HospitalInspections.org

Based on visual observation the facility failed to provide the continuation of the exit discharge to include access to the public way from all required exits. The access provides an easier transition for occupants to evacuate from all exits in the building. The deficient practice had the potential to affect 1 of 1 residents.
The exit discharge was deficient for 2 of 6 exits.

Findings:

During the facility tour on 8/24/2017, between the hours of 8:00a-4:30p observation revealed no exit discharge to public way located on exit from corridors in Med. Surg.

Interview with Administrator revealed the facility was not aware that the exit discharge did not continue to the public way.

Based on visual observation the facility failed to provide exterior emergency lighting with two bulbs in order to prevent total darkness when one bulb fails. Additionally, the exit discharge, at all required exits, shall be provided with lighting in emergency situations during nighttime hours. The deficient practice had the potential to affect 1 of 1 residents.
2 of 6 exits had emergency lighting that was deficient.

Findings:

During the facility tour on 8/24/2017, between the hours of 8:00a-4:30p observation revealed that 2 bulb light was not located at the exit discharge to light the exit discharge.

Interview with Administration revealed the facility was not aware of the 2-bulb requirement for emergency lighting fixture(s) and that the light fixture was not installed.

Based on visual observation the facility failed to assure that the building had a complete, supervised, automatic sprinkler system installed in accordance with NFPA 13. Activation of the sprinkler system shall trigger notification of the emergency to the fire alarm system within 90 seconds, which results in protection of life and property. This deficiency has the potential to affect 1 of 1 residents.

Findings:

During the facility tour on 8/24/2017, between the hours of 8:00a-4:30p observation revealed no sprinkler protection in the ASU #12 and ASU bathroom.

Interview with Administrator revealed the facility was not aware the automatic sprinkler system was not complete, which was acknowledged by the Administrator during the exit meeting.

Based on visual observation, the facility failed to comply with the requirements of NFPA 99 and other applicable codes with regard to electrical systems. In cases of a failure in the electrical systems this could have a detrimental affect on the life safety of the occupants. The deficient practice had the potential to affect 1 of 1 residents.

Findings:

During the facility tour on 8/24/2017, between the hours of 8:00a-4:30p observation revealed no emergency stop located remote of the emergency generator.

Interview with Administrator revealed the facility was not aware that these electrical system components were not provided.