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201 EIGHTH AVENUE SE

OELWEIN, IA 50662

No Description Available

Tag No.: K0076

Based on observation and interview, the facility failed to maintain proper storage of oxygen tanks in accordance with National Fire Protection Association (NFPA) Standard 99, Standard for Health Care Facilities. This deficient practice affects approximately 2 staff in one of fourteen smoke zones. This facility has a capacity of 25 and a census of 5.

Findings include:

Observation and interview on 07/20/15 at 10:55 a.m., revealed the facility failed to secure one of three oxygen tanks in the ER Clean Supply Room. The Plant Operations Manager verified this observation at the time of the survey process.

No Description Available

Tag No.: K0147

Based on observation and interview, the facility failed to maintain the buildings electrical wiring system in accordance with National Fire Protection Association (NFPA) Standard 70, National Electrical Code, 1999 Edition. This deficient practice affects occupants in three of fourteen smoke zones and approximately 6 residents, staff, and visitors. This facility has a capacity of 25 and a census of 5.

Findings include:

1. Observation and interview on 07/20/15 at 10:21 a.m., revealed that Room #213 contained a surge protector that was being used to supply power to a lamp.

2. Observation and interview on 07/20/15 at 10:42 a.m., revealed that the Clean Utility Room on 2nd Floor North contained an electric water heater without a cover for the electrical wiring splices.

3. Observation and interview on 07/20/15 at 11:09 a.m., revealed that the Cafeteria Serving Area contained a non GFCI (Ground Fault Circuit Interrupter) protected electrical outlet that was within six feet of a sink with faucet.

4. Observation and interview on 07/20/15 at 11:23 a.m., revealed the Health Information Office contained a surge protector that was being used to supply power to a microwave. The Plant Operations Manager verified these observations at the time of the survey process.

LIFE SAFETY CODE STANDARD

Tag No.: K0076

Based on observation and interview, the facility failed to maintain proper storage of oxygen tanks in accordance with National Fire Protection Association (NFPA) Standard 99, Standard for Health Care Facilities. This deficient practice affects approximately 2 staff in one of fourteen smoke zones. This facility has a capacity of 25 and a census of 5.

Findings include:

Observation and interview on 07/20/15 at 10:55 a.m., revealed the facility failed to secure one of three oxygen tanks in the ER Clean Supply Room. The Plant Operations Manager verified this observation at the time of the survey process.

LIFE SAFETY CODE STANDARD

Tag No.: K0147

Based on observation and interview, the facility failed to maintain the buildings electrical wiring system in accordance with National Fire Protection Association (NFPA) Standard 70, National Electrical Code, 1999 Edition. This deficient practice affects occupants in three of fourteen smoke zones and approximately 6 residents, staff, and visitors. This facility has a capacity of 25 and a census of 5.

Findings include:

1. Observation and interview on 07/20/15 at 10:21 a.m., revealed that Room #213 contained a surge protector that was being used to supply power to a lamp.

2. Observation and interview on 07/20/15 at 10:42 a.m., revealed that the Clean Utility Room on 2nd Floor North contained an electric water heater without a cover for the electrical wiring splices.

3. Observation and interview on 07/20/15 at 11:09 a.m., revealed that the Cafeteria Serving Area contained a non GFCI (Ground Fault Circuit Interrupter) protected electrical outlet that was within six feet of a sink with faucet.

4. Observation and interview on 07/20/15 at 11:23 a.m., revealed the Health Information Office contained a surge protector that was being used to supply power to a microwave. The Plant Operations Manager verified these observations at the time of the survey process.