Based on observation, group interview, staff interview and a review of the Resident Handbook, the facility failed to ensure residents in the group meeting held on 11/28/18 were aware of the survey results and where they were located in the facility. The facility further failed to ensure there were signs posted in the facility indicating the location of the survey results. This deficient practice affected all 10 residents in the group meeting and had the potential to affect all 134 residents who resided in the facility. Findings Include: A review of the Resident Handbook, pages 8-11 documented: .Resident Rights .(g)(1) Information and communication .(g)(10) The resident has a right to .Examine the results of the most recent survey of the facility conducted by Federal or State surveyors and any plan of correction in effect with respect to the facility; . During the group meeting conducted on 11/28/18 at 10:45 a.m., all ten residents who attended stated they did not know where the survey results were located. On 11/28/18 at 11:35 a.m., the surveyor observed a white notebook in the lobby on a table labeled, State Notebook, but no sign was posted indicating where the survey results were located. On 11/29/18 at 8:22 a.m., the surveyor observed a white notebook in the lobby on a table labeled, State Notebook, but no sign was posted indicating where the survey results were located. On 11/29/18 at 9:01 a.m., there were no signs posted throughout the facility indicating where to find the survey results. On 11/29/18 at 9:52 a.m., an interview was conducted with EI(Employee Identifier) #5, Social Work Director. EI #5 was asked how were residents made aware of the survey results and where they were located in the facility. EI #5 said residents were made aware of the survey results if they requested to see them and where they were located. EI #5 was asked who was responsible for ensuring residents were aware of the survey results and where they were located. EI #5 said, Our (Social Work Department) responsibility. EI #5 was asked if there were signs posted throughout the facility indicating where the survey results were located. EI #5 said, No, not that I am aware of. EI #5 was asked why was it important for residents to be aware of the survey results and where they were located. EI #5 said, They (residents) want to know we (facility) are up to standard and in compliance.

Based on observations, interviews and a review of a facility policy titled, Federal Rights of Resident/Guest(s) and a form titled, .JOB DESCRIPTION, the facility failed to ensure residents' rooms and common areas were maintained to provide a safe, clean, comfortable homelike environment. The deficient practice affected Room Locator (RL) #'s 1-24, on three of four units and two resident common areas in the facility and had the potential to affect all 134 residents residing in the facility. Findings Include: A review of a facility policy titled, Federal Rights of Resident/Guest(s), with an effective date of November 28, 2016, revealed: .PURPOSE: All resident/guest(s) in long term care facilities have rights guaranteed to them under Federal and State law. STANDARD: .(i) Safe environment. The resident/guest has a right to a safe, clean, comfortable and Homelike environment, . A review of a facility document titled, .JOB DESCRIPTION JOB TITLE: Housekeeping Technician, with an effective date of 01/01/93 revealed the following: .GENERAL PURPOSE Under the direction of the Director of Housekeeping is responsible for cleaning and maintaining the floors . cleaning of resident's room and common areas . STANDARD REQUIREMENTS .4 .report and/or correct unsafe .conditions, equipment repair and maintenance needs .ESSENTIAL JOB FUNCTIONS .3. Check equipment for proper functioning and reports any defective equipment .11 . Report to the supervisor any furniture, fixtures, etc. (and so on) that are in need of repair . During the initial tour of the facility on 11/27/18 at 4:42 p.m., the following observations were made: RL#19 - toilet bowl lid was broken in half. RL#20 - three broken slates and a 4th one had a chip missing out of it (blinds broken). RL#21 - one broken slate (at end of blind). RL#22 - two holes in the closet on the left and right side of the door. On 11/28/18 at 11:40 a.m., observations were made on the 200 hall of the following: RL #1 - chipped floor tile, ring of rust around the drain and on the faucet. RL #2 - closet door did not move, it was off track; faucet in bathroom under left handle had a crack in the metal with crumbling edges. RL#3 - closet door did not open, it was off track. RL#4 - faucet in the bathroom under the left handle had broken edges. RL#5 - the left closet door did not work. EI (Employee Identifier) #6, LPN (Licensed Practical Nurse), could not close the closet door and reported she would put in a work order. RL #6 - rust around the bathroom sink drain and faucet, broken pieces of missing tile were in the doorway and in front of the drawers under the television, there was a buildup of debris in the corner. RL #7 - buildup of debris was in the corner under the television, in front of the drawers, at the doorway and at the adjoining wall. RL#8 - rusted bathroom sink drain. RL#9 - rusted bathroom sink drain. RL#10 - rusted bathroom sink drain, missing piece of broken tile was in the doorway and the bottom of the right drawer had the front panel missing. On 11/28/18 at 12:12 p.m., the following observation was made: RL #23 - a door to the smoking area was found to have approximately 1.5 inches of rust exposed through the metal portion of the bottom of door. On 11/28/18 at 12:15 p.m., the following observation was made: RL #23 - the metal frame around the door used by residents to access the courtyard was found with pieces of flaking rust approximately 12 inches above the ground level. On 11/29/18 at 8:08 a.m., a tour of the facility was made EI #2, the Maintenance and Housekeeping Director. EI #2 was asked to describe what he observed. RL #3 - a piece missing from the bottom of the door; a piece