Other·April 14, 2023

F584 (Rev. 173, Issued: 11-22-17, Effective: 11-28-17, Implementation: 11-28-17) §483.10(i) Safe Environment. The resident has a right to a safe, clean, comfortable, and homelike environment, including but not limited to receiving treatment and supports for daily living safely. The facility must provide— §483.10(i)(1) A safe, clean, comfortable, and homelike environment, allowing the resident to use his or her personal belongings to the extent possible. (i) This includes ensuring that the resident can receive care and services safely and that the physical layout of the facility maximizes resident independence and does not pose a safety risk. (ii) The facility shall exercise reasonable care for the protection of the resident's property from loss or theft. §483.10(i)(2) Housekeeping and maintenance services necessary to maintain a sanitary, orderly, and comfortable interior; §483.10(i)(3) Clean bed and bath linens that are in good condition; §483.10(i)(4) Private closet space in each resident room, as specified in §483.90 (e)(2)(iv); §483.10(i)(5) Adequate and comfortable lighting levels in all areas; §483.10(i)(6) Comfortable and safe temperature levels. Facilities initially certified after October 1, 1990, must maintain a temperature range of 71 to 81°F; and §483.10(i)(7) For the maintenance of comfortable sound levels. Title 22 § 72523. Patient Care Policies and Procedures. (a) Written patient care policies and procedures shall be established and implemented to ensure that patient related goals and facility objectives are achieved. On 3/2/2023, an unannounced visit was conducted to the facility to investigate a complaint about physical environment and dietary services. The facility failed to provide a safe environment for the residents, staff, and visitors, as indicated in the facility’s policies and procedures by not: 1. Providing safe water temperatures of less than 121 degrees Fahrenheit (°F) in three hand sinks in 16 residents' restroom. 2. Checking water temperature in 28 of 28 hand sinks and three of three showers used by residents and not maintaining record of water temperature checks. As a result, residents, staff, and visitors were placed at risk of sustaining burns, scalding (injury from hot liquid or steam), and uncomfortable water temperatures. 1. During an interview on 3/2/2023, at 3:17 p.m., the Maintenance Supervisor (MS) stated Shower Room 3 was placed out of order due to residents complained of water being too cold on 3/1/2023. During a concurrent interview and observation on 3/2/2023, at 2:21 p.m., the MS stated the water temperature in the hand sink of the residents' restroom should range between 100°F to 120°F and should not exceed 120°F. The MS also stated that the facility has seven water heaters that supplied hot water in resident restrooms. With the evaluator, the MS measured the water temperature by turning on the hot water faucet fixture in Resident 4’s restroom, the temperature was 124.8°F. The MS explained that due to residents’ complaints of cold water in Shower Room 3 on 3/1/2023, he increased the water temperature from the water heater. The MS stated that now the temperature was too high, and he needed to adjust the valve on the water heater to lower the temperature. There was no caution sign posted in the restroom to warn the person using the sink of risk of scalding. The MS confirmed there was no posted precautionary sign. During a concurrent observation and interview on 3/2/2023, at 2:26 p.m., the MS measured the hot water temperature by turning on the hot water faucet fixture in Resident 3’s hand sink and placing a probe thermometer through the running water. The temperature was 122.7°F and no precautionary sign was posted. During a concurrent observation and interview on 3/2/2023, at 2:28 p.m., the MS measured the hot water temperature in the hand sink fixture inside the rooms of Residents 1 and 2. The water temperature was 135°F and there was no hot water caution sign posted in the restroom, which was confirmed by the MS. The MS said he would adjust the water heater temperature. On 3/2/2023, at 2:35 p.m., during a concurrent observation and interview, the MS turned a control valve in the water heater room located in the middle patio area. The MS explained that by turning the control valve, it would allow more cold water into the mixing valve to provide lower temperature to the hand sinks. The MS also stated the water heater control dial was previously set between 125°F and 130°F and on 3/1/2023, he increased the temperature to 160°F because the residents were complaining of cold water in Shower Room 3. The MS was observed adjusting the water heater control dial to 130°F. During an interview with the MS on 3/2/2023, at 3:37 p.m., the MS stated that he “forgot” to adjust the water heater control dial to the previous setting. On 3/2/2023, at 4:42 p.m., during an interview, the