North Arkansas Regional Medical Center

“INFECTION PREVENTION CONTROL ABX STEWARDSHIP CFR(s): 482.42 The hospital must have active hospital-wide programs for the surveillance, prevention, and control of HAIs and other infectious diseases, and for the optimization of antibiotic use through stewardship. The programs must demonstrate adherence to nationally recognized infection prevention and control guidelines, as well as to best practices for improving antibiotic use where applicable, and for reducing the development and transmission of HAIs and antibiotic resistant organisms. Infection prevention and control problems and antibiotic use issues identified in the programs must be addressed in collaboration with the hospital-wide quality assessment and performance improvement (QAPI) program. This Condition is not met as evidenced by: 51070 Based on review of policy, observation, clinical record review, and interviews, it was determined the facility failed to maintain a safe sanitary environment to prevent the transmission of infectious organisms. The facility also failed to utilize nationally recognized standards to identify and accurately report surgical site infections. The failed practice had the likelihood of affecting all patients receiving care in the facility. See tag A-0750”

“PATIENT RIGHTS: CARE IN SAFE SETTING CFR(s): 482.13(c)(2) The patient has the right to receive care in a safe setting. This Standard is not met as evidenced by: 51070 Based on facility document review, observation and interviews it was determined the facility failed to monitor safe temperature settings for 13 of 13 blanket warmers throughout the facility (1 First Tower, 2 Critical Care, 1 Emergency Room (ER), 1 Gastroenterology Lab, 2 Obstetrics, 1 Observation, 1 Radiology, 4 Operating Room & Surgery). The failed practice did not ensure blanket warmers were at a safe temperature based on manufacturers guidelines or other to prevent thermal injury to patients skin. The failed practice had the likelihood of affecting patients who require warm blankets and/or staff who handle them. Findings follow: A. Review of facility document titled “Nuvolo PM Strategy AEM (alternative equipment maintenance) vs OEM (Original Equipment Manufacturer) Macro “received from Chief Nursing Officer on 04/23/26 showed 13 Blanket warmers in the facility receiving maintenance every year or every 24 months. B. During observation on 04/22/26 at 2:00 PM of Labor and Delivery, Surveyor #1 noted a baby blanket warmer that was hot to touch with inability to keep hand placed on the warmer. The temperature dial showed numbers 1-10 settings, however, no temperature was shown. Evidence was requested which showed what the current temperature was and that the temperatures were being monitored to ensure blankets were safe to apply to a patient’s skin, none was provided. C. On 04/22/26 at 2:15, During interview with the Biomedical Technician, he stated the hospital units should be monitoring the blanket warmers and the Biomedical Department performs annual maintenance and checks as needed. D. During observation on 04/21/26 at 2:30 PM the Emergency Department, Surveyor # 1, noted a blanket warmer with a large temperature dial set on 250. Evidence was requested which showed what the temperature should be and that the temperature was monitored to ensure blankets were a safe temperature. During an interview on 4/22/26 at 1:00 PM with the ER Manager, she stated there were no temperatures available for the blanket warmer. E. During an interview on 04/30/26 at 11:00 AM, the Chief Nursing Officer confirmed there were no temperature logs for any of the blanket warmers in their facility, and she confirmed the findings in A-D. 53764 Based on facility document review, observation and interviews it was determined the facility failed to ensure a safe environment for suicidal ideation (SI) or at-risk patients. The failed practice did not provide a ligature free environment, to decrease risk for intentional harm to themselves or others. The failed practice had the likelihood of affecting patients who require protection when demonstrating suicidal ideation or harm to others. Findings follow: A. Review of policy titled “Suicide Precautions and Observation of Patients with Psychosocial Needs”, last reviewed 06/23/20 states: “It is the goal of North Arkansas Regional Medical Center to prevent, staff and visitors from harming staff and others ...Any patient presenting to the emergency department with the following should have their belongings secured upon arrival. All patients admitted due to a suicide attempt, with known suicidal ideation, and/or need for observation will be placed on Suicide Precautions/observation by physician order ... Potentially harmful items will be removed, i.e. sharp items, breakable items, telephone cords, and call light cords.” B. During the initial tour of the Emergency Department (ED) on 04/20/26 at 2:30 PM, an SI patient was observed, in ED room #8, sitting on the bed. Surveyor #4, noted that there were computer cables/cords in the room, which were not in the line of site of staff members at the nurse’s station. C. During interview on 04/20/26 at 2:45 PM with the Emergency Room (ER) manager, she stated they use ED room #7 and #8 for suicidal and homicidal ideation patients, so they can be observed from the nurse’s station. She also verified that all ligature risks are to be removed from those rooms prior to at risk patients being placed in them. During an interview on 04/22/26 at 2:00 PM, she states that “we can reach out to the house supervisor for a sitter” when needed, for the high-risk patient. D. During an interview on 04/23/26 at 14:45, the Chief Nursing Officer confirmed the findings in A-B.”

