**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on policy review, medical record review, observation, and interview, the facility failed to promote dignity and respect for 1 of 28 sampled residents (Resident #80). Resident #80 had been assisted to his wheelchair and left partially dressed in a T-shirt and an adult brief. The findings include: Review of the policy titled, Resident Rights, dated 5/19/2023, revealed, . Federal and state laws guarantee certain basic rights to all residents of this facility .rights include the resident's right to: a. a dignified existence; b. be treated with respect, kindness, and dignity . Review of medical records revealed Resident #80 was admitted to the facility on [DATE] with diagnoses which included Cellulitis of Back, Other Mechanical Complication of Internal Fixation Device of Left Femur, and Unspecified Abnormalities of Gait and Mobility. Review of the admission Minimum Data Set (MDS) assessment dated [DATE], revealed Resident #80 required Extensive Assistance with 2 person physical assist with transfers and dressing. Observation and interview on 7/12/2023 at 11:15 AM, revealed Resident #80 sitting in a wheelchair at the bedside dressed in a T-shirt and an adult brief. When the surveyor knocked on the resident's door and asked to enter the room Resident #80 answered yes and took the disposable incontinence pad from his bed and placed it over his lap. Resident #80 stated, I haven't had on pants today at all. I was told my pants are in the laundry. When asked if he preferred to be without pants on in his room, Resident #80 replied, Hell no it makes me feel like a baby sitting here in this diaper. That's why I grabbed this pad to put over my diaper. Observation and interview on 7/12/2023 at 11:28 AM revealed, Unit Manager/LPN (Licensed Practical Nurse) #8 observed Resident #80 in his wheelchair wearing a T-shirt and an adult brief. The Unit Manager/LPN #8 stated, [Resident #80] could have just gotten out of bed and the Certified Nursing Assistant [CNA] had not dressed him yet. Unit Manager/LPN #8 asked Resident #80 where his pants were and he replied, I guess my pants are in the laundry, that's what the tech said this morning. The Unit Manager confirmed Resident #80 required assistance with transfers and dressing.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on facility policy review, observations and interviews, the facility failed to ensure a safe and clean environment in 6 of 101 resident rooms (room [ROOM NUMBER], #99, #100, #103, #106, and #113) observed. The findings include: Review of the policy titled, Homelike Environment, dated 5/19/2023, revealed, .Residents are provided with a safe, clean, comfortable and homelike environment .facility staff and management maximizes, to the extent possible, the characteristics of the facility that reflect a personalized, homelike setting .clean, sanitary . Observation in room [ROOM NUMBER] on 7/9/2023 at 1:08 PM, revealed debris, which included food and paper scattered on the floor under B bed, behind B bedside table, and beside A bed. The A bed closet was missing lamination on the front of the door. The entrance door had multiple areas of damaged wood with splintered wood along the edge of the door below the door knob. The wall outside of the bathroom close to the floor had damaged finishes with black scuff marks. Continued observation revealed water and black substance around the bottom of the commode and floor in the bathroom. The bathroom had a strong urine odor present. Observation and interview in room [ROOM NUMBER] on 7/9/2023 at 1:38 PM, revealed the Housekeeping Director confirmed there was debris scattered around the floor, water and black mold like debris around the base of the commode and on the floor, and a strong urine odor present in the bathroom. While touching the commode during the observation, the Housekeeping Director confirmed the commode base was loose and leaking water. Observation and interview in room [ROOM NUMBER] on 7/9/2023 at 2:10 PM, revealed the Maintenance Assistant #1 confirmed the commode base was loose and moveable. Continued observation and interview revealed the Maintenance Assistant confirmed the missing lamination on A bed closet, the splintered wood on the entrance door edge, the damaged wall with scuff marks and black smudges. The Maintenance Assistant confirmed the splintered wood on the entrance door and the loose commode base was a safety concern for the residents residing in the room. During an interview on 7/12/2023 at 11:30 AM, revealed Housekeeper #2 stated