of weather stripping was rusted. RL #1 - chipped floor tile, ring of rust around the drain and on the faucet. RL #2 under the faucet handle was corroded and cracked; closet door did not move, off track; faucet in the bathroom under the left handle had broken edges that were crumbling. RL #6- chipped floor tile was in the doorway, corner floor molding was missing, stains that appeared to be rust around the drain and two spots of what appeared to be rust under the faucet. In the corner, on floor beneath the television, appeared to be a wax buildup. EI #2 described this as surface wax that had dirt in it and was pushed up in the corner. RL #7- appeared to be the same buildup as in RL #6. RL #8- appeared to be rust stain in the bathroom sink. RL #9- the bathroom sink had a rust stain that needed to be cleaned RI #10- the same type of stain as RL #9 . RI #12- chipped tile in the doorway. EI #2 reported when the new floors were put down, the man evidently chipped it and that was about a year ago. EI #2 added the front of the drawer was missing and the corner molding was missing RI #11- there was what appeared to be rust at the caulk joint above the sink. RL #13- It definitely needs cleaning around the base of the walls and floors need cleaning. The wall needs to be wiped off. RL #14- the base of the walls and the caulk joint around the tube need to be cleaned. On 11/29/18 1:16 p.m. the surveyor continued observations with EI #2. The following observations were made: RL #15 -EI #2 reported a rusted door casing at the bathroom door. Some soft substance looked like gum on the wall. Paint flaking by the window; old finish material at bottom of the tub. RL #17 -EI #2 reported rust in the window seal, wax buildup in some corners and the bathroom paint was flaky/chalky. RL#18- EI #2 reported the corner molding was missing, the tub had old finish residue in bottom of the tub close to the drain. Wax buildup in some of the corners. The bed had rubbed the paint behind the headboard. The footboard of the first bed had exposed wood that was smooth because the finish was gone. RL#16 -EI #2 reported there was a rusted door casing and wax buildup in some of the corners. There was old finish material in the bottom of the tub. On 11/29/18 at 1:42 p.m., an interview was conducted with EI #2. EI #2 was asked what was the concern of doorway tiles being broken, missing pieces of tile and tile being unleveled and he answered a potential fall. EI #2 was asked what was the concern of persistent wax build. EI #2 answered it looked bad. EI #2 was asked if he was aware of the wax buildup in the corners of resident rooms before the survey started and he answered in some areas but not in the amount of rooms pointed out during the tour. EI #2 was asked what was the concern of old finish residue discoloring the bottom of tubs and he answered it looked bad and it did not look clean. EI #2 was asked what was the concern of the closet doors not being in working order. EI #2 answered there was a slim possibility that they could come off of the track and fall on someone. EI #2 was asked should the closet doors be in working order even if falling on a resident was not a possibility and he answered it was. EI #2 was asked what was the concern of rooms with sinks that had rust stains on the drain and/or the faucet. EI #2 answered it looked bad and was a potential for a skin tear. EI #2 was asked what was the concern with flaky, peeling paint in resident rooms and he answered it looked bad. EI #2 was asked what he saw at the door casing of two of five doors in the courtyard and he answered peeling rust. EI #2 was asked what was the concern of the peeling rust on the door casings and he answered the potential for a skin tear. EI #2 was asked what was the concern of a toilet tank lid being broken in half, with a broken half of the lid being left on the tank where a resident used the restroom unsupervised. EI #2 answered a potential for a skin tear. An interview was conducted on 11/29/18 at 3:02 p.m. with EI #1, the Administrator. EI #1 was asked what was his expectations of housekeeping staff in providing a clean environment. EI #1 answered he expected them to keep it clean like they would at their house. EI #1 was asked what was his expectations of maintenance to keep the environment safe and homelike. EI #1 answered if they see it or if they are notified about it, to fix it as soon as possible. This citation was written as a result of the investigation of complaint/report #AL00035945.

Based on interview and a review of a facility document titled, Facility Assessment, the facility failed to evaluate and identify areas of the environment needing to be maintained. This deficient practice had the potential to affect all 134 residents residing in the facility. Findings Include: Cross Reference F584. A review of a document titled, Facility Assessment, dated 11/19/18, revealed the following: .The following criteria were examined and evaluated by our team . Physical environment .considerations necessary for resident population. Equipment necessary for resident population . During the recertification the survey team identified multiple environmental concerns including: missing floors tiles, rusted doorframes, rusted bathroom sinks, broken bathroom fixtures, peeling paint, dirty and wax build up on floors, broken closet doors, broken furniture and other environmental concerns. On 11/29/18 at 4:56 PM, an interview was conducted with Employee Identifier (EI)#1 Administrator. EI #1 was asked if EI #2, Maintenance Supervisor, was involved as a participant with the facility assessment. EI #1 said Yes . EI #1 was asked when was the facility assessment updated. EI #1 said, Last week . EI #1 was asked why did the facility assessment not reflect the needed maintenance repairs. EI #1 said, I don't have an answer for that. EI #1 was asked was anything (a plan) put in place to take care of the environment/maintenance concerns. EI #1 said, No. This citation was written as a result of the investigation of complaint/report #AL00035945.