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Based upon observations made in the presence of the facility manager on 09-14-2022, it was determined that the facility did not maintain exit and directional signs with continuous illumination that is served by the emergency lighting system in accordance with NFPA 101 19.2.10.1 and 7.10.

This deficiency affected 1 of numerous exit signs.

Findings include:
During the facility tour it was observed that the exit signage was missing from the pre-op hall/corridor exit. Exit and directional signs shall be displayed in accordance with NFPA 101 7.10.

Based upon observations made in the presence of the facility managers on 09-14-2022, it was determined that the facility did not maintain electrical equipment in accordance with NFPA 101 19.5.1 and 9.1.2.

This deficiency affected 1 GFIC outlets.

Findings include
1-During the facility tour it was observed that the 1 outlet at the ER med room hand wash sink was not GFIC protected and was observed to be within 6ft of the sink and not GFCI protected. The facility manager confirmed these findings. GFCI outlets are required where the receptacles are installed to serve the countertop surfaces and are located within 6 ft. (1.83 m) of the outside edge of the sink. NFPA 101 Section 19.5.1, 9.1.2; 1999 NFPA 70 Article 210-8(7)

Based upon observations made in the presence of the facility manager on 09-14-2022, it was determined that the facility was using portable space heaters in resident rooms. NFPA 101 19.7.8.

This deficiency affected three resident rooms
.
Findings include:
During the facility tour it was observed that facility was using 2 portable space heaters, one in the Employee health office and one in the clinical support services office these offices are part of the Medical surgical smoke compartment. Portable space-heating devices shall be prohibited in all health care occupancies in accordance with NFPA 101 19.7.8.

Based upon observations made in the presence of the facility manager on 09-14-2022, it was determined that the facility did not maintain medical gas storage in accordance with NFPA 99 5.1.3.3.2.

This deficiency affected 1 of several stored cylinders.

Findings include:
1-During the facility tour with the facility manager it was discovered that there was a E cylinder in the Nursery room that was not secured and not in accordance with NFPA 99 5.1.3.3.2 (7)