“DELIVERY OF DRUGS CFR(s): 482.25(b) §482.25(b) Standard: Delivery of Services In order to provide patient safety, drugs and biologicals must be controlled and distributed in accordance with applicable standards of practice, consistent with Federal and State law. This Standard is not met as evidenced by: 31039 Based on review of policy and interview, it was determined the facility failed to follow acceptable standards of practice in that pharmacists did not review the medication orders for appropriateness prior to the first dose being dispensed, for all orders while the pharmacy is closed for seven out of seven (Sunday through Saturday) days every week (excluding Stat orders). By not allowing a pharmacist to review the order prior to dispensing, the facility cannot assure the order has been reviewed for; therapeutic appropriateness, therapeutic duplication in the patient’s medication regimen, appropriateness of the drug, dose, frequency, and route, medication-medication interactions, medication-food interactions, medication-lab interactions, medication-disease interactions, real or potential allergies or sensitivities or other contraindications. This failed practice had the likelihood to affect all patients who received new orders after the pharmacist left for the day. Findings follow: A. Record review of the facility’s policy titled, “After Hours Pharmacy Services,” effective date 08/30/2006, showed medications that are over-ridden (not reviewed by a Pharmacist), must be independently double checked by another nurse for allergies, contradictions, drug or food interactions, therapeutic duplications, and appropriateness of the drug, dose, frequency and route of administration. B. During an interview on 04/21/2026 at 10:17 AM, the Director of Pharmacy verified a pharmacist does not review orders written while the pharmacy is closed. The Director of Pharmacy stated there are an average of 60 medication orders that come in every evening, while the Pharmacy is closed, that are not reviewed by a Pharmacist.”

“DIRECTOR OF DIETARY SERVICES CFR(s): 482.28(a)(1) The hospital must have a full-time employee who- (i) Serves as director of the food and dietetic services; (ii) Is responsible for daily management of the dietary services; and (iii) Is qualified by experience or training. This Standard is not met as evidenced by: 40282 Based on review of the Arkansas Rules and Regulations for Hospitals and Related Institutions, 2024, North Arkansas Reginal Medical Center (NARMC) Tray Audit reports, and interview, it was determined the director of food services failed to perform daily management of dietary services to assure safe practices for food handling in that of food temperatures on the patient tray line were not meeting regulated food temperatures taken before and after every meal in 11 of 47 (03/05/26-04/20/26) days. The failed practice did not ensure food was maintained at safe food temperatures during tray line service and had the likelihood to affect anyone receiving food from the dietary service. Findings follow: A. Review of Arkansas Rules and Regulations for Hospitals and Related Institutions, 2024, showed temperatures of food at bedside to be for hot foods >140-degree Fahrenheit (F) and cold foods < 40 degrees. B. Review of NARMC Tray Audit forms for 03/05/26-04/20/26 showed the following: temperatures. 1. 03/05/26 Breakfast (hot foods) a. Eggs:133 degrees F b. French Toast Sticks:124 degrees F (cold foods) c. Grapes:49 degrees F Dinner (hot foods) d. Broccoli 135 degrees F 2. 03/11/26 Lunch (hot foods) a. Greenbeans:137 degrees F (cold foods) b. Lemon Bar: 56 degrees F 3. 03/16/26 Lunch (hot foods) a. Soup:133 degrees F 4. 03/18/26 Breakfast (hot foods) a. Eggs:132 degrees F b. Ham & Gravy:133 degrees F (cold foods) c. Applesauce:49 degrees F 5. 3/20/26 Lunch (hot foods) a. Carrots 131 degrees F (cold foods) 47 degrees F 6. 03/25/26 Dinner (cold foods) a. Oranges: 43 degrees F b. Chocolate Milk: 42 degrees F 7. 03/26/26 Lunch (hot foods) a. Meatloaf: 124 degrees F b. Mashed Potatoes with Gravy:134 degrees F (cold foods) c. Fruit Cocktail: 48 degrees F 8. 04/05/26 Breakfast (hot foods) a. Eggs: 131 degrees F b. Pancakes: 130 degrees F 9. 04/08/26 Lunch (hot foods) a. Green Beans: 137 degrees F (cold foods) b. Applesauce: 46 degrees F Dinner (hot foods) c. White Rice 135 degrees F d. Canned Carrots 137 degrees F 10. 04/17/26 Dinner (cold foods) a. Grapes: 46 degrees F 11. 04/20/26 Lunch (hot foods) 1. Broccoli and Cauliflower: 130 degrees F (cold foods) 2. Peaches: 47 degrees F C. During interview on 04/21/26 at 9:15 AM the Director of Food and Nutrition verified the findings above.”

