HospitalInspections.org

Based upon observations and staff interviews on 3/31/15 between approximately 0800 and 1200 hours the facility has failed to maintain corridor walls so that they will resist the passage of smoke. This could allow the toxic product of combustion to move out of a room and into the exit access corridor and the smoke compartment which would endanger the residents, staff and/or visitors within the smoke compartment.

The findings include, but are not limited to:
There is an uncovered penetration in the corridor wall by room 101 and the cross-corridor doors.

The above was discussed and acknowledged by the Facility Maintenance Director.

Based upon observations and staff interviews on 3/31/15 between approximately 0800 and 1200 hours the facility has failed to maintain the exit discharge free of obstructions. This could cause an inability or delay in the evacuation of residents in the event of an emergency which would endanger residents, staff and/or visitors.

The findings include, but are not limited to:
The exterior rear courtyard exit gate requires two operations to unlatch and open in violation of NFPA 101 7.2.1.5.4.

The above was discussed and acknowledged by the Facility Maintenance Director.

Based upon observations and staff interviews on 3/31/15 between approximately 0800 and 1200 hours the facility has failed to provide fire sprinkler protection to all required areas of the facility. This could result in a fire not being contained to the area of origin and could endanger residents, staff and/or visitors.

The findings include, but are not limited to:

There is an approximately 10' by 14' unsprinklered storage room in the atrium that has a passthrough cut out of the cement wall connecting it to adjacent corridor storage rooms. (This room was formerly surrounded by 2 hour construction, but the passthrough has negated the 2 hour fire separation).

The above was discussed and acknowledged by the Maintenance Director.

Based upon observations and staff interviews on 3/31/15 between approximately 0800 and 1200 hours the facility has failed to properly install alcohol based hand rub dispensers. Dispensers installed improperly could result in hand rub coming in contact with an electrical source resulting in a fire causing potential endanger to residents, staff and/or visitors within the facility.

The findings include, but are not limited to:

There was an ABHR device installed directly above an electrical outlet in the corridor by the north soiled utility room.

The above was discussed and acknowledged by the Maintenance Director.