Health inspection·February 29, 2024

F 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. Based on observations, interviews, and facility policy review, the facility failed to ensure the bathroom shared by two (Residents #1 and #4) residents, out of three resident bathrooms observed were maintained in a safe, functional, sanitary, and comfortable environment. The findings include: On 2/29/24 at 9:55 AM, the shared bathroom for Residents #1 and #4 was observed to have brown debris in a splatter pattern on the wall to the right of the toilet and on the wall to the left of the sink. The bathroom had an unpleasant odor of feces. The sink was partially separated from the wall and loose. The baseboard was separated from the wall in two areas. (Photographic evidence obtained) On 2/29/24 at 12:15 PM, the shared bathroom for Residents #1 and #4 was observed for a second time. The bathroom continued to have brown debris in a splatter pattern on the wall to the right of the toilet and on the wall to the left of the sink. The bathroom continued to have an unpleasant odor of feces. The sink was still partially separated from the wall and loose. The baseboard was still separated from the wall in two areas. (Photographic evidence obtained) An interview was conducted with Employee A, Certified Nursing Assistant (CNA) on 2/29/24 at 1:00 PM, who was caring for Resident #1 and Resident #4. When asked if Resident #1 uses the bathroom in their room. She stated, Her roommate (Resident #4) uses the bathroom. She (Resident #1) is incontinent and has that care provided in her bed. She was asked who is responsible for keeping the resident bathrooms clean. She stated, The janitors, housekeepers. We do change the trashcan liners, but the housekeepers do the actual cleaning. When asked if she noticed if Resident #1's bathroom needed any additional cleaning today. She stated, When I went in there this morning, I noticed that it did need to be cleaned. I noticed all the stuff on the wall. When asked if she had reported any issues with Resident #1's bathroom to maintenance. She stated, No, I haven't. On 2/29/24 at 1:20 PM, the shared bathroom for Residents #1 and #4 was observed for a third time. The bathroom continued to have brown debris in a splatter pattern on the wall to the right of the toilet and on the wall to the left of the sink. The bathroom continued to have an unpleasant odor of feces. The sink was still partially separated from the wall and loose. The baseboard was still separated from the wall in two areas. An interview was conducted with Employee B, Licensed Practical Nurse (LPN) on 2/29/24 at 1:30 PM, who was caring for Resident #1 and Resident #4. When asked if Resident #1 uses the bathroom in her room. She stated, Not at this time, she did in the past. She used to walk around all the time. She doesn't really walk around now; she has declined a little bit. She was asked if her roommate, Resident Page 1 of 2 105632 105632 02/29/2024 Aviata at Harts Harbor 11565 Harts Rd Jacksonville, FL 32218

F 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few #4, uses the bathroom in her room. She stated, I think so. She was asked if she had noticed or been made aware of any issues in their bathroom today. She stated, No. I just went into her bathroom, and it was ok. She was asked if she noticed any debris or splatter on the bathroom walls. She stated, No. The CNA or the housekeeper would probably clean it. Employee B, LPN was then asked to observe Resident #1's bathroom. When asked if she saw the brown debris on the walls. She stated, Yes, I see that now. When asked if she knew how long the brown splatter/debris has been on the walls in this bathroom. She stated, No, I don't know. On 2/29/24 at 2:20 PM, the Maintenance Director was interviewed. He was asked if he has any work orders for the bathroom belonging to Residents #1 and #4. He stated, No, I do not. He was asked to observe their bathroom. Upon entering the bathroom, he was asked if he had been made aware of the sink coming loose from the wall or the baseboard coming off the wall. He stated, No, ma'am, I have not. I may need to replace the baseboard because that has been taped before, and when it is open like that, it can attract roaches because of the glue inside. I did not know about the sink. A review of the facility's policy titled 5-Step Daily Room Cleaning (revised 10/25/16) revealed: Purpose: To teach Environmental Services employees the proper cleaning method to sanitize a patient room or any area in a health care facility. 3. Spot clean walls: Vertical surfaces are not completely wiped down daily- but must be spot cleaned daily. Walls- especially by the trash cans, light switches, and door handles- will need special attention. (Photographic evidence obtained) . 105632 Page 2 of 2