“MAINTENANCE OF PHYSICAL PLANT CFR(s): 482.41(a) The condition of the physical plant and the overall hospital environment must be developed and maintained in such a manner that the safety and well-being of patients are assured. This Standard is not met as evidenced by: 47688 Observation of Med Surg, Laundry, Dietary, and the Intensive Care Unit showed that the facility failed to maintain the physical environment in a safe, sanitary, and properly maintained condition to ensure resident health and safety. This deficient practice had the potential to affect all residents, staff, and visitors residing in or utilizing affected areas of the facility by increasing the risk for infection control concerns, environmental safety hazards, and compromised sanitary conditions. A. On 04/22/2026 at 9:30am the Laundry room washers were observed dirty with visible buildup/residue. B On 04/22/2026 at 10:15 am the Laundry room walls and ceiling were observed with damaged and deteriorated. C. On 04/22/2026 at 10:45 am the Laundry room vents and ductwork were observed with deteriorating and chipped paint.. D. On 04/22/2026 at 11:05 am the Kitchen ceiling was observed with peeling and damaged paint. EOn 04/22/2026 at 11:08 am the Kitchen vent about the food preparation area was observed with rust and chipped paint. F. On 04/22/2026 at 12:20 pm Med Surg Room 90 showed to have an exhaust fan vent not functioning properly. G. On 04/22/2026 at 12:33 pm ICU Door 5221 was observed with a damaged and missing seal around it. The findings of A-G were verified with the Director of Maintenenace. Observation of the facilities policies and procedures showed that the facility failed to ensure required maintenance, safety, and environmental monitoring documentation was consistently completed and maintained for review. This deficient practice had the potential to affect all residents, staff, and visitors by creating the risk that critical building systems, life safety equipment, emergency preparedness functions, and environmental safety controls may not be routinely inspected, tested, or verified for proper operation. Findings: A. Weekly generator checks. B. Weekly water temperature checks. C. Emergency Generator light checks. D. Weekly eyewash station checks. E. Monthly Ceiling tile inspection/checks. F. Monthly Fire extinguisher inspection/checks. G. Yearly Emergency door inspection/check. H. Yearly polarity/attention testing. I. Yearly Electrical infrared panel testing. The findings of A-I were verified with the director of maintenance.”

“INFECTION CONTROL SURVEILLANCE, PREVENTION CFR(s): The infection prevention and control program includes surveillance, prevention, and control of HAIs, including maintaining a clean and sanitary environment to avoid sources and transmission of infection, and addresses any infection control issues identified by public health authorities; and This Standard is not met as evidenced by: 31039 Based on review of policy, observation, and interview, it was determined the facility failed to maintain a clean and sanitary environment in that they failed to keep hand washing sinks and surrounding areas clean, per policy, in one of one (Emergency Department) Medication Room observed. By not keeping the hand washing sinks and surrounding areas clean, the facility could not ensure employees hands were clean to perform tasks like medication preparation, medication administration and patient care, to prevent the spread of infection. This failed practice had the likelihood of affecting all patients receiving medications and patient care in this area. Findings follow: A. Record review of the facility’s policy titled, “Environmental Services: Procedure for Cleaning the Emergency Department,” showed the Medication Room was to be cleaned daily. B. During a tour of the Emergency Department on 04/20/2026 from 2:13 PM to 2:53 PM, observation showed the following: The Medication Room medication preparation hand-washing sink was visibly dirty, with a brown substance accumulated around the sink’s edges and the back splash where it attached to the counter. Where the backsplash met the counter, a brown substance accumulated where the caulk was missing and along the caulk. The floor was visibly dirty with large dust accumulation, hair accumulation, and when this Surveyor took a clean wet paper towel to the floor, it collected dirt, dust, hair and was brown. C. The findings were verified at the time of observation by the Chief Nursing Officer. 