Administrator (ADM) stated the water temperature in the resident’s restroom hand sink and shower rooms should range between 105°F to 120°F. The ADM explained water temperature exceeding 120°F can cause burns and water temperature below 105°F would be too cold for residents to take showers. The ADM also stated that a caution sign should be posted by the faucet if the water temperature exceeded 120°F. On 3/3/2023, at 10:46 a.m., during a concurrent observation and interview with the MS, the evaluator observed the MS measured the water temperature by turning on the hot water faucet fixture of the hand sink of Resident 7’s restroom by placing a probe thermometer through the running water. The water temperature was 125°F. The MS explained, the resident’s restroom was close to the water heater, and he would adjust the valve in the water heater room to allow more cold water to the mixing valve. On 3/3/2023, at 11:01 a.m., during a concurrent observation and interview with the MS, the evaluator observed another water heater room with four water heaters in the middle patio area. The MS stated three of the water heaters provided hot water to residents’ restrooms and the other provide hot water to the kitchen. The MS stated he had adjusted the control valve to allow more cold water to decrease water temperature in Resident 7’s restroom sink. A review of the facility’s policy titled, “Water Temperatures, Safety of,” reviewed and approved on 9/28/2022, indicated tap water in the facility shall be kept within a temperature range to prevent scalding of residents: a. Water heaters that service resident rooms, bathrooms, common areas, and tub/shower areas shall be set to temperatures no more than 120°F and no cooler than 105°F. b. If any time water temperatures feel excessive to touch (i.e., how enough to be painful or cause reddening of the skin after removal of the hand from the water), staff will report these findings to the immediate supervisor. c. Direct-care staff shall be informed of risk factors for scalding/burns that are more common in the elderly, such as: decreased skin thickness, decreased skin sensitivity, peripheral neuropathy, reduced reaction time, decreased cognition, decreased mobility, and decreased communication. d. The length of exposure to warm or hot water, the amount of skin exposed, and the resident’s current condition affect whether exposure to certain temperatures will cause scalding or burns. A review of the facility’s policy titled, “Maintenance Policies & Procedures,” reviewed and approved on 9/28/2022, indicated to maintain plumbing fixtures in safe and good operating conditions. A review of 2019 California Plumbing Code, Domestic Hot-Water Distribution Systems for Health Facilities and Clinics indicated that temperature control valves shall be provided to automatically regulate the temperature of hot water delivered to plumbing fixtures used by patients to a range of 105°F minimum to 120°F maximum. 2. On 3/2/2023, at 2:35 p.m., during an interview, the MS stated that he did not check the water temperature on that day (3/2/2023) because he was busy checking the water pipes in the attic. On 3/2/2023, at 4:08 p.m., the Evaluator requested the MS the facility’s water temperature log for review. The MS stated every morning he checked the water temperature in the shower rooms and picks random residents’ rooms to check water temperature in the hand sinks. The MS stated it had been two years since he stopped recording the water temperatures checks and there was no temperature log for the Evaluator to review. On 3/2/2023, at 4:42 p.m., during an interview with the ADM and the Director of Nursing (DON), the ADM stated that facility water temperatures should be checked and documented. The DON stated there should be a log recording the water temperatures taken. A review of the facility’s policy titled, “Water Temperatures, Safety of,” reviewed and approved on 9/28/2022, indicated the following: a. Maintenance staff is responsible for checking thermostats and temperature controls in the facility and recording these checks in a maintenance log. b. Maintenance staff shall conduct periodic tap water temperature checks and record the water temperatures in a safety log. The facility failed to provide a safe environment for the residents, staff, and visitors, as indicated in the facility’s policies and procedures by not: 1. Providing safe water temperatures of less than 121 degrees °F in three hand sinks in 16 residents' restroom. 2. Checking water temperature in 28 of 28 hand sinks and three of three showers used by residents and not maintaining record of water temperature checks. As a result, residents, staff, and visitors were placed at risk of sustaining burns, scalding, and uncomfortable water temperatures. The above violations had a direct relationship to the health, safety, or security of the residents, staff, and visitors.