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Based on observations and interview , the facility failed to maintain the 2 hour fire resistance separation between 2 different building types in 2 locations. This deficient practice would affect all approximately 20 staff members within the affected zones. The facility had a capacity of 25 residents and a census of 7 residents.

Findings include:

Observations and interview on 12/5/11, revealed the following:

1. The 2 Hour Fire Barrier located above the Conference Room Corridor Doors to the Clinic revealed only 1 sheet of 5/8 inch sheetrock which provides a 1/2 hour separation not the required 2 hour fire separation. This barrier also revealed a hole (approximately 3 inches in size) and a wire bundle penetration (approximately 1/2 inch in size).

2. The 2 Hour Fire Barrier Wall to the Surgery Suite revealed a wire penetration (approximately 1/2 inch in size) located above the suspended ceiling tile.

3. The 2 Hour Fire Barrier Wall to the Surgery Suite and the '74 Addition revealed a hole (approximately 4 inches in size) located in the left side of the Fire Wall above the suspended ceiling, a cable penetration (approximately 1 inch in size) located above the suspended ceiling, a brick hole pentostatin (approximately 3 inches in size) located above the suspended ceiling. The Fire Doors at this location also failed to close and latch properly into the door frame with the swing of the door closers.

The Facility Maintenance Director confirmed these findings on the date of inspection.

Based on observations and interview, the facility failed to maintain 3 of approximately 40 corridor room walls in 2 of 6 smoke zones properly separated from the corridor. This deficient practice could affect approximately 3 residents within the affected zones. The facility had a capacity of 25 residents and a census of 7 residents.

Findings include:

Observations and interview on 12/5/11, revealed the following:

1. The 2nd Floor '64 Addition Pharmacy revealed a wire bundle penetration (approximately 1 inch in size) located in the Corridor Wall.

2. The 2nd Floor '64 Addition Room 200 revealed a wire bundle penetration (approximately 1 inch in size) located in the Corridor Wall.

3. The 2nd Floor '38 Addition Dietician Office revealed a flexible conduit penetration (approximately 1/4 inch in size) located in the Corridor Wall above the door.

The Facility Maintenance Director confirmed these findings on the date of inspection.

Based on observations and interview, the facility failed to maintain 2 of approximately 30 room corridor doors in 1 of 6 smoke zones in proper working condition. This deficient practice would affect approximately 2 residents within the affected zones. The facility had a capacity of 25 residents and a census of 7 residents.

Findings include:

Observations and interview on 12/5/11, revealed the following:

1. The 2nd Floor '38 Addition Patient Room 214 revealed the door had been detached from the door closer that was attached to the door and the wall but detached in the middle of the device.

2. The 2nd Floor '38 Addition Nursing Administrator Office revealed the door had been detached from the door closer.

The Facility Maintenance Director confirmed these findings on the date of inspection.

Based on observations and interview, the facility failed to maintain proper 1 hour vertical fire separation in 3 of approximately 60 rooms within 3 of 6 smoke zones. This deficient practice could affect approximately 7 residents within the affected zones. The facility had a capacity of 25 residents and a census of 7 residents.

Findings include:

Observations and interview on 12/5/11, revealed the following:

1. The 2nd Floor '38 Addition Respiratory Therapy Stress Room revealed a vertical conduit penetration (approximately 1/4 inch in size).

2. The 2nd Floor '64 Addition Clean Utility Room revealed a vertical conduit penetration (approximately 1/2 inch in size) located above the Corridor Door door closer.

3. The 1st Floor Patient Registration Audio Corner revealed 2 vertical cable penetration (approximately 1/2 inch in size).

The Facility Maintenance Director confirmed these findings on the date of inspection.

Based on observations and interview, the facility failed to maintain 3 of 6 smoke barriers in accordance with National Fire Protection Association (NFPA) Standard 101, 2000 edition, 19.3.7.3. Smoke barriers shall be continuous from outside wall to outside wall and from floor to a roof extending through all concealed spaces. Smoke barriers shall have a fire resistance rating of not less than 1/2 hour. This deficient practice affects approximately 4 residents within the facility. This facility has a capacity of 25 and a census of 7 residents.

Findings include:

Observations and interview on 12/5/11, revealed the following:

1. The 1st Floor '74 Addition Smoke Barrier by X-Ray revealed a wire penetration (approximately 1/4 inch in size) located above the suspended ceiling.

2. The 2nd Floor '38 Addition Smoke Barrier by Room 222 revealed a conduit penetration (approximately 1 inch in size) located above the suspended ceiling.

3. The 2nd Floor '38 Addition 1 Hour Fire Wall to the '64 Addition revealed a cable bundle penetration (approximately 1 inch in size) and a wire penetration (approximately 1/2 inch in size) located above the suspended ceiling.

The Facility Maintenance Director confirmed these findings on the date of inspection.

