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631 NORTH BROAD STREET EXT.

GROVE CITY, PA 16127

Doors with Self-Closing Devices

Tag No.: K0223

Based on observation and interview, it was determined that the facility failed to inspect doors with closures on one of over fifty doors.

Findings include:

Observation on July 13, 2021, at 10:16 a.m., revealed the second floor, door 229, had the closure arm disconnected and zip tied preventing it from working properly.

Interview with the maintenance tech, on July 13, 2021, at 10:16 a.m., confirmed the door with the closure was disconnected.

Corridor - Doors

Tag No.: K0363

Based on observation and interview, it was determined that the facility failed to inspect one of over one hundred corridor doors.

Findings include:

Observation on July 13, 2021, at 11:00 a.m., revealed the first floor, door 1516, near PACU and ASU failed to latch in the frame.

Interview with the maintenance tech, on July 13, 2021, at 10:16 a.m., confirmed the door failed to latch.

Gas and Vacuum Piped Systems - Inspection and

Tag No.: K0908

Based on document review and interview, it was determined that the facility failed to comply with requirements of one of one gas and vacuum piped systems.

Findings include:

Document review on July 13, 2021, at 9:05 a.m., revealed the following medical gas deficiences on their April 27-28 2021 report:
A. (9:05 a.m.) med gas due point monitor is inaccurate;
B. (9:05 a.m.) normal change over lights are burnout/not present;
C. (9:05 a.m.) rm 302 cover frame damaged;
D. (9:05 a.m.) outlets/inlets leaks.

Interview with the maintenance tech on July 13, 2021, at 9:05 a.m., confirmed the deficiences listed above on the report were not corrected at the time of the survey.

Electrical Systems - Wet Procedure Locations

Tag No.: K0913

Based on observation and interview, it was determined that the facility failed to maintain electrical systems within wet procedure locations on two of three building levels.

Findings include:

Observation on July 13, 2021, between 9:44 a.m. and 12: 28 p.m., revealed the following wet procedure deficiencies:
A. (9:44 a.m.) second floor nursery sink, lacked a non-ground fault circuit interrupter (GFCI) outlet near the sink area;
B. (9:58 a.m.) second floor, room 254, lacked a non-ground fault circuit interrupter (GFCI) outlet near the sink area;
C. (10:00 a.m.) second floor, room 256, lacked a non-ground fault circuit interrupter (GFCI) outlet near the sink area;
D. (12:28 p.m.) first floor, therapy, had a hydro thermal hydrocollator that was not plugged into a GFCI outlet.


Interview with the maintenance tech on July 13, 2021, at 12:28 p.m., wet procedure deficiencies listed above.

Electrical Equipment - Power Cords and Extens

Tag No.: K0920

Based on observation and interview, it was determined that the facility failed to inspect electrical equipment on two of three floors.

Findings include:

Observation on July 13, 2021, between 10:10 a.m. and 12:20 p.m. revealed the following electrical equipment deficiencies:
A. (10:10 a.m.) second floor, room 212, had a microwave, toaster oven, and water cooler plugged into a surge protector;
B. (10:42) first floor, data room 1070, had a surge protector plugged into a surge protector;
C. (12:20) first floor, near corridor 14111, behind vending, had a surge protector secured tightly to the wall.

Interview with the maintenance tech, on July 13, 2021 at 12:20 p.m., confirmed the electrical deficiencies listed above.