Nonfunctioning Bathroom Ventilation in Multiple Resident Rooms
Summary
The facility failed to ensure bathroom ventilation systems were operational in seven resident bathrooms, including rooms 120, 301, 303, 305, 308, 309, and 313, out of 24 resident rooms sampled in a facility with a census of 60. During the initial tour on 1.21.2026, surveyors observed that the bathroom ventilation was not functioning in these seven rooms. On a later tour on 1.26.2026 with Water Management, the same bathrooms were again observed to have nonfunctioning ventilation. In interview, Water Management confirmed the bathroom ventilation was not working in those rooms and stated it should be functioning. Water Management also confirmed the HVAC service company had been notified and reported the bathroom vents were not working because cold temperatures caused the coils to freeze. It was further confirmed that the bathroom vents were not checked when temperatures dropped below freezing, and the issue would have been identified when the vents were checked that month; the vents were checked quarterly. A record review showed the most recent bathroom vent check was completed in October 2025.
Penalty
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The facility failed to prevent pungent urine odors from permeating common areas and the dining room, affecting all residents. Observations and interviews confirmed the presence of these odors over several days, despite housekeeping efforts. The facility did not adhere to its policy on maintaining a homelike environment with pleasant scents.
Persistent Urine Odor in Common Areas and Dining Room
Penalty
Summary
The facility failed to ensure that pungent smells of urine did not permeate into common areas and the dining room, potentially affecting all residents. Observations over several days revealed a consistent presence of urine odor in the 300/400 hall nurses station/common area and dining room, as well as the 600 hallway. The urine smell was noted at various times of the day, with some areas also having a musty odor. Interviews with staff, family members, and the ombudsman confirmed the presence of these odors, despite the use of cleaning products and air fresheners by housekeeping staff. The facility's policy on maintaining a homelike environment, which includes pleasant and neutral scents, was not adhered to. The deficiency was identified during a complaint investigation, highlighting the facility's non-compliance with ensuring a clean and odor-free environment. The facility census at the time was 51 residents, and the issue was documented under Complaint Number OH00152901.
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