Based on observations and interview, the facility failed to maintain 1 of approximately 8 sets of smoke barrier doors in proper working condition. This deficient practice would affect approximately 3 residents within the facility. The facility had a capacity of 25 residents and a census of 7 residents.

Findings include:

Observation and interview on 12/5/11, revealed the 1st Floor Surgery Clinic Hallway Door from the Nurse's Station failed to close and latch properly into the door frame with the swing of the door closer when tested. The Facility Maintenance Director confirmed this finding on the date of inspection.

Based on observations and staff interview, the facility failed to provide separation of 6 of approximately 15 hazardous areas from other compartments in accordance with National Fire Protection Association (NFPA) Standard 101, The Life Safety Code, 2000 edition, 19.3.2.1. This deficient practice would affect approximately 7 residents within the affected zones. The facility had a capacity of 25 residents and a census of 7 residents.


Findings include:

Observations and interview on 12/5/11, revealed the following:

1. The Basement Purchasing Office revealed the door failed to close and latch properly into the door frame with the swing of the door closer when tested.

2. The 1st Floor Surgery Storage Room revealed a vertical hole (approximately 1/2 inch in size) located in the ceiling lid of the room.

3. The Basement North Mechanical Room revealed multiple penetrations (approximately 2 inches in size to approximately 3 feet in size each) in the fire resistant protective covering for the Steel "I" Beams throughout the room.

4. The Basement North Elevator Room revealed the door failed to close and latch properly into the door frame with the swing of the door closer when tested.

5. The 3rd Floor Data Server Room revealed a vertical cable penetration (approximately 1/2 inch in size) located in the ceiling lid.

6. The 2nd Floor '64 Addition Nurse's Station Mechanical Room revealed a pipe bundle penetration (approximately 1 inch in size) located in the ceiling lid.

The Facility Maintenance Director confirmed these findings on the date of inspection.

Based on observations and interview, the facility failed to maintain 2 means of egress in 1 of 6 smoke zones easily accessible at all times. This deficient practice would affect approximately 6 residents and 4 staff members within the affected zone. The facility had a capacity of 25 residents and census of 7 residents.

Findings include:

Observations and interview on 12/5/11, revealed the following:

1. The 2nd Floor '64 Addition Medication Mixing Room door revealed a hasp and latch device on this door.

2. The 2nd Floor '64 Addition Corridor revealed multiple lifts and storage in the corridor at the time of inspection.

The Facility Maintenance Director confirmed these findings on the date of inspection.

Based on observations and interview, the facility failed to maintain 3 exit signs in 1 of 6 smoke zones in proper working condition. This deficient practice would affect approximately 5 staff members within the affected zones. The facility had a capacity of 25 residents and a census of 7 residents.

Findings include:

Observations and interview on 12/5/11, revealed the following:

1. The 1st Floor Kitchen revealed the North Exit sign failed to be illuminated at the time of inspection.

2. The 1st Floor Kitchen revealed the South Exit sign failed to be illuminated at the time of inspection.

The Facility Maintenance Director confirmed these findings on the date of inspection.

Based on observations, record review, and interview, the facility failed to maintain the building's fire alarm system in accordance with the National Fire Protection Association (NFPA) Standard 72, National Fire Alarm Code, 1999 edition. This deficient practice would affect all residents throughout the facility. The facility had a capacity of 25 residents and a census of 7 residents.

Findings include:

Observations, record review, and interview on 12/5/11, revealed the following:

1. The 1st Floor Surgery Storage Room revealed a heat detector (1 of 1 heat detector) was damaged.

2. The 3rd Floor IT Storage room revealed a heat detector (1 of 1 heat detector) was damaged.

3. Record review of the facility's Fire Alarm Inspection Reports revealed the Inspection Reports did not provide a list of the locations, serial numbers, or indications stating if the devices had passed or failed the inspection for the initiating and supervisory devices for the Fire Alarm System.

The Facility Maintenance Director confirmed these findings on the date of inspection.

Based on observations and interview, the facility failed to maintain the building's sprinkler system in accordance with the National Fire Protection Association (NFPA) Standard 25, Standard for the Inspections, Testing, and Maintenance for Sprinkler Systems, 1999 edition. This deficient practice would affect approximately 5 residents within the affected zones. The facility had a capacity of 25 residents and a census of 7 residents.

Findings include:

Observations and interview on 12/5/11, revealed the following:

1. The 1st Floor Medical Records revealed a dirty sprinkler head located by the 2 hour fire wall.

2. The Surgery Clinic Hallway to the Surgery Pass Through revealed the sprinkler head next to the Pass Through door had a unknown white substance on the sprinkler head.

The Facility Maintenance Director confirmed these findings on the date of inspection.

