Penalty

Fine: $57,3906 days payment denial

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

Surveyors identified that the facility failed to maintain a safe, clean, comfortable, and homelike environment for several residents who used wheelchairs. Observations over multiple days revealed that the wheelchairs of four residents had cracked, torn, or otherwise damaged armrest padding and seats, and in some cases, a build-up of dirt and grime on the wheels. These deficiencies were confirmed by both the Director of Nursing and the Director of Maintenance during joint inspections. The affected residents had significant medical histories, including acquired limb absence, diabetes, epilepsy, Alzheimer’s disease, schizophrenia, major depressive disorder, paraplegia, bipolar disorder, anxiety disorder, alcohol abuse, hypertension, cerebrovascular disease, aphasia, and seizure disorders. All required wheelchairs for ambulation and varying levels of assistance with activities of daily living. The observations specifically noted that the damaged and unclean wheelchairs were in use by the residents in hallways and their rooms, and that the issues persisted over several days. The facility staff acknowledged the need for repair and cleaning of the wheelchairs during the survey. The report documents that the facility did not ensure that residents’ wheelchairs were maintained in good repair, directly impacting the environment provided to these residents.