she was assigned to the clean the rooms on the Capitol Hill Hall. She confirmed she began cleaning on the back of the hall (pointing towards the end of the hallway, room [ROOM NUMBER]) and she was finished with all but the one she currently was cleaning, room [ROOM NUMBER]. Observation and interview in room [ROOM NUMBER] on 7/12/2023 at 11:45 AM, revealed the Administrator observed the room and confirmed there was scattered debris on the floor including under both beds. Observation and interview in room [ROOM NUMBER] on 7/12/2023 at 11:47 AM, revealed the Administrator observed the room and confirmed there was trash/debris scattered on the floor, a call light on the floor under B bed and a small trash can with broken and large jagged edges in the corner beside B bed. Continued observation revealed the Administrator confirmed there was a bunch of hair in the bathroom floor and dried brown debris around the base of the toilet. Observation and interview in room [ROOM NUMBER] on 7/12/2023 at 11:50 AM, revealed the Administrator observed the room and confirmed there was a call light under B bed on the floor, gloves and trash behind a small trash can, and debris scattered under both beds and around the floor. Continued observation revealed the Administrator confirmed A bed had food from the breakfast meal scattered over the top cover of the bed and overbed table. Observation and interview in room [ROOM NUMBER] on 7/12/2023 at 11:55 AM, revealed the Administrator observed the room and confirmed there was debris scattered around the room including under both beds and brown debris around the base of the toilet in the bathroom. Observation and interview in room [ROOM NUMBER] on 7/12/2023 at 12:00 PM, revealed the Administrator observed the floor in the bathroom and confirmed brown/black debris around the toilet base and in multiple places around the bathroom floor. The Administrator confirmed there was a strong urine odor present in the bathroom. Continued observation revealed the Administrator observed the room entrance door and confirmed the putty placed in the holes below the doorknob had dried leaving a rough sharp edge present that could cause potential skin injury to a resident.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on facility policy review, facility document review, medical record review, and interview, the facility failed to conduct quarterly care conferences for 15 of 28 (Resident #9, #15, #17, #18, #22, #27, #31, #53, #65, #66, #72, #81, #93, #95 and #111) sample residents reviewed. The findings include: Review of the facility policy titled, Care Plans Comprehensive dated 5/18/2023 revealed, .A comprehensive, person-centered care plan that includes measurable objectives and timetables to meet the resident's physical, psychosocial and functional needs is developed and implemented for each resident .The interdisciplinary team [IDT], in conjunction with the resident and his/her family or legal representative, develops and implements a comprehensive, person centered care plan for each resident .developed within 7 days of the completion of the Minimum Data Set (MDS) assessment .The resident is informed of his or her right to participate in his or her treatment, and provide advance notice of care planning conferences . Review of medical records revealed Resident #9 was admitted to the facility of 5/14/2023 with diagnoses which included Urinary Tract Infection(UTI), Hemiplegia and Hemiparesis following Cerebral Infarction Affecting and Type 2 Diabetes Mellitus Without Complications. Review of the Comprehensive MDS dated [DATE] revealed Resident #9 had a Brief Interview for Mental Status (BIMS) of 3 which indicated a severe Cognitive Impairment. Review of the Performance Improvement Plan (PIP) revealed Resident #9 had no quarterly care conference meeting. Review of medical records revealed Resident #15 was admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses which included Encounter for Surgical Aftercare Following Surgery on the Digestive System, Fibromyalgia, Type 2 Diabetes Mellitus Without Complications, and Morbid (Severe) Obesity Due to Excess Calories. Review of the Quarterly MDS assessment dated [DATE] revealed Resident #15 had a BIMS score of 15 which indicates no Cognitive Impairment. Review of the PIP revealed Resident #15 had no quarterly care conference. Review of medical records revealed Resident #17 was admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses which included Congestive Heart Failure, Noninfective Gastroenteritis and Colitis, and Chronic Obstructive