Based on observations and interview, the facility failed to maintain 4 of approximately 6 fire extinguishers in 2 of 6 smoke zones in accordance with the National Fire Protection Association (NFPA) 10, Standard for Portable Fire Extinguishers, 1998 edition. This deficient practice would affect approximately 5 staff members and approximately 4 residents within the affected zones. The facility had a capacity of 25 residents and a census of 7 residents.

Findings include:

Observations and interview on 12/5/11, revealed the following:

1. The 1st Floor Main Lobby revealed the fire extinguisher was being blocked by a plant.

2. The 1st Floor West Exit revealed the fire extinguisher was installed at a height over approximately 5 feet off the ground.

3. The 3rd Floor Data Server Room revealed the fire extinguisher was obstructed by storage.

4. The 2nd Floor '64 Addition revealed the fire extinguisher located by Room 207 was obstructed by a lift device.

The Facility Maintenance Director confirmed these findings on the date of inspection.

Based on record review and interview, the facility failed to install the HVAC (Heating, Ventilation, and Air Conditioning) in accordance with the National Fire Protection Association (NFPA) 90A, Standard for the Installation of Air Conditioning and Ventilation Systems, 1999 edition. This deficient practice would affect all residents throughout the facility. The facility had a capacity of 25 residents and a census of 7 residents.

Findings include:

Record review and interview on 12/5/11, revealed the Medical Surgery Center, the In-Patient Area, the 3rd Floor, and the Conference Room Corridor were equipped with Forced Air supply in the Corridors and the Cooridor Rooms were not supplied with return air. This constituted the use of the corridor as a return air plenum which is in violation of the NPFA 90A and NFPA 99. Interview with the Facility Maintenance Director confirmed the facility was under a waiver for this deficiency.

Based on observation and interview, the facility failed to maintain the commercial cooking range hood system in accordance with the National Fire Protection Association (NFPA) 96, Standard for Ventilation Control and Fire Protection of Commercial Cooking Operations, 1998 edition Section 3-2.5. This deficient practice would affect approximately 4 staff members within the affected zones. The facility had a capacity of 25 residents and a census of 7 residents.

Findings include:

Observation and interview on 12/5/11, revealed the following:

1. The Kitchen Range Hood/Ansul System revealed the Pull Station was obstructed by a cooler in the Kitchen.

2. The Kitchen Range Hood revealed 2 of 3 baffles in the Hood were installed horizontally and not vertically.

The Facility Maintenance Director confirmed these findings on the date of inspection.

Based on observations and interview, the facility failed to maintain ceiling smoke tiles for proper smoke separation in 2 of approximately 35 rooms within 2 of 6 smoke zones. This deficient practice would affect approximately 3 residents within the facility. The facility had a capacity of 25 residents and a census of 7 residents on the date of inspection.

Findings include:

Observation and interview on 12/5/11, revealed the following:

1. The 1st Floor '74 Addition Lab Storage Closet revealed 1 ceiling smoke tile was not properly placed in the ceiling smoke tile grid.

2. The 3rd Floor Data Server Room revealed a missing ceiling smoke tile.

The Facility Maintenance Director confirmed these findings on the date of inspection.

Based on observation and interview, the facility failed to maintain the building's electrical system in accordance with the National Fire Protection Association (NFPA) Standard 70, National Electrical Code, 1999 edition. This deficient practice would affect approximately 3 residents within the affected zone. The facility had a capacity of 25 residents and had a census of 7 residents.

Findings include:

Observation and interview on 12/5/11, revealed an open electrical junction box located above the suspended ceiling in the 1st Floor Conference Room Corridor. The Facility Maintenance Director confirmed this finding on the date of inspection.

Based on record review and interview, the facility failed to provide proper documentation for the fire watch policy for the sprinkler system outage policy. This deficient practice would affect all residents throughout the facility. The facility had a capacity of 25 residents and a census of 7 residents.

Findings include:

Record review and interview on 12/5/11, revealed the facility failed to provide the Iowa Department of Inspections and Appeals, the facility's Insurance Company, and the Local Fire Department as Authorities Having Jurisdiction as part of the Fire Watch Policy. The phone numbers for these Authorities Having Jurisdiction were not provide. The Facility Maintenance Director confirmed this finding on the date of inspection.

Based on record review and interview, the facility failed to provide proper documentation for the fire watch policy for the fire alarm system outage policy. This deficient practice would affect all residents throughout the facility. The facility had a capacity of 25 residents and a census of 7 residents.

Findings include:

Record review and interview on 12/5/11, revealed the facility failed to provide the Iowa Department of Inspections and Appeals, the facility's Insurance Company, and the Local Fire Department as Authorities Having Jurisdiction as a part of the Fire Watch Policy. The phone numbers for these Authorities Having Jurisdiction were not provide. The Facility Maintenance Director confirmed this finding on the date of inspection.

