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Regulations Update

Marci Pederson, RN, BSN, Nurse Educator/Consultant

Federal Regulation F253

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

South Dakota long-term care facilities had 27 deficiencies cited for F253 in 2010.  It ranks number five in the top twenty deficiencies for long-term care facilities in South Dakota.

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

Housekeeping Services:
Housekeeping staff may not know how important they are to their employing facilities.  Have you ever thought what life would be like for your residents or patients without the people who provide housekeeping?  When I worked as a surveyor, one of my preceptors gave me some valuable advice when I was still in orientation, “If you ever want to know what is really going on with the residents/patients, talk with housekeeping staff.”  The housekeeping staff are usually in every room of the facility every day cleaning floors, dusting, emptying waste baskets, cleaning sinks, washing mirrors, and so much more.  During this process the housekeepers are present in the residents’ rooms.  “Listening to the residents” may not be included in housekeepers’ job descriptions, but many housekeepers end up doing just that while they are in the residents’ rooms.  This isn’t part of the regulation or the intent of the regulation.  Nonetheless, this may be part of what housekeepers might do for residents/patients along with their usual housekeeping duties.  As we all know, one thing leads to another – so it is also a good idea to consider reviewing with housekeeping staff how they can ensure compliance with residents’ confidentiality rights so resident information is not shared with the wrong person. 

Maintenance Services:
Maintenance staff make a difference between a safe and unsafe environment for our residents/patients.  This regulation does not directly address accident hazards but when the physical environment is not in good repair and is not orderly, accident hazards can also develop which could lead to another deficiency for (F323) accident hazards.  We have all had busy times in our own homes when we don’t have enough time to discard junk mail, put away laundry, or wash dishes.  It gets pretty cluttered in no time.  Have you ever noticed how you feel when this happens?  Most of us begin to feel a little rise in anxiety.  The rise in anxiety can occur in residents/patients and staff when a health care facility is not maintained and kept clutter free. 

Housekeeping and maintenance staff are key members of the health care team and we need them to help our facilities run smoothly.  

What characteristics make excellent housekeeping and maintenance staff?  Here are ten characteristics of excellent housekeeping and maintenance staff.  You may ask where these characteristics came from.  These are characteristics I observed in facilities who did not receive deficiencies for F253.

  1. Excellent housekeepers pay attention to detail.  How does one know if housekeepers pay attention to detail?  Here is an example.  When floor corners and edges are clean with no build up of dirt adhering to that area of the floor, housekeepers are paying attention to detail and are not just moving the wet mop back and forth.
  2. Excellent housekeepers have a basic understanding of infection control. 
    • Excellent housekeepers know what to use to clean a bathroom, equipment, and room of a resident/patient with Clostridium difficile.  A 1:10 bleach solution is the recommended cleaning method.  They would mix one part bleach to nine parts water.  There are at least a couple of ready-to-use products available, but the most economical product is the 1:10 bleach solution recommended by the Centers for Disease Control and Prevention. 
    • Having excellent housekeeping staff can make a difference between having a couple of residents/patients with flu-like symptoms and having several residents/patients with flu-like symptoms.  Housekeepers make sure they follow facility cleaning procedures.  They change their mop bucket sanitizing solution according to the manufacturer’s recommendations.  They mix the sanitizing product at the correct concentration.  They are religious about cleaning resident/patient contact items such as door knobs, hand rails, telephones, toilet stools, bathtubs, showers, etc. 
    • They wash their hands according to facility procedures.
  3. Excellent maintenance staff have preventive maintenance systems in place and they take action when there is a discrepancy in their monitoring reports.  Monitoring water temperatures is one example.  If the water temperature logs reveal the water in residents’/patients’ rooms is over 125° F, maintenance staff  will take action to correct the problem, and while this is being accomplished they will take measures to ensure residents/patients do not have access to hot water until it is corrected.
  4. Excellent maintenance staff know how to clean their tools after fixing a clogged toilet stool of a resident/patient who has Clostridium difficile.  They will clean their tools with a 1:10 bleach solution containing one part bleach and nine parts water.
  5. Excellent housekeepers make sure they wear appropriate PPE when cleaning blood and body fluids.
  6. Excellent maintenance workers monitor the exhaust ventilation systems to make sure they are functioning.  This should be part of their scheduled preventive maintenance system.   The worker will test the ventilation for outward air flow in the soiled laundry room as scheduled and/or whenever there is a strong odor in that area.  If there is no outward air flow, the maintenance staff person will take action to repair the ventilation system.  Recently I was working with a facility laundry employee.  There was a very strong odor in the soiled linen room.  The laundry employee tried to resolve the problem ineffectively by propping the door open between the clean laundry area and the soiled laundry room.  At the time the facility had two cases of influenza.  It was possible the faulty ventilation system could have been a causative factor for any increase in flu cases even though the direct care staff were doing everything they could to prevent further transmission.
  7. Excellent housekeepers clean floors using dustless methods to prevent spreading bacteria, spores, and viruses through the air.
  8. Excellent housekeepers keep their MSDS book in their work area so they have ready access to product information if a cleaning chemical spill occurs.
  9. Excellent maintenance workers utilize a work order system and make every effort to repair or test equipment in a prompt manner.
  10. Excellent housekeepers keep their cleaning carts clean to prevent potential cross-contamination when using their cart.

Please call AESS today at 605-668-8475 to set up an environmental assessment and for all of your survey solutions needs.  I can provide these services in a way which is helpful and non-threatening to staff.  While on site, I can work with staff to set up improvement plans and preventive maintenance systems to be pro-active instead of re-active.


As a former health facilities senior surveyor, Marci worked at the Department of Health Office of Licensure and Certification for eight years. Marci provides Survey Preparedness Consulting designed to create a culture of constant survey preparedness by helping staff understand regulatory requirements, not just comply with them.

Do the math! The facility bottom line improves when resident care continually improves.

Read more Regulations Updates. The Avera Solutions’ Blog contains writings from Marci and other Avera Education & Staffing Solutions staff and consultants.

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.