HospitalInspections.org

Based on visual observation the facility failed to provide corridor doors that were not closing and latching in the frame. When the doors latch a smoke resistive seal is formed to protect the room ' s occupants. The deficient practice had the potential to affect 20 of 20 residents.
4 of 4 corridors had doors that were deficient.

Findings:

During the facility tour on 2/1/2018, between the hours of 9:00a-3:00p observation revealed corridor doors to surgery waiting, clean utility by nurses station, X-ray & dining room did not latch in the frame.

Interview with Maintenance revealed the facility was not aware of the doors to these rooms were not latching in the frame.

Based on visual observation the facility failed to assure the construction of the smoke barriers walls. The walls are required to be continuous and properly protected from penetrations and gaps. Unprotected penetrations would permit the movement of smoke from one compartment to the other in the facility. The deficient practice had the potential to affect 20 of 20 residents.
4 of 4 smoke barriers were deficient.

Findings:

During the facility tour on 2/1/2018, between the hours of 9:00a-3:00p observation revealed penetrations in the barrier walls at ER, business office, northwest hall & Central Supply corridor.

Interview with Maintenance revealed the facility was not aware of unsealed penetration.

Based on visual observation, the facility failed to provide emergency electrical wiring to essential equipment in accordance with NFPA 70. The deficiency has the potential to affect 20 of 20 residents.

Findings:

During the facility tour on 2/1/2018, between the hours of 9:00a-3:00p observation revealed the medicine refrigerator located in the nurses station was not connected to emergency power.

Interview with Maintenance revealed the facility was not aware that the refrigerator was not on emergency power.

Based on visual observation, the facility failed to provide a remote annunciator to operate outside of the generating room in a location readily observed by operating personnel. The annunciator is hard-wired to indicate alarm conditions of the emergency power source. In cases of a power outage the emergency generator powers essential life safety equipment for the facility. The deficient practice had the potential to affect 20 of 20 residents.

Findings:

During the facility tour on 2/1/2018, between the hours of 9:00a-3:00p observation revealed there was no remote annunciator panel for the emergency generator for the hospital.

Interview with Maintenance revealed the facility was not aware that a remote annunciator was not installed to indicate alarm conditions of the emergency generator.