Pulmonary Disease (COPD). Review of the Quarterly MDS assessment dated [DATE] revealed Resident #17 had a BIMS score of 13 which indicated no Cognitive Impairment. Review of the PIP revealed Resident #17 had the last care plan conference on 9/25/2022. Review of medical records revealed Resident #18 was admitted to the facility on [DATE] with diagnoses which included Hemiplegia and Hemiparesis Following Cerebral Infarction Affecting Left Non-Dominant Side, Acute Embolism and Thrombosis of Right Femoral Vein and Schizoaffective Disorder, Bipolar Type. Review of the Quarterly MDS assessment dated [DATE] revealed Resident #18 had a BIMS Score of 99 which indicated the resident was unable to complete the interview. Review of the PIP revealed Resident #18 had the last care conference on 1/17/2023. Review of medical records revealed Resident #22 was admitted to the facility on [DATE] with diagnoses which included Generalized Osteoarthritis, Chronic Kidney Disease Stage 3 and Obstructive and Reflux Uropathy. Review of the Quarterly MDS assessment dated [DATE] for Resident #22 revealed a BIMS score of 00 which indicated severe Cognitive Impairment and the resident was unable to complete the interview. Review of the PIP revealed Resident #22 had the last care conference on 8/7/2022. Review of medical records revealed Resident #27 was admitted to the facility on [DATE] with diagnoses which included Other Specified Complications of Vascular Prosthetic Devices, Implants and Grafts, Dependence on Renal Dialysis, and COPD. Review of the Annual MDS assessment dated [DATE] for Resident #27 revealed a BIMS score of 15 which indicated no Cognitive Impairment. Review of the PIP revealed Resident #27 had the last care conference on 8/24/2022. Review of medical records revealed Resident #31 was admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses which included UTI, Hematuria, Acute Kidney Failure, and Rhabdomyolysis. Review of the Quarterly MDS assessment dated [DATE] revealed Resident #31 had a BIMS score of 13 which indicates no Cognitive Impairment. Review of the PIP revealed Resident #31 had the last care conference on 3/2/2023. Review of medical records revealed Resident #53 was admitted to the facility on [DATE] with diagnoses which included Parkinson's Disease, COPD, and Chronic Respiratory Failure with Hypercapnia. Review of the Quarterly MDS assessment dated [DATE] revealed Resident #53 had a BIMS score of 15 which indicated no Cognitive Impairment. Review of the PIP revealed Resident #53 had the last care conference on 10/23/2022. Review of medical records revealed Resident #65 was admitted to the facility on [DATE] and readmitted to the facility on [DATE] with diagnoses which included Encounter for Orthopedic Aftercare following Surgical Amputation, Peripheral Vascular Disease and Type 2 Diabetes Mellitus with Diabetic Neuropathy. Review of the Quarterly MDS assessment dated [DATE] revealed Resident #65 had a BIMS score of 13 which indicated no Cognitive Impairment. Review of the PIP revealed Resident #65 had the last Care Conference on 8/7/2022. Review of medical records revealed Resident #66 was admitted to the facility on [DATE] with diagnoses which included Epilepsy with Status Epilepticus, Nontraumatic Intracerebral Hemorrhage in Hemisphere, and Type 2 Diabetes Mellitus without complications. Review of the Quarterly MDS assessment dated [DATE] for Resident #66 revealed a BIMS score of 15 which indicated no Cognitive Impairment. Review of the PIP revealed Resident #66 had the last care conference on 9/15/2022. Review of medical records revealed Resident #72 was admitted to the facility on [DATE] and readmitted to the facility on [DATE] with diagnoses which included Parkinson's Disease, Epilepsy, and Type 2 Diabetes Mellitus. Review of the Annual MDS assessment dated [DATE] for Resident #72 revealed a BIMS score of 99 which indicated severe Cognitive Impairment and the resident was unable to complete the interview. Review of the PIP revealed Resident #72 had the last care conference on 10/23/2022. Review of medical records revealed Resident #81 was admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses which included Intervertebral Disc Stenosis Canal of Lumbar Region, COPD, and Hypothyroidism. Review of the Quarterly MDS assessment dated [DATE] revealed Resident #81 had a BIMS score of 13 which indicated no Cognitive Impairment. Review of the PIP revealed Resident #81 had the last care conference on 12/16/2022. Review of medical records revealed Resident #93 was admitted to the facility on [DATE] with diagnoses which included Hemiplegia and Hemiparesis following Cerebral Infarction affecting Left Non-Dominant Side, Morbid (Severe) Obesity due to Excess Calories, Other Speech and Language Deficits following Cerebral Infarction, and Dysphagia following other Cerebrovascular Disease. Review of the Quarterly MDS assessment dated [DATE] for Resident #93 revealed a BIMS score of 9 which indicated moderate Cognitive Impairment. Review of the PIP revealed Resident #93 had the last care conference on 10/23/2022. Review of medical records revealed Resident #95 was admitted to the facility on [DATE] with diagnoses which included Covid-19, Hemiplegia and Hemiparesis following Cerebral Infarction affecting Left Dominant Side, and Type 2 Diabetes Mellitus without Complications. Review of the Quarterly MDS assessment dated [DATE] for Resident #95 revealed a BIMS score of 11 which indicated moderate Cognitive Impairment. Review of the PIP revealed Resident #95 had the last care conference on 6/9/2022 Review of medical records for Resident #111 was admitted to the facility on [DATE] with diagnoses which included Hemiplegia and Hemiparesis Following Cerebral Infarction affecting Right Dominant Side, Other Sequelae of Cerebral Infarction, and Major Depressive Disorder Single Episode Mild. Review of the Quarterly MDS dated [DATE] revealed Resident #111 had a BIMS score of 99 which indicated severe Cognitive Impairment and the resident was unable to complete the interview. Review of the PIP revealed Resident #111 had a care conference on 9/12/2022 and then follow up conference was not done until 7/5/2023. During an interview with the Administrator on 7/11/2023 at 1:30 PM, the Administrator confirmed the facility had failed to schedule and conduct quarterly care conferences for the residents. She stated she discovered the lack of quarterly conferences in May of 2023 during a discussion with Social Services.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on facility policy review, medical record review, observation and interview, the facility failed to maintain clean fingernails for 1 resident (#97) of 26. The findings include: Review of facility policy, Care of Fingernails/Toenails, dated 2001, revised October 2010, revealed .nail care cleaning during bath/shower and as needed (prn) and trimming as indicated . Medical record review revealed Resident #97 was admitted to the facility on [DATE] with diagnoses which included Type II Diabetes Mellitus Without Complications, Alzheimer's Disease, and Depression. Medical record review of the Quarterly Minimum Data Set, dated [DATE] revealed a Brief Interview for Mental Status score of 8, indicating moderate cognitive impairment, required extensive assistance for Activities of Daily Living with one person and limited assistance for personal hygiene. Medical record review of the Care Plan dated 4/15/19, Bathing Intervention dated 1/21/19, revealed .Activities of Daily Living Self Care Performance Deficit .Bathing: Check nail length and trim and clean on bath day and as necessary. Report any changes to the nurse . Observation of Resident #97 on 4/29/19 at 10:40 AM, 2:00 PM, 4/30/19 at 1:00 PM and 5/1/19 at 12:30 PM revealed Resident #97 with all fingernails having large amounts of dark brown debris underneath them. Interview with Certified Nurse Aide (CNA) #6 on 5/1/19 at 3:00 PM in the Capital Hill hallway confirmed personal hygiene care had been completed. Further interview with CNA #6 in the presence of Resident #97 in the Activity room confirmed dark debris under each nail. Interview with Licensed Practical Nurse #4 on 5/1/19 at 3:03 PM in Resident #97's room confirmed dark debris under each fingernail.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and interview the facility failed to ensure a Significant Change Minimum Data Set (MDS) was assessed for 1 of 4 sampled residents (Resident #46) reviewed for hospice and failed to accurately assess a Quarterly MDS for 1 of 8 sampled residents (Resident #83) reviewed. Findings include: Medical record review revealed Resident #46 was admitted to the facility on [DATE] with diagnoses including Gastroesophageal Reflux Disease, Alzheimers Disease, Unspecified Dementia with Behavioral Disturbances, Anemia, Dysphagia, Type 2 Diabetes Mellitus, Essential Hypertension, and Chronic Kidney Disease Stage 3. Medical record review revealed Hospice services for Resident #46 were discontinued on 12/22/17. Further medical record review revealed no Minimum Data Set Assessment was completed for discontinued services of Hospice on 12/22/17. Interview with Licensed Practical Nurse (LPN) #6 on 5/16/18 at 10:35 AM in the MDS office confirmed significant change MDS Assessment for Resident #46 should have been completed when Hospice services were discontinued. Further interview revealed LPN #6 stated, I missed her significant change MDS when she came off Hospice in December 2017. Further interview with LPN #6 confirmed the facility failed to complete a Significant Change MDS for Resident #46.