40282 Based on policy review, observation and review of freezer temperature logs and interview it was determined the Infection Control Officer failed to identify and control infections in that the freezer temperatures were not monitored to prevent microbial contamination of breast milk in one of one (Women’s Services) breast milk freezer. The failed practice did not ensure the breast milk was being stored at 0 degrees Fahrenheit to inhibit microbial growth and contamination and had the likelihood of affecting all newborns who had their mother’s breast milk stored in the freezer. Findings Included: A. Review of facility policy titled “Protocol: Breast pumping, storage of Expressed Breastmilk, and Heating Breastmilk” dated 02/22/17 showed the facility was to maintain the freezer at 0 degrees Fahrenheit (F) for storage of breast milk. B. During observation of the Women’s Services tour on 04/21/26 at 1:00 PM, a breast milk freezer was noted and the freezer’s log for 03/01/26 to 04/21/26 showed the following: 1. March 03/01 to 03/07: blank 03/08: temperature -1 03/09 - 03/11: blank 03/12 to 03/16: daily temperatures ranged from -1 to -3 03/17: blank 03/18 to 03/23: daily temperatures ranged from -1 to -3 03/24: blank 03/25: temperature -2 03/28 to 03/3: daily temperatures ranged from -1 to -3 2. April 04/01 to 04/07: daily temperatures ranged from -1 to -3 04/08 to 04/09: blank 04/10 to 04/21: daily temperatures ranged from -1 to -6 C. During interview on 04/21/26 at 1:00 PM the Compliance Risk Officer verified the findings in A and B. 50014 Based on review of medical records, policy and procedures, Infection Prevention and Control Plan, CDC guidelines, and interviews it was determined that the facility failed to track and report the Surgical Site Infections (SSIs), the facility breached the mandated CDC NHSN Guidelines and failed to execute its Infection Control Program. The failed practice impacted #18 and #21 of #21 surgical patients in that there was not any post-operative blood work done to ensure the patient remained infection free. Findings follow: A .Review of Infection Prevention and Control Plan dated 09/01/13, showed “...In order to ensure that the Plan is effective, monitoring will be conducted on a regular and ongoing basis to evaluate processes designed to reduce the risk of endemic and epidemic hospital acquired infections in patients ... Statement of Need: ...The risk of infection is inherent in the healthcare environment and that processes must be implemented to reduce or eliminate the risk. These processes include: Infection Surveillance .... Purpose: To ensure that the hospital provides quality health care in a cost effective manner, a comprehensive Infection Control Management Plan with be implemented to maintain, monitor and enforce a program which has as its objectives the safety of everyone who enters the organization, and improvement of patient care practices through education, communication, and surveillance of infection and performance. ...Management of the Information: ... B. Targeted surveillance with total house monitoring will be done for all hospitalized patients ... ...The Infection Control Manager is responsible ... Investigating and keeping records and logs of all communicable diseases or other reportable infections involving patients and reporting to the PEPS (Promoting Environmental and Patient Safety Committee). ...The members of the Medical Staff are responsible for: Reporting to the Infection Control Manager any Hospital acquired infections identified during or after discharge from the hospital. Adhering to all Infection Control policies and procedures. ...Ongoing Monitoring and Measurement of Performance: The PEPS Committee is responsible for establishing performance improvement standards to objectively measure the effectiveness of the Infection Control Program. Ongoing monitoring and measuring of performance regarding actual or potential risk related to one or more of the following will be done for the Infection Control Plan ... ...Postoperative Infection Reporting: ...Total knee infection rated to be 0.8-5.0 per 100 cases ... Total hip infection rated to be 0.9-2.4 per 100 cases. ...” B. Review of Definition of Hospital-Acquired (Nosocomial) Infections with unknown date, showed “ ...A surgical cite infection can involve the skin and subcutaneous tissue, deep tissues of the incision, or any organ/space manipulated during the operative procedure. Infection occurs 30 days after the operative procedure or 90 days if implant is in place and the infection appears to be related to the operative procedure. Specific criteria must be met depending on whether the infection is ski, deep tissue, or organ space. ...Specific infections that are not Health Care Acquired are listed in the CDC NHSN document. C. Review of the Centers for Disease and Prevention (CDC) Surgical Site Infection Site form dated January 2025, showed “Element: Must meet the following criteria: Date of event occurs within 30 or 90 days following the National Healthcare Safety Network (NHSN) operative procedure (where day 1 = the procedure date) according to the list in Table 2 ... Patient has at least one of the following: .... b. a deep incision that is deliberately opened, re=assessed, or aspirated by a surgeon, physician, or physician designee or spontaneously dehisces AND organism(s) identified from the deep soft tissues of the incision by a culture or non-culture based