Health inspection·February 7, 2024

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. Based on observation, resident interview, and staff interview, the facility failed to ensure the resident's environment was kept clean, sanitary, and homelike. This affected eight (#01, #02, #03, #04, #05, #06, #07, and #09) of 10 residents reviewed for environment. The facility census was 48. Findings include: Observations on 02/06/24 at 10:04 A.M. and on 02/07/24 at 11:31 A.M. of the resident bathroom shared between Resident #01 and Resident #02, revealed the bathroom floor had a black/brown substance on the floor surrounding the toilet bowl. A brown/black substance was also built up inside the toilet bowl. Observations on 02/06/24 at 10:08 A.M. and on 02/07/24 at 11:29 A.M. of the resident bathroom shared between Resident #03 and Resident #09, revealed the bathroom floor had a brown substance on the floor surrounding the toilet bowl. A brown substance was also built up inside the toilet bowl. During an interview on 02/06/24 at 10:10 A.M., Resident #03 reported housekeeping staff cleaned resident rooms on a daily basis, but did not always clean the toilet in the bathroom. Observations on 02/06/24 at 10:30 A.M. and on 02/07/24 at 11:36 A.M. of the resident bathroom shared between Resident #04, Resident #05, Resident #06, and Resident #07, revealed a foul odor was present immediately upon entering the bathroom. The bathroom floor had a brown substance on the floor surrounding the toilet bowl. A black substance was also built up inside he toilet bowl and a dark-colored line was coming down from where the toilet flush handle was located. During an interview on 02/06/24 at 11:13 A.M., Housekeeper #405 reported all resident rooms were cleaned daily, which was to include cleaning of resident bathrooms and toilets. During an interview on 02/07/24 at 8:17 A.M., Licensed Practical Nurse (LPN) #302 reported housekeeping staff cleaned resident rooms on a daily basis, but resident rooms including bathrooms were often not as clean as they should be. A walk-through tour and interview was completed with Housekeeper #410 on 02/07/24 beginning at 11:38 A.M. During this time, Housekeeper #410 confirmed responsibility for cleaning the bathrooms for Resident #01, Resident #02, Resident #03, Resident #04, Resident #05, Resident #06, Resident #07, and Resident #09, and verified each bathroom had already been cleaned that day. During the tour, Housekeeper #410 confirmed each of the aforementioned observations in the resident bathrooms. Housekeeper #410 reported the floor surrounding the toilet bowls appeared to be stained along with some buildup, Page 1 of 2 365740 365740 02/07/2024 Majestic Care of Clyde 700 Helen Street Clyde, OH 43410

F 0584 and the dark line on the toilet tank was a crack that would not come off. Level of Harm - Minimal harm or potential for actual harm This deficiency represents non-compliance investigated under Complaint Number OH00150441. Residents Affected - Some 365740 Page 2 of 2