Health inspection·August 15, 2024

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 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 and interviews, the facility failed to maintain the laundry room area in a clean and sanitary [NAME] and failed to maintain laundry equipment in proper working condition. The findings include: A tour of the laundry room was conducted with Staff J, a Laundry Services Aide, on 08/15/24 at 8:35 AM. Upon entering the laundry room, the surveyor observed 2 washing machines and 2 dryers present in the same room. When asked if all the machines were working properly, Staff J stated the first washing machine had been leaking for a while and they had to use a garbage can to catch the water leaking from the door of the machine. The surveyor observed a piece of fabric wrapped around a plastic pipe which went from the side of the washing machine to the door of the washing machine. Further observation revealed water was leaking from this pipe and down the door of the machine despite the machine not being turned on. Closer observation revealed there was no floor drain in the room, which could result in a slipping hazard for the staff. Staff J stated the water would fill the whole floor of the room if the garbage can was not present to catch it. She further stated they had to empty the garbage can multiple times per day as it would fill up with water from the machine. When asked to clarify how long this washing machine had been leaking, Staff J stated it had been 6 to 8 months. She further stated the facility was aware of this issue but that she had been told that parts were not available to fix this washing machine because of its age. Continued observation revealed both washing machines had buckets located behind them which contained numerous foreign objects, including coins, pens, straws, lint, gloves, bandages, and other unidentified matter. When asked how often these buckets are cleaned out, Staff J stated she did not know. Further observation in the laundry room revealed a large number of uncovered pillows which were stacked on a counter next to the washing machines and adjacent to the handwashing sink. This could result in contamination to the pillows from the washing machines or the sink. When asked why these pillows were in the laundry room, Staff J stated the pillows used to be kept in the resident's rooms, but the previous laundry manager told the staff the pillows had to be kept in the laundry room in plastic bags to keep them clean for resident use. The surveyor also observed linens stacked on a shelf next to the handwashing sink which were uncovered. This could result in contamination to the linens from the sink. Two cardboard boxes were located under the sink which could be a tripping hazard for the staff. In the clean linen area, the surveyor observed there were clear shower curtain liners being used to cover the linens on the shelves. There was one area of the shelving which was uncovered. The surveyor observed there were mop heads being stored above the uncovered clean linen area. Staff J told the surveyor that the shower curtain liners often became ripped by the staff or fell off because they were only held on by tape and that they had to be replaced often. (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 3 Event ID: 105807 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105807 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Madison Health and Rehabilitation Center 2481 West US 90 Madison, FL 32340 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)