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1001 PINE STREET

RENOVO, PA 17764

General Requirements - Other

Tag No.: K0100

Based on observation and interview, it was determined the following item(s) did not meet the minimum standards for the operation of a facility as set forth by the Department and by other State and local agencies responsible for the health and welfare of residents within the facility.

Findings include:

1. Review of documentation on May 8, 2023, at 11:00 a.m., revealed the facility lacked a carbon monoxide detector near the Dietary area.

Exit interview with the facility administrator and facility representative #1, on May 8, 2023, at 12:00 p.m., confirmed the lack of a carbon monoxide detector.

Building Construction Type and Height

Tag No.: K0161

Based on observation and interview, it was determined the facility failed to maintain fire-rated construction, affecting one of three smoke compartments.

Findings include:

1. Observation on May 8, 2023, at 10:47 a.m., revealed unsealed penetrations located above the common wall doors.

Exit interview with the facility administrator and facility representative #1, on May 8, 2023, at 12:00 p.m., confirmed the unsealed penetrations.

Doors with Self-Closing Devices

Tag No.: K0223

Based on observation and interview, it was determined the facility failed to maintain doors with self-closing devices, affecting two of three smoke compartments.

Findings include:

1. Observation on May 8, 2023, at 11:00 a.m., revealed the smoke barrier doors located at the Acute Hall could not close and latch when released due to dragging on the floor.

Exit interview with the facility administrator and facility representative #1, on May 8, 2023, at 12:00 p.m., confirmed the doors could not close and latch.

Subdivision of Building Spaces - Smoke Barrie

Tag No.: K0372

Based on observation and interview, it was determined the facility failed to maintain smoke barrier walls, affecting two of three smoke compartments.

Findings include:

1. Observation on May 8, 2023, at 11:28 a.m., revealed unsealed penetrations located above the cross-corridor doors at the Dietary area.

Exit interview with the facility administrator and facility representative #1, on May 8, 2023, at 12:00 p.m., confirmed the penetrations.

Electrical Equipment - Power Cords and Extens

Tag No.: K0920

Based on observation and interview, it was determined the facility failed to maintain electrical wiring and equipment, affecting one of three smoke compartments.

Findings include:

1. Observation on May 8, 2023, at 10:58 a.m., revealed the Phone room had several extension cords in use.

Exit interview with the facility administrator and facility representative #1, on May 8, 2023, at 12:00 p.m., confirmed the unauthorized extension cords.

Gas Equipment - Cylinder and Container Storag

Tag No.: K0923

Based on observation and interview, it was determined the facility failed to maintain medical gas storage, affecting one of three smoke compartments.

Findings include:

1. Observation on May 8, 2023, at 11:10 a.m., revealed three unsecured oxygen cylinders located in the Medical Gas Storage room.

Exit interview with the facility administrator and facility representative #1, on May 8, 2023, at 12:00 p.m., confirmed the unsecured cylinders.