The contamination affected shower facilities on two floors of the 89-bed nursing home. Twenty-five residents living on hall 300 and 16 residents in the Memory Care Unit used the compromised bathing areas daily.
During an initial tour on November 24, inspectors documented extensive ceiling damage in the hall 300 shower room. Black substance coated portions of the ceiling. Loose plaster hung in the left corner above the bathtub. A ceiling grate had come loose, with cracked plaster surrounding it.
Near the shower room door, inspectors found more black and brown substance on the ceiling by a sprinkler head. The contamination appeared to have been painted over previously but was now showing through the paint.
The Memory Care Unit shower room presented even more concerning conditions. Inspectors observed blackish brown substance covering the ceiling that appeared to be mold. The room carried a distinct musty smell.
Staff members confirmed what inspectors documented. Certified Nursing Assistant #156 verified the blackish brown substance on the Memory Care Unit shower room ceiling during an interview on November 25. While she said the room didn't smell musty at that moment, she admitted detecting a musty odor when she first entered the shower room at the start of her shift.
"When she first entered the shower room upon starting her shift there was a musty smell in the shower room," the inspection report stated.
Another nursing assistant, CNA #189, confirmed the black substances and loose plaster in the hall 300 shower room during a separate interview.
The facility's own policy, dated July 28, 2020, required maintaining "a safe, clean, comfortable and homelike environment." The policy specifically stated that housekeeping and maintenance services would be provided "as necessary to maintain a sanitary, orderly, and comfortable environment."
The conditions violated federal requirements that nursing homes maintain areas that are safe, easy to use, clean and comfortable for residents, staff and the public.
The inspection represented the culmination of multiple complaints filed against the facility. Federal investigators noted the deficiency stemmed from three separate complaint investigations numbered 2622146, 2591474, and 2580514.
The contaminated shower rooms posed particular concerns for the affected residents. The 25 residents on hall 300 and 16 residents in the Memory Care Unit depended on these facilities for basic hygiene needs. Memory Care Unit residents, who typically have dementia or Alzheimer's disease, face heightened vulnerability to environmental hazards due to their cognitive impairments.
Mold exposure can trigger respiratory problems, allergic reactions, and other health complications, especially among elderly residents who often have compromised immune systems. The musty odors detected by staff suggested ongoing moisture problems that could worsen contamination over time.
The facility had attempted to address at least some of the contamination by painting over the black substance near the door of the hall 300 shower room. However, the underlying problem persisted, with the contamination bleeding through the paint.
Federal inspectors classified the violation as causing "minimal harm or potential for actual harm" to residents. The designation indicated that while residents hadn't suffered documented injuries from the contaminated shower rooms, the conditions created risk of future harm.
The loose plaster and damaged ceiling grates represented additional safety hazards beyond the suspected mold contamination. Falling plaster could injure residents during bathing, when they are most vulnerable and potentially unable to protect themselves.
Nursing assistants who work in these shower rooms daily faced occupational exposure to the contaminated environments. Their acknowledgment of musty odors indicated awareness of problematic conditions, yet the contamination persisted.
The facility operates under a policy promising residents they can "receive care and services safely" in an environment that "maximizes resident independence and does not pose a safety risk." The contaminated shower rooms directly contradicted these commitments.
Forty-one residents at Arbors at Delaware continued using shower facilities with black ceiling contamination, loose plaster, and musty odors that staff could detect from the moment they entered the rooms.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Arbors At Delaware from 2025-11-26 including all violations, facility responses, and corrective action plans.