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interview, the facility failed to provide nail care for 1 of 40 sampled residents (Resident #26) reviewed. Findings include: Medical record review revealed Resident #26 was admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses including spastic hemiplegia affecting right nondominant side, stage 4 pressure ulcer of sacral region, cerebrovascular disease, dysphagia, arthritis due to other bacteria, aphasia, gastrostomy status, neuromuscular dysfunction of bladder, pain, major depressive disorder, anxiety disorder, right ankle & left ankle contracture, dysthymic disorder and shortness of breath Medical record review of the admission Minimum Data Set (MDS) dated [DATE] revealed Resident #26 had a Brief Interview for Mental Status score of 5, indicating severe cognitive impairment. Continued review revealed the resident required extensive assistance of 2 persons for personal hygiene and required total dependence for bathing. Medical record review of the Discharge Assessment-Return Anticipated MDS dated [DATE] revealed Resident #26 had short term memory problem and was severely impaired cognitively. Continued review revealed the resident required total dependence for personal hygiene and bathing. Medical record review of the care plan dated 12/13/17 revealed Resident #26 required assistance with Activities of Daily Living due to both cognitive and physical deficits. Further review revealed the resident would receive a shower twice weekly and sponge bath alternate days. Medical record review of Physician Orders dated 5/5/18 revealed Resident #26 was placed on contact isolation related to Methicillin-Resistant Staphylococcus Aureus (MRSA), a type of bacterial infection. Observation of Resident #26 on 5/14/18 at 12:06 PM, 5/14/18 at 10:00 AM, 5/14/18 at 4:30 PM and 5/15/18 at 8:10 AM revealed the resident's finger nails had blackened debri under them. Interview with Certified Nurse Aide (CNA) #4 on 5/15/18 at 3:10 PM at the [NAME] nursing station revealed Resident #26 was scheduled to receive a bed bath on Tuesday and Saturday. CNA #4 stated she gave Resident #26 a bed bath today before lunch. Interview and observation with the Director of Nursing (DON) on 5/15/18 at 3:20 PM in Resident #26's room revealed blackened debri under the resident's the finger nails. The DON stated it means her hands weren't soaked. The DON confirmed the facility failed to provide nail care for Resident #26.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Observation on 5/15/18 at 10:45 AM in the [NAME] Way medication room refrigerator revealed two multi-dose vials of Tubersol (Purified Protein Derivative for tuberculin testing) opened and undated. Interview with LPN #1 on 5/15/18 at 10:45 AM in the [NAME] Way medication room confirmed the two multi-dose vials of Tubersol should have been dated when opened. Interview with the Director of Nursing (DON) on 5/15/18 at 12:05 PM in her office confirmed multi-dose vials of medications should have been dated when opened. Further interview with DON confirmed the facility failed to date multi-dose vials when opened. Based on facility policy review, medical record review, observation and interview the facility failed to store 3 medications in a locked compartment for 1 resident (Resident #74) of 24 residents reviewed on the Inglebrook Way hall and failed to date 2 of 4 multi-dose vials of medication after being opened in one of three refrigerators. Findings include: Review of facility policy Storage and Expiration of Medications, Biologicals, Syringes and Needles with a revision date of 10/31/16 revealed .Facility should ensure that all medications and biologicals, including treatment items, are securely stored in a locked cabinet/cart or locked medication room that is inaccessible by residents and visitors .Once any medication or biological package is opened .facility staff should record the date opened on the medication container when the medication has a shortened expiration date once opened . Medical record review revealed Resident #74 was admitted to the facility