§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 review of facility policy, observations, and resident and staff interviews, it was determined that the facility failed to maintain a clean, safe, comfortable and homelike environment on four of four nursing units (Seventh, Sixth , Fifth and Fourth Floor nursing units and for two of four residents (Residents R6 and R8)
Findings include:
A review of facility policy "housekeeping procedure occupied resident room" last reviewed October 2018, indicated all resident rooms will be cleaned daily to maintain a clean safe surrounding.
During observations and resident interviews on the 7th floor nursing unit, on 9/10/19, at 8:54 a.m. the following was noted, the main hallway had a film of black build up. The janitor room was unlocked with two cleaning carts and a spray bottle of cleaner in the room. Housekeeping Employee E1 did not have keys to access the cleaning room. A nurse aide kiosk in the main hallway hall had greasy visible smears on it and it did not work. In Room 705 the floor had brown build up, the residents clock was not working, and Resident R6 stated he/she wants the clock to work. Room 706 the floor had brown build up, Resident R8 stated she recently moped the floor around the bed their self with a rag.
During observations completed on the 6th floor on 9/10/19, at 9:24 a.m. the following was noted. The 6th floor kitchenette soap dispenser was broken, and several fruit flies were in the room. The residents ice storage cooler had melted, and contained room temperature water. An access panel in the hallway contained electrical conduits and wires, and did not have a lock. Rooms 621 had an unsecured oxygen cylinder, and brown build up on the floor. Room 622 had brown build up on the floor. The linen storage room contained a linen cart the cart curtain was folded over the top of the cart, on top of the cart were two empty soft drink bottles, and a plate with brown crumbs and crumbs from the plate were spilled onto the curtain.
During observations on the 5th floor on 9/10/19, at 9:41 a.m. the following was noted. The main hallway floor had black build up on it. The kitchenette had brown build up on the wall behind the garbage can. In room 520 Door the bed side was unoccupied, the bottom two dresser drawers were not seated in the runners correctly and pulled all the way out, one handle was missing, and another handle was hanging loosely and only held in with one screw, and the front of the dresser had several scratches. The cabinet for the unoccupied bed contained 3 large plastic bags with a unknown residents clothes in them.
During observations on the 4th floor on 9/10/19, at 10:00 a.m. the resident and family vending machine area had an IV pole with a bed sheet dangling from it. The outside activities garden was overgrown with 9 large empty weather worn pots strewn about.
During staff interview on 9/10/19, at 10:05 a.m. the Nursing Home Administrator and Director of Nursing confirmed the above observations and that the facility failed to maintain a clean, safe and comfortable homelike environment.
28 Pa Code: 207.2(a) Administrator's Responsibility.
Previously Cited 7/15/19 and 11/9/18
28 Pa. Code: 201.18(b)(1)(2)(e)(1) Management.
Previously cited 11/9/18.
| | Plan of Correction - To be completed: 09/30/2019
1. No residents were negatively impacted by this deficient practice.
2. Hallways will be mopped by the housekeeper on the floor daily as part of general housekeeping protocol.
3. Hallways will be placed on a preventative schedule for stripping and waxing. All hallways to be stripped and waxed at a minimum of quarterly by housekeeping personnel. The Director of Housekeeping/ Maintenance Director will be responsible for assigning this task, scheduling the task, and ensuring the task was completed. This monitoring will be documented using an audit tool.
4. There is a janitor closet on each resident care floor. The Director of Housekeeping/Maintenance Director will educate all Housekeeping staff on ensuring these janitor closets are locked at all times.
5. The Director of Housekeeping/Maintenance Director will ensure all Housekeeping staff has access to keys to the janitor closets.
6. The Director of Housekeeping/Maintenance Director has established a deep cleaning schedule of resident rooms.
7. The housekeeping staff is assigned a daily deep clean of a resident room by the Director of Housekeeping/Maintenance Director.
8. The Administrator, or designee, completes and audit tool on each deep cleaned room daily and addresses any concerns/issues with the housekeeper whom completed the deep clean as well as the Director of Housekeeping.
9. The Director of Housekeeping/Maintenance has developed a routine pest control schedule with Ehrlich pest control. Ehrlich is treating the fruit flies that are present in the facility. Ehrlich reports of service are maintained in the Director of Housekeeping/Maintenance Director office.
10. A whole house audit of soap dispensers will be completed by the Maintenance Department.
11. Soap dispensers found to be broken or not in working order will be replaced by maintenance personnel.
12. Soap dispensers will be placed on the monthly maintenance checklists that are completed by the maintenance department to remain in compliance.
13. The Dietary Manager, or designee, will place ice chests on a weekly rotating cleaning schedule.
14. The Dietary Manager, or designee, will complete an audit on the ice chests daily for one week, then weekly for one month, then quarterly thereafter to ensure they are empty and cleaned.
15. The access panel identified in this deficiency will have a hasp lock placed on it by the maintenance department.
16. The Director of Nursing, or designee, will complete education with all staff in regards to oxygen canisters always being in a carrier.
17. Central Supply personnel will complete an audit on oxygen canisters daily for one week, then weekly for four weeks, then monthly thereafter, to ensure canisters are in holders.
18. Department Heads are assigned room rounds daily to ensure that residents rooms are adequately maintained, including furniture. Issues identified during room rounds will be recorded in the maintenance log books on each unit for maintenance personnel to address.
19. The outside grounds will be maintained by the maintenance department.
20. The Director of Maintenance, or designee, will complete an audit weekly of the outside grounds to ensure the grass is cut, weeds are pulled, and clutter is cleared.
21. All audits will be reviewed at monthly Quality Assurance meeting for ongoing monitoring and follow up.
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