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Tag No.: K0161
Based on observation and interview, it was determined the facility failed to maintain building construction requirements in one location, affecting one of one floor.
Findings include:
1. Observation on December 8, 2020, at 9:40 a.m., revealed the ceiling panel located within clean line required repair.
Exit interview with the facility administrator on December 8, 2020, between 10:35 a.m. and 10:45 a.m., confirmed the building construction deficiency.
Tag No.: K0321
Based on observation and interview, it was determined the facility failed to maintain one hazardous area enclosure, affecting one of one floor.
Findings include:
1. Observation on December 8, 2020, at 9:55 a.m., revealed the medical records room door was held open by unapproved means (door chock).
Exit interview with the facility administrator on December 8, 2020, between 10:35 a.m. and 10:45 a.m., confirmed the hazardous area enclosure deficiency.
Tag No.: K0353
Based on observation and interview, it was determined the facility failed to maintain the automatic sprinkler system in one location, affecting one of one floor
Findings include:
1. Observation on December 8, 2020, at 9:02 a.m., revealed the automatic sprinkler gauges were overdue for replacement, or recalibration (12/2014).
Exit interview with the facility administrator on December 8, 2020, between 10:35 a.m. and 10:45 a.m., confirmed the automatic sprinkler system deficiency.
Tag No.: K0363
Based on observation and interview, it was determined the facility failed to maintain one corridor opening, affecting one of one floor.
Findings include:
1. Observation on December 8, 2020, at 9:15 a.m., revealed the resident room 218 door was not smoke-tight.
Exit interview with the facility administrator on December 8, 2020, between 10:35 a.m. and 10:45 a.m., confirmed the corridor opening deficiency.
Tag No.: K0923
Based on observation and interview, it was determined the facility failed to maintain cylinder storage in one location, affecting one of one floor.
Findings include:
1. Observation on December 8, 2020, at 9:33 a.m., revealed an unsecured oxygen tank was located within the oxygen storage room.
Exit interview with the facility administrator on December 8, 2020, between 10:35 a.m. and 10:45 a.m., confirmed the oxygen cylinder storage deficiency.