LOUISVILLE, KY- LANDMARK OF IROQUOIS PARK REHAB AND NURSING CENTER

Honor the resident’s right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 50442

Based on observation, interview, record review, and review of the facility’s policies, the facility failed to provide a clean and homelike environment for residents. The bathrooms and hallways had a strong odor of urine and were not clean, floors were soiled, sticky, stained and/or rusted. The failure to maintain a clean, homelike environment had the potential to affect Resident (R) 31, R44, and R75, as well as, all other residents residing on two of the three facility halls, with 15 resident rooms on each hallway.

The findings included:

Review of the facility’s policy titled, Landmark-Clinical Standard and Guidance: Resident Rights Guidelines, effective date 07/12/2023 and last reviewed 04/12/2024, revealed the resident’s comfort, safety, and overall welfare must be promoted, protected, and enhanced at all times.

Review of the facility’s policy titled, Landmark-Clinical Standard and Guidance: Homelike Environment Guidance, effective date 06/20/2023 and last reviewed 04/12/2024, revealed that it is the policy of the facility to ensure that the environment provided by the facility is safe, sanitary, functional, and comfortable. All room contents to include clothes, furniture, devices, linens, bedspreads, privacy curtains, window coverings, wall hangings, wallpaper, and floors should be clean and in good repair.

Review of the facility’s policy titled, Landmark-Clinical Standards and Guidance: Resident Room Clean Policy, effective date 02/17/2021 and last reviewed on 02/16/2024, explained the procedure for cleaning a resident’s room, which including mopping floors.

1. a. Observation on 06/23/2024 at 12:27 PM of the facility revealed the hallway which contained Rooms 106-116 smelled of urine. Further observation on 06/23/2024 at 12:59 PM revealed that the shared bathroom between rooms [ROOM NUMBERS] smelled of urine. At 1:04 PM on 06/23/2024 it was observed that the hallway containing Rooms 121 -135 smelled strongly of urine. At 1:06 PM on 06/23/2024 observation of room [ROOM NUMBER] revealed the room had a strong urine smell and the floors were dirty. The floors had black marks and a clear, dry, sticky substance on them. At 1:46 PM on 06/23/2024, it was observed that room [ROOM NUMBER] smelled strongly of urine. The floors were dirty. There were black smudges on the floor and a large, dried puddle of urine from a resident’s indwelling catheter, which had leaked onto the floor. Paper towels and other paper debris littered the floor on the side of the room near the window. The floor in room [ROOM NUMBER] was observed on 06/23/2024 at 1:57 PM to be dirty and looked like it had not been mopped recently.

b. Observation on 06/24/2024 at 11:45 AM revealed that room [ROOM NUMBER] still smelled strongly of urine; however, the dried puddle of urine had been mopped up. The hallway with Rooms 121 -135 still had a strong smell of urine.
c. Observation on 06/25/2024 at 8:49 AM revealed that the hallway containing Rooms 121 – 135, smelled strongly of urine. In an interview on 06/25/2024 at 9:36 AM, Certified Nursing Assistant (CNA) 3 confirmed that the hallway with Rooms 121 -135 smelled like urine.
d. Observation on 06/26/2024 at 8:31 AM revealed that the hallway with Rooms 121 – 135 once again smelled strongly of urine. Observation later at 9:05 AM on the hallway that contained Rooms 108 -116, revealed it also smelled of urine.
e. An interview with R75 on 06/27/2024 at 10:25 AM revealed that she felt like the entire facility smelled like urine, especially the hallway that housed Rooms 121 -135.

An interview with Housekeeper (HK) 1 at 9:58 AM on 06/25/2024 revealed that the common areas (such as the hallways and dining rooms) and residents’ rooms and bathrooms were cleaned daily. A later interview with another housekeeper, HK 2, on 06/25/2024 at 1:40 PM, also revealed residents’ rooms and bathrooms were cleaned daily.

On 06/26/2024 at 8:31 AM, during a second interview with HK 1, he stated that it sometimes smelled bad in the morning. Although members of the survey team verified the urine smell at this time, HK1 stated that he did not think that the hallway containing Rooms 121 through 135 smelled like urine.

On 06/26/2024 at 8:33 AM in an interview with CNA 2, she stated that she did not think the hallway smelled like urine even though members of the survey team verified there was a strong smell of urine.

An interview with Licensed Practical Nurse (LPN) 1 on 10:27 AM on 06/27/2024 confirmed the odor of urine and added that the odor was much better today than usual. She stated that up front, when you entered the facility, it sometimes had a strong smell of urine.  

An interview with the Director of Nursing (DON) on 06/27/2024 at 10:29 AM revealed that R75, who resided on one of the halls which smelled of urine, refused to send her undergarments to the laundry. Instead, the resident washed them out and hung them up in her room to dry. She did not use soap on the undergarments, only water, and, per the DON, this was the reason that the hallway containing her room, continually smelled like urine.

Interview with the Administrator on 06/26/2024 at 2:10 PM revealed that she was unaware of the urine smell. When asked if she felt the smell of urine constituted a homelike environment, she stated no.

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2. a. During an observation on 06/23/2024 at 4:01 PM, R44’s bathroom had a quarter-sized brown substance on the floor beside the toilet, as well as a brown substance smeared on the wall located above the toilet paper holder.

