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Regulations Update

Federal Regulation - F253 Housekeeping and Maintenance

Marci Pederson, RN, BSN, Nurse Educator/Consultant

South Dakota long term care facilities had 28 deficiencies cited for F253 in 2009. It ranks number five in the top ten deficiencies for long-term care facilities in South Dakota.

F253 states, “Housekeeping and maintenance services necessary to maintain a sanitary, orderly, and comfortable interior”

The overall intent of F253 is to focus on the facility’s responsibility to provide effective housekeeping and maintenance services.

The Guidance to Surveyors for this regulation is brief, but compliance with this regulation is of utmost importance to our residents. This particular regulation overlaps with the Infection Control F441 regulation and the Kitchen Sanitation in F371.

We need to explore the process of perception when we look at this regulation.  Each of us has our own perception of what it means to be sanitary/clean, orderly, or comfortable. For that reason housekeeping and maintenance services need to have policies and procedures in place to help ensure consistent practices in the quest for a sanitary, orderly, and comfortable environment.

The following questions are helpful to ask when assessing compliance with this regulation:

  • Is resident equipment sanitary?
  • Is the area orderly?
  • Is the area uncluttered and in good repair?
  • Can residents and staff function unimpeded?

Resident equipment

This ranges from toothbrushes to dentures, denture cups, eye-glasses, water pitchers, emesis basins, hair brushes, combs, bed pans, commodes, urinals, wheelchairs, mechanical lifts, walkers, canes, telephones, positioning devices, beds, and toilet stools. Resident equipment is anything which is used to provide the resident with the best care possible. When resident equipment is not sanitary, it presents an infection control risk to the residents. Most resident equipment should not be shared. Mechanical lifts, however, are usually shared unless the resident is in isolation. Shared mechanical lifts contact surfaces should be sanitized between residents.

What kind of systems are in place to ensure the residents’ equipment is sanitary?  Are there cleaning schedules for the wheelchairs? Are assignments given to specific staff to clean the wheelchairs on a weekly or bi-weekly basis? Are they expected to sign off on the cleaning schedule when they complete the task to help them be accountable for this? What do the toilet stools or commodes look like?  Are they clean? Do you ever notice lingering odors from toilets or commodes? Does maintenance service check the larger equipment on a regular basis to ensure the equipment is functioning according to manufacturers’ recommendations and in a safe manner? What kind of system is set up to ensure equipment is safe and sanitary?


“Orderly” is defined as an uncluttered physical environment that is neat and well-kept. This concept is also a matter of perception. What I perceive as neat and orderly may be different than what another person perceives as neat and orderly.  For that reason it is helpful to listen to your residents and/or their family members in regards to this. Safety usually outweighs “homelike” if it is not possible for an area to be both safe and homelike. For instance, a resident may prefer a clutter room, but does this clutter result in unsanitary or unsafe conditions? If unsanitary or unsafe conditions are occurring, staff will need to educate and negotiate with the resident to adjust the living area to accommodate sanitary and safe conditions.

Comfortable Environment

When you visit with your residents about their comfort do they provide a positive response or do they have complaints?  For the residents who cannot voice their opinion, what type of facial expressions do they exhibit?

What could be addressed in deficiencies for F253?  I have listed some examples in the list below.

  • Dirty mechanical lifts
  • Whirlpool tubs with enamel chipped which causes a non-cleanable surface
  • Toothbrushes stored on the back of a toilet stool
  • Commodes with brown material on the seat for two days in a row
  • Dirty hand rails
  • Excessive flies
  • Doors to resident rooms which show an accumulation of old dirt
  • Dirty wheelchairs
  • Broken vinyl on wheelchair arm rests which creates a non-cleanable surface

How can an F253 deficiency be prevented? Initiate an environmental walk-through by someone who does not normally work in the facility on a daily basis. Why would it be preferable for someone who isn’t in the facility daily to do environmental rounds? Here is why. Have you ever noticed how dirty stuff pops out at you at home when you are getting ready for company?  Suddenly we notice:

  • How dirty a light switch is
  • How the wall needs to be washed where the dog likes to lean when he lies down on the cold air vent
  • How dusty the cupboard doors are
  • How the dishwasher and oven doors have all this dried stuff running down the side
  • How the toaster has grease on the side

We didn’t notice these things until we started looking at our home in a way an outsider might look.

Survey preparation requires team work and effort. Is your team on board for a successful survey when the Department of Health arrives?  Call today to set up an environmental assessment. I can provide this service in a way which is helpful and non-threatening to staff. While on site, I can work with staff to set up a plan to stay ahead of the environmental crunch. Start early so your team can accomplish change; improvements require sufficient time.

Contact Avera Education and Staffing Solutions at 605-668-8475 to schedule a consultation.


Marci Pederson, RN, BSN

Marci Pederson, RN, BSN

As a former health facilities senior surveyor, Marci served a variety of health care facilities. Her experience includes nursing education, medical/surgical nursing, psychiatric nursing, infection control, utilization review and quality assurance.

Have a question for Marci? A topic idea for her next column? Need more information on having a mock survey at your facility? Send her an email at