Health inspection·June 15, 2023

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 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** Based on observations, interview and record review, the facility failed to maintain a safe and homelike environment by failing to ensure properly functioning toilets in 2 of 4 halls observed (100 and 200 halls). Toilets were observed to be backed up, overflowing and slow to drain resulting in flooding in two rooms on the 100 hall (105 and 107). The findings include: On 6/15/23 at approximately 9:00 AM, an interview was conducted with resident #4 during which he stated that the toilet in his room was slow to drain and would at times become clogged requiring the maintenance main to use a plunger to unclog it. At this time the toilet in his room was flushed and found that it was slow to drain and did not completely empty during the flush cycle. He stated this happens about once a week. On 6/15/23 at approximately 9:15 AM, an observation was made of room [ROOM NUMBER] in which the water in the bathroom toilet was observed to be at the rim of the toilet, the water was dark brown and there were feces noted with toilet paper. At this time an interview was conducted with the staff member F, Certified Nursing Assistant (CNA) who was providing one on one care to the resident in the room. She stated that the toilet has been backing up but that maintenance would be in to clear it when he has time. She stated that this occurs from time to time, but they can usually unplug it with a plunger. On 6/15/23 at approximately 9:25 AM an observation was made of room [ROOM NUMBER], staff member I, a floor tech, was observed placing towels down on the floor around the toilet and around the 4 resident's beds. Employee I, a floor tech, said that the toilet overflowed to the point that the water was coming out into the resident's room and under the wall into room [ROOM NUMBER]. Housekeeping staff were observed in room [ROOM NUMBER] with towels noted on the floor and a mop was being used to clean up the water in the room. At this time staff member I, stated that this is the first time this had happened on this hall, it usually happens on the 300 hall. Photographic evidence obtained. On 6/15/23 at approximately 10:20 AM an interview was conducted with the administrator during which she stated that she was aware of the issue in rooms [ROOM NUMBERS] with the toilet backing up and flooding the room. She stated that she feels it is the result of someone using too much toilet paper when using the bathroom or they flushed something they should not have down the toilet. She was not aware of the clogged toilet in room [ROOM NUMBER]. Page 1 of 2 105269 105269 06/15/2023 Groves Center 512 S 11th St Lake Wales, FL 33853

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some On 6/15/23 at approximately 10:42 AM, an interview was conducted with the resident council president who stated she has been ill but does remember there being concerns with the toilets not working. She stated that the Social Services Director would have a record of the concern but at this time she was not feeling well enough to continue the interview. On 6/15/23 at approximately 10:52 AM, an interview was conducted with the Social Services Director who stated that she was not familiar with the resident council voice concerns about the toilets in the facility not working. She reviewed the notes from the last 6 resident council meetings and had no record of the complaint. She stated that she would have written a grievance if they had. On 6/15/23 at approximately 11:00 AM a telephone interview was conducted with the building supply maintenance provider who state that the facility had a clog in the shower room on the 100 hall a few months ago but she would need to refer the surveyor to her supervisor if more information was needed. She was given contact information for a return call. On 6/15/23 at approximately 11:07 AM, an interview was conducted with the Administrator and the Maintenance Director who reported they normally have issues on the 300 hall but they are easily fixed by using a plunger to clear the line. He stated that the residents will put the brown paper towels in the commodes, and this causes them to back up. When this occurs, the CNAs put in workorders and he will come clear the lines using the plunger. At this time the Maintenance Director stated that there are no current issues in the building but was informed by the Administrator that there were issues in the 100 hallway today. On 6/15/23 at approximately 11:20 AM, a follow up observation was made of rooms [ROOM NUMBERS] in which the floors were dry however the bathroom toilets remained clogged. An observation was conducted of the toilet in room [ROOM NUMBER] and it remained clogged. On 6/15/23 at approximately 12:43 PM a follow up interview was conducted with the administrator who stated that she had heard in stand up meeting (staff meeting) that the toilets in room [ROOM NUMBER] were clogging and overflowing, she called the building services provider for service in May. She is not usually notified of clogged toilets unless it was something that the maintenance director could not fix. She stated that the issue was with the residents and staff using too much toilet paper or flushing paper towels down the toilets. She reported she has not done education with staff or residents about not doing this and does not have a performance improvement plan to address this. A review of the work order report for April 19, 2023 through June 15, 2023, revealed the maintenance department had to respond concerns related to the drains not function in the residents and therapy bathroom [ROOM NUMBER] times. The room number and dates/times were not on the report. A review of a purchase order dated May 12, 2023 for the building supply maintenance provider revealed that the facility were provided with 15 minutes of drain cleaning ($148) labor, the trip charge ($75), travel ($49.50) and equipment ($150) the total cost of the service was $423.00. On 6/15/23 at approximately 2:09 PM, a return call was received from the regional manager for the building supply maintenance provider who reported that the facility had issues with the showers not draining so they pressure checked a drainage pipe in May 2023. She reported that they did not have documentation of conducting an inspection of the sewar system at the facility in the last 6 months. 105269 Page 2 of 2