Review of R44’s Quarterly Minimum Data Set (MDS) Assessment, dated 06/06/2024, revealed the facility assessed R44 to have a Brief Interview for Mental Status (BIMS) score of 15/15, indicating the resident was cognitively intact. During an interview with R44 on 06/23/2024 at 4:01 PM, he stated his biggest concern at the facility was with housekeeping services. R44 confirmed his bathroom currently had stool (feces) on the floor and smeared on the wall. R44 stated the stool had been in the bathroom for at least two or three days. R44 stated the housekeeping staff was in his room every day; however, the housekeeper did not speak good English and would just look at him and not respond when he would voice his concerns.

During an interview with Housekeeper (HK) 4 on 06/24/2024 at 1:53 PM, she stated she spoke limited English. The Administrator was present during the interview and assisted by using a translator app. HK4 stated she was responsible for cleaning R44’s bathroom and cleaned them every day and even every hour. HK4 stated she did not see the brown substance on the floor or wall. At that time, the Administrator told HK4 to clean the brown substance from R44’s bathroom floor and wall.

Additional observation of R44’s bathroom on 06/24/2024 at 2:25 PM revealed the brown substance had been cleaned off of the wall above the toilet paper holder; however, there was still a quarter-sized brown substance on the floor beside the toilet. The DON was made aware that R44’s bathroom was not clean, and she stated she would send another Housekeeper to clean it. The DON stated rounds were done by other staff this morning and she did not think the brown spots were there.

b. Review of a Quarterly MDS Assessment, dated 05/13/2024, revealed the facility assessed R31 to have a BIMS score of 15/15, indicating the resident was cognitively intact. During an interview with R31 on 06/26/2024 at 2:35 PM, she stated housekeeping does not clean well. She stated a female housekeeper that did not speak English would have to be told by residents that she needed to sweep prior to mopping. R31 further stated the housekeeper did not clean the vanity or mirrors and therefore, her roommate would often do that.

During an interview with CNA12 on 06/26/2024 at 7:00 PM, she stated she did not feel like the facility was not clean or homelike for the residents.

During an interview with CNA13 on 06/26/2024 at 7:30 PM, she stated the facility was very dirty, actually filthy and she did not think housekeeping staff was doing very much. CNA13 stated there had been feces in the bathroom floors and when she reported to housekeeping staff, nothing would be done.

During an interview with HK3 on 06/28/2024 at 9:49 AM, he stated he would clean resident rooms and bathrooms one to two times daily depending on the condition of the rooms. He stated deep cleans were done by schedule and would be logged into a book; however, daily cleans were not logged. HK3 stated he thought the facility could be cleaner. HK3 further stated they did not have an acting manager and the Administrator oversaw the housekeeping staff.

Logs referenced by HK3 were reviewed. The facility’s document titled, Quality Control
Inspection-Housekeeping, revealed random daily spot checks of 34 residents’ bathrooms over a three-week period from 05/23/2024 through 06/12/2024. The spot checks showed nine of the inspected bathrooms had to be re-cleaned.

Review of facility’s Deep Clean Room Schedule and Carpet and Hard Floors Cleaning Schedule revealed that the facility only had these check off sheets for the months of January and April of 2024. Neither the Deep Clean Room Schedule nor the Carpet and Hard Floors Cleaning Schedule from January were signed or dated by the Administrator. For the month of April, the Deep Clean Room Schedule for April was not signed and dated (to indicate that it was complete.).

During an interview with the Administrator on 06/28/2024 at 10:07 AM, she stated she thought the facility was clean and homelike for the most part. The Administrator stated she expected housekeeping to maintain a homelike and clean environment for the residents.

3. Observation at 1:20 PM on 06/23/2024 an observation of the bathroom shared between rooms [ROOM NUMBERS] revealed the floors of the bathroom had rust stains on them from the rusting door jamb of the bathroom door. Observation on 06/23/2023 at 1:28 PM revealed the floors in the bathroom shared by rooms [ROOM NUMBERS] also had rust stains from the rusting door frames of the bathroom door. It was observed on 06/23/2024 at 1:39 PM and 1:43 PM that the flooring under the window in rooms [ROOM NUMBERS] were stained with rust and discolored with water stains. At 1:46 PM on 06/23/2024, observation of the floor under the window and in the bathroom shared by rooms [ROOM NUMBERS] revealed rust stains from the rusting bathroom door’s door jamb. On 06/23/2024 at 1:57 PM, the bathroom for room [ROOM NUMBER] and 131 had rust stains on the floor and rust on the door jamb leading into the bathroom.

On 06/26/2024 at 8:55 AM, interview with the Maintenance Director revealed that he was unaware of the rust on the floors in the rooms and bathrooms in Rooms 121,123, 125, 127, 128, and 129 and was unaware of the rust on the door jambs for these rooms. He stated that the facility was in the process of repainting and remodeling. An outside company had been hired to do the remodel; however, they had only done part of the remodel prior to quitting. He also stated that there were no plans to replace the flooring, but housekeeping could try and remove the rust.

During an interview with the DON on 06/27/2024 at 10:29 AM, she was asked about the rust on the flooring and on the door jambs and stated that maintenance was in the process of remodeling, and both were to be replaced.