microbiologic testing method which is performed for purposes of clinical diagnosis or treatment (for example, not Active Surveillance Culture/Testing [ASC/AST]) or culture or non-culture based on microbiologic testing method is not performed. A culture or non-culture based microbiologic testing method is not performed. A culture or non-culture base test from the deep soft tissues of the incision that has a negative finding does not meet the this criterion.” D. Review of NARMC “Obtaining Post Surgical Infection Information from Physicians” effective date 04/16/99, showed “To monitor the incidence of post-op infections, information pertaining to post discharge will be obtained from physicians performing surgical procedures.” E. Review of Arkansas Orthopedics & Sports Medicine Visit Note dated: 02/18/26 “This is a 52 year old female who is being seen for a chief complaint of right knee. Patient #18 is 10 days post right knee removal of hardware, irrigation and debridement, placement of antibiotic spacers. Comes in well doing really good states pain is manageable. Otherwise states that she is tolerating everything pretty well ... Assessment and plan she is close to two weeks out from a right knee removal of deep orthopedic hardware with underlying infection. With placement of antibiotic spacers. She is on Rocephin 2 grams daily. Will have her continue with this we will follow-up in 1 month to reassess ... 03/09/26 “ ...Patient is 4 weeks status post right knee ROH (removal of hardware), l&D (irrigation and debridement), antibioticspacers. 4 weeks status post removal of total knee arthroplasty with application of temporary antibiotic spacer components. She comes in after having some increasing pain and just related to being nervous about the infection. On exam today incision is very well-approximated no erythema at all. Minimal swelling. Good knee range of motion. Only lacks a couple days full extension. Flexes to at least 90. Good stability. We had a long discussion about how her knee would be painful while she had his temporary components in place but that she is doing so well at this point we will have her slowly progress activities as she can tolerate them. Not doing a lot though until after her neck surgery. Organ to see her back in 2 weeks to reevaluate and make sure things are looking good if things look good we will proceed with stage II of her revision right total knee arthroplasty.” 03/23/26 “Patient is 6 weeks status post right knee l&D and antibiotic spacers. Comes in doing really good, states that she still having some feelings of instability with fevers or chills. Physical exam good motion 0 degrees to about 110 with a stable varus valgus. Good strength 5 out of 5 sensation intact throughout. Otherwise unremarkable no pain over the medial lateral joint spaces walks with good cadence still little favoring to the right knee based on some pain as well as leg length discrepancy. She is utilizing a walker. Assessment and plan 1. Right total knee arthroplasty removal of hardware implementation of antibiotic spacers. At this point we will hold off on x-rays we will get those next week if she is going come back for aspiration following discontinuation of the antibiotics, I advocated that we will take at least 2 days for the Rocephin to clear her system to make sure that we don’t obtain false negative cultures. Will schedule right total knee arthroplasty removal of antibiotic spacers with total knee arthroplasty revision at that time based on cultures. She was in agreement this and very appreciative.” 03/30/26 “Patient is 6 weeks status post right total knee arthroplasty removal of hardware implementation of antibiotic spacers., status post IV antibiotics. 6 weeks status post removal of total knee arthroplasty with antibiotic spacers comes in doing well. States the knee still hurts a lot but getting around better on it. States that hurts to weight-bear. Denies any fevers or chills. Denies any redness or swelling in the leg anymore. On exam today her incisions well-healed. She actually has really good motion from Oto 100 degrees. Good stability. Her knees got a slight swelling in it. We talked about aspirating to verify there is no infection as we plan to proceed with revision total knee arthroplasty. She wants to do this. She was placed supine on the table her right superior lateral knee is prepped and alcohol injected with 3 cc of lidocaine. We then used an 18-gauge needle and aspirated the knee. We only got about 2 cc of bloody fluid. Covered this with a Band-Aid and Ace wrap. Will send these for aerobic anaerobic cultures. As long as these come back negative we will proceed with revision right total knee arthroplasty.” F. Review of North Arkansas Regional Medical Center Operative Note for Patient #18 04/07/26 at 10:04 AM, showed “Right total knee arthroplasty of all three components for failed right total knee arthroplasty with septic arthritis.” No evidence provided for post operative blood