her housekeeping concerns to staff.
Observation of the Lower Nursing Unit on January 24, 2024, at 8:45 AM, revealed the following:
A dining lounge in the southeast hallway was missing cove base along a four-foot portion of the wall. There was a broken floor tile on the west side of the dining floor. The west wall of the dining lounge contained at least 10 areas where holes were filled with white putty, and not painted.
The dining area named "61 dining room" contained a dining table in which the leg was being balanced with a folded-up piece of paper. Another dining table was missing the top edge rounded border with a broken piece of the border on one side.
A ceiling tile was stained, and water damaged near a storage room door.
A heating and air conditioning wall cover near the back hall nursing station was discolored and the slats were bent in and twisted.
A whole section of the northwest hallway was missing cove basing.
The right side of a base cabinet in the clean utility/storage room was disintegrating and expanding due to water damage. There were loose tiles between the cabinet and the ice machine. There was a rust-colored stain on the floor behind the ice machine and a brown water stain on the wall behind the ice machine.
A dining area in the northwest hallway contained white dust that covered the seating areas of many chairs being used by residents. The floor had streaks of a white substance where the facility attempted to mop up putty dust. There were pieces of white dried putty on the floor in the corners.
The facility's main elevator tracks on first and second floor had a significant buildup of dust and debris along with pieces of material and paper.
The findings were reviewed with the Nursing Home Administrator and Director of Nursing during a meeting on January 24, 2024, at 3:05 PM.
483.10(i)(1)-(7) Safe/clean/comfortable/Homelike Environment Previously cited 11/17/23, 4/12/23 and 12/9/22
28 Pa. Code 201.18 (e)(2.1)Management
| | Plan of Correction - To be completed: 02/08/2024
Step 1: The cove base in Resident 13's room was securely fastened to the wall. Resident 13's wall was patched and painted. The walls were wiped down and cleaned of any spillage and the floors both inside and outside the transition strip were cleaned. The nebulizer treatment on floor in Resident 14's room was removed. The hand sanitizer station between Resident rooms 11 and 12 has been removed and sanitizer liquid has been cleaned up. Resident 18's room floor was swept and mopped, removing the brown sticky spots. Resident 19's trash can was emptied with new liner placed. The baseboard heating unit cover was fixed. The floor was scrubbed and clean was cleaned of the multiple sticky spots and the dust build-up was removed. Resident 20 and 21's room was cleaned, trash was picked up from floor, gloves removed, and trash removed. The room was then swept and mopped to remove any debris or spots from the floor. The wall fly light trap outside of resident 22 and 23 room was removed. The walls in residents 22 and 23 were cleaned and wiped down, removing dust build up in corners. Resident 24 and 25's room floor was cleaned and mopped. Spillage spots and food were cleaned and mopped to remove from room. Resident 28 and 29's bathroom wall was repaired and painted to remove marring and correct peeling paint. North Hall peeling wallpaper near shower room and room 19 has been removed and repaired. Resident 30 and 31's bathroom has been cleaned and white dust removed. The wall light glass has been reattached and corrected. The trash was removed from the trash can and a liner was placed in trashcan. Resident 30 and 31's room was swept and mopped. Lower-Level Southeast dining room cove base has been placed on wall. West hall dining room has been painted to cover the patches that were filled with putty. The dining room "61" has had the furniture that was off balance has been corrected with a permanent fix. The dining room table missing the top edge rounded border will be replaced with another piece of furniture. The ceiling tile near the storage room on lower level has been replaced with new. The HVAC cover slate has been straightened, cleaned and painted. The lower-level cove base missing in the northwest hallway will be placed on wall to correct. The right side of base cabinet in the clean/storage room was fixed to remove the disintegrating cabinet piece. The loose tiles between the cabinet and ice machine have been corrected. The rust color stain on the floor behind the ice machine has been cleaned, as well as the wall. All surfaces in the northwest dining room have been cleaned to remove white dust. The floor in the same dining room has been cleaned to remove white putty substance, dried putty on floor was also removed in the process. The elevator tracks on both floors of the facility have been cleaned to remove buildup of debris, dust, and materials. Step 2: The Director of Maintenance will do a facility sweep to identify any other areas within the facility that are missing cove base and replace. The Director of Maintenance will look at all other furniture in the dining rooms to ensure that all furniture is whole and in good condition. The Director of Maintenance will sweep the rest of the facility to correct any further stained ceiling tiles. The Director of Environmental Services and Nursing Home Administrator will walk through facility to identify and correct resident rooms for cleanliness, including ensuring trash liners are in cans, rooms are free from debris, dust, gloves, and briefs. Any identifying issues will be corrected. The Director of Maintenance will ensure that the upper-level ice machine drain cleaned as well as surrounding area. The Director of Environmental Services will observe all other resident dining areas to ensure cleanliness on floors, chairs, and tables. The Director of Maintenance will go through clean storage/utility rooms to ensure cleanliness and cabinets are in satisfactory condition.
Step 3: The Director of Environmental Services/Designee will in-service housekeeping staff on proper procedures for cleaning rooms. The Director of Environmental Services/Designee will educate housekeeping on removing of garbage daily from resident rooms and replacing with trash liners. The Director of Environmental Services/Designee will educate housekeeping staff on dining room cleaning schedule to ensure cleanliness. The Nursing Home Administrator/Designee will educate maintenance staff on project finishing, including cleaning up dust or other remanence from remodeling projects. Step 4: The Director of Maintenance/designee will audit walls, cove base, storage rooms throughout facility weekly for one month, with substantial compliance, the Director of Maintenance will then inspect bi-weekly for two quarters bringing results to the quality assurance committee. The Director of Housekeeping and Nursing Home Administrator will do bi-weekly walk-throughs for two months to ensure cleanliness, all findings will be brought to the morning meeting so corrective action can be taken immediately. After substantial compliance, the Director of Environmental Services/Designee and Nursing Home Administrator will do walk throughs weekly, bringing results to quality assurance committee. The IDT team will do weekly rounds for cleanliness of assigned areas throughout facility, these assignments include resident rooms and common areas throughout facility.
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