on [DATE] with diagnoses including Chronic Obstructive Pulmonary Disease, Hypertension and Type II Diabetes Mellitus. Observation on 5/14/18 at 10:00 AM in Resident #74's room revealed one bottle of Hydroxyzine HCL (antihistamine with sedative properties) 25 mg, one bottle Fluticasone (nasal spray) 50mcg and a Ventolin Inhaler (breathing medication) in an open drawer of the bedside table. Observation and interview with Licensed Practical Nurse (LPN) #1 on 5/14/18 at 10:20 AM in Resident #74's room revealed an open drawer on the bedside table with one bottle of Hydroxyzine HCL labeled for Resident #74 containing 50 tablets, one bottle of Fluticasone nasal spray and one Ventolin inhaler. Continued interview with LPN #1 revealed It shouldn't be there and confirmed the resident had not been assessed to self administer medications. Continued interview with LPN #1 confirmed the facility failed to keep the 3 medications in a locked medication cart.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on facility policy, observation and interview the facility failed to establish and maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections related to wash basins sitting on the bathroom floor unbagged for 6 of 24 residents (Resident # 37, Resident #46, Resident #79, Resident #112, Resident #117, and Resident #420) reviewed on [NAME] Way. Findings include: Review of facility policy, Infection Control-General Policies and Procedures dated 10/20/16, revealed .Develop prevention, surveillance, and control measures to protect residents and personnel from healthcare-associated infection . Medical record review revealed Resident #37 was readmitted to the facility on [DATE] with diagnoses including Essential Hypertension, Benign Prostatic Hyperplasia, Anxiety, Major Depressive Disorder, Unspecified Sequelae of Cerebral Infarction, and Urinary Tract Infection. Observation on 5/14/18 at 9:42 AM and at 2:44 PM in Resident #37's bathroom revealed wash basin sitting on the bathroom floor unbagged. Medical record review revealed Resident #46 was admitted to the facility on [DATE] with diagnoses including Gastroesophageal Reflux Disease, Alzheimers Disease, Unspecified Dementia with Behavioral Disturbances, Anemia, Dysphagia, Type 2 Diabetes Mellitus, Essential Hypertension, and Chronic Kidney Disease Stage 3. Observation on 5/14/18 at 10:00 AM and at 2:50 PM in Resident #46's bathroom revealed wash basin sitting on the bathroom floor unbagged. Medical record review revealed Resident #79 was admitted to the facility on [DATE] with diagnoses including Unspecified Protein-Calorie Malnutrition, Essential Hypertension, Chronic Pulmonary Embolism, Unspecified Osteoarthritis and Muscle Weakness. Observation on 5/14/18 at 9:45 AM and at 2:47 PM in Resident #79's bathroom revealed wash basin sitting on the bathroom floor unbagged. Medical record review revealed Resident #112 was readmitted to the facility on [DATE] with diagnoses including Vitamin Deficiency, Essential Hypertension, Heart Disease Unspecified, Vascular Dementia with Behavioral Disturbance, Anxiety Disorder and Gastrostomy Status. Observation on 5/14/18 at 9:23 AM and at 2:40 PM in Resident #112's bathroom revealed wash basin sitting on the bathroom floor unbagged. Medical Record review revealed Resident #117 was readmitted to the facility on [DATE] with diagnoses including Pulmonary Heart Disease, Anemia in Chronic Kidney Disease, Type 2 Diabetes Mellitus, Chronic Combined Systolic and Diastolic Heart Failure, Chronic Obstructive Pulmonary Disease, and Chronic Kidney Disease, Stage 4. Observation on 5/14/18 at 9:30 AM and at 2:37 PM in Resident #117's bathroom revealed wash basin sitting on the bathroom floor unbagged. Medical Record Review revealed Resident #420 was admitted to the facility on [DATE] with diagnoses including Unspecified Protein-Calorie Malnutrition, Unspecified Dementia without Behavioral Disturbances, Muscle Weakness and Personal History of Malignant Neoplasm of Prostate. Observation on 5/14/18 at 9:06 AM and at 2:34 PM in Resident #420's bathroom revealed wash basin sitting on the bathroom floor unbagged. Interview with Certified Nursing Assistant (CNA) #2 on 5/14/18 at 2:55 PM in Resident #37's room revealed wash basins should be bagged in the bathroom placed between handrail and wall. Interview with Licensed Practical Nurse (LPN) #1 on 5/14/18 at 2:59 PM confirmed wash basins should be bagged and stored in residents bathroom not on the floor. Further interview with LPN confirmed the facility failed to maintain a sanitary environment.