work before or after surgeries. G. Review of North Arkansas Regional Medical Center “Operative Note” dated 04/21/26 at 1:15 PM, showed Patient #21 “Revision right total knee arthroplasty with removal of antibiotic spacers. Right septic total knee arthroplasty status post I&D and hardware removal.” No evidence of preoperative lab work or post-operative lab work found. H. In an interview with the Infection Control Preventionist on 04/22/26 at 2:29 PM, she stated “My process for identifying surgical infections is to email the surgeons after the patients surgery date. They do not always respond so I watch for our surgical patients to come through the Emergency Room. The surgeons are not good about responding to my email requests.” She verified findings in A-G. I. In an interview with the CNO on 04/23/26 at 9:30 AM, she stated “Our orthopedic surgeons do not consistently use our lab for post-operative blood work. We depend on those physicians to communicate their infections to our Infection Control Nurse. Our Infection Control Nurse sends them emails to verify infections. They do not always respond to them.” She verified findings in A-H. 51070 Based on observation and interview, the facility failed to ensure a sanitary dietary environment and proper cleaning and maintenance of food service equipment. The failed practice did not ensure a sanitary dietary environment to prevent the potential for contamination of food served and had the likelihood of affecting all patients who received food from dietary services. Findings included: A. During tour of the dietary department on 04/22/26 at 2:45 PM this following was observed: 1. Back dry food and drink storage room : a. Walls with visible dirt and grim throughout. b. Several cracked floor tiles with missing pieces showed exposed glue and concrete floor underneath. c. Shelves of dry food goods were stored next to cinderblock wall with a large hole in which fire blocks were observed and brownish leak running from the hole down to the floor. d. Shelves with drinks were stored under a large air handler that showed areas of heavy rust and two painted metal panels that were bowed and paint flaking off. e. The far cinderblock wall showed 3 open holes with old tubing and foam sticking out above stored dry good goods. 2. Food preparation areas: a. Two ovens and one stove with visible dirt and grime build up on the oven doors and handles. b. A Ceiling access panel showed peeling paint over the food tray prep area. d. Grill: Visible rust and grease build up behind the grill. e. Tray preparation area with rust on the pipes. f. Pots and pans that were “clean” per interview with Dietary Director with visible food and small debris particles. g. Tile throughout the kitchen with several areas of broken and chipped pieces. h. Multiple areas showed peeling flaky paint. 3. The findings above were confirmed by the Director of Food Services on 04/22/26 at 3:30 PM. Based on observation and interview, the facility failed to maintain a clean sanitary laundry facility that was free of physical and mechanical defects. The failed practice did not prevent the spread of infectious organisms. The failed practice had the likelihood of affecting all patients within the facility. A. During a tour of the Laundry Services Department on 04/21/26 at 10:30 AM and again on 04/22/26 at 1:15 PM, the following was found: 1. The washers and dryers were in one large room. There was no observed delineation between the dirty area with the washers and clean area with the dryers. 2. The sorting area for soiled linen had a cabinet with several boxes of clean baby blankets. During an interview with the Environmental Services (ES) Manager on 04/21/26 at 10:40 AM, she confirmed the laundry had some storage issues and the baby blankets which were currently in circulation had been stored in the cabinet. 3. Four (4) of four front loading washers were observed with brownish rust-colored leaks running down the front and/or side of each machine. Also, there was brownish rust-colored patina around each pipe entering/exiting the washers and at the bottom of each door. 4. Along the back wall of the laundry a large painted air vent was observed with torn, flaking insulation, and areas of rustlike substance. Four uncovered bins with dirty linen were parked underneath the air vent. 5. A large folding machine was observed to have a buildup of lint and a brownish grease-like substance along the pipe above the machine. 6. The pipes and tops of machines had a build up of visible lint throughout. 7. The ceiling above the area where staff were observed folding linen showed an area of flaking ceiling paint. 8. Several wood cabinets were used to store clean linen along the front wall of the dryer/folding area. All of the cabinets observed had unsealed wood making it difficult to disinfect. B. During an interview with the ES Manager and the Director of Engineering on 04/22/26 at 1:40 PM, the findings in A were confirmed.”