Based on observations and interview , the facility failed to maintain the 2 hour fire resistance separation between 2 different building types in 2 locations. This deficient practice would affect all approximately 20 staff members within the affected zones. The facility had a capacity of 25 residents and a census of 7 residents.

Findings include:

Observations and interview on 12/5/11, revealed the following:

1. The 2 Hour Fire Barrier located above the Conference Room Corridor Doors to the Clinic revealed only 1 sheet of 5/8 inch sheetrock which provides a 1/2 hour separation not the required 2 hour fire separation. This barrier also revealed a hole (approximately 3 inches in size) and a wire bundle penetration (approximately 1/2 inch in size).

2. The 2 Hour Fire Barrier Wall to the Surgery Suite revealed a wire penetration (approximately 1/2 inch in size) located above the suspended ceiling tile.

3. The 2 Hour Fire Barrier Wall to the Surgery Suite and the '74 Addition revealed a hole (approximately 4 inches in size) located in the left side of the Fire Wall above the suspended ceiling, a cable penetration (approximately 1 inch in size) located above the suspended ceiling, a brick hole pentostatin (approximately 3 inches in size) located above the suspended ceiling. The Fire Doors at this location also failed to close and latch properly into the door frame with the swing of the door closers.

The Facility Maintenance Director confirmed these findings on the date of inspection.

Based on observations and interview, the facility failed to maintain 3 of approximately 40 corridor room walls in 2 of 6 smoke zones properly separated from the corridor. This deficient practice could affect approximately 3 residents within the affected zones. The facility had a capacity of 25 residents and a census of 7 residents.

Findings include:

Observations and interview on 12/5/11, revealed the following:

1. The 2nd Floor '64 Addition Pharmacy revealed a wire bundle penetration (approximately 1 inch in size) located in the Corridor Wall.

2. The 2nd Floor '64 Addition Room 200 revealed a wire bundle penetration (approximately 1 inch in size) located in the Corridor Wall.

3. The 2nd Floor '38 Addition Dietician Office revealed a flexible conduit penetration (approximately 1/4 inch in size) located in the Corridor Wall above the door.

The Facility Maintenance Director confirmed these findings on the date of inspection.

Based on observations and interview, the facility failed to maintain 2 of approximately 30 room corridor doors in 1 of 6 smoke zones in proper working condition. This deficient practice would affect approximately 2 residents within the affected zones. The facility had a capacity of 25 residents and a census of 7 residents.

Findings include:

Observations and interview on 12/5/11, revealed the following:

1. The 2nd Floor '38 Addition Patient Room 214 revealed the door had been detached from the door closer that was attached to the door and the wall but detached in the middle of the device.

2. The 2nd Floor '38 Addition Nursing Administrator Office revealed the door had been detached from the door closer.

The Facility Maintenance Director confirmed these findings on the date of inspection.

Based on observations and interview, the facility failed to maintain proper 1 hour vertical fire separation in 3 of approximately 60 rooms within 3 of 6 smoke zones. This deficient practice could affect approximately 7 residents within the affected zones. The facility had a capacity of 25 residents and a census of 7 residents.

Findings include:

Observations and interview on 12/5/11, revealed the following:

1. The 2nd Floor '38 Addition Respiratory Therapy Stress Room revealed a vertical conduit penetration (approximately 1/4 inch in size).

2. The 2nd Floor '64 Addition Clean Utility Room revealed a vertical conduit penetration (approximately 1/2 inch in size) located above the Corridor Door door closer.

3. The 1st Floor Patient Registration Audio Corner revealed 2 vertical cable penetration (approximately 1/2 inch in size).

The Facility Maintenance Director confirmed these findings on the date of inspection.

Based on observations and interview, the facility failed to maintain 3 of 6 smoke barriers in accordance with National Fire Protection Association (NFPA) Standard 101, 2000 edition, 19.3.7.3. Smoke barriers shall be continuous from outside wall to outside wall and from floor to a roof extending through all concealed spaces. Smoke barriers shall have a fire resistance rating of not less than 1/2 hour. This deficient practice affects approximately 4 residents within the facility. This facility has a capacity of 25 and a census of 7 residents.

Findings include:

Observations and interview on 12/5/11, revealed the following:

1. The 1st Floor '74 Addition Smoke Barrier by X-Ray revealed a wire penetration (approximately 1/4 inch in size) located above the suspended ceiling.

2. The 2nd Floor '38 Addition Smoke Barrier by Room 222 revealed a conduit penetration (approximately 1 inch in size) located above the suspended ceiling.

3. The 2nd Floor '38 Addition 1 Hour Fire Wall to the '64 Addition revealed a cable bundle penetration (approximately 1 inch in size) and a wire penetration (approximately 1/2 inch in size) located above the suspended ceiling.

The Facility Maintenance Director confirmed these findings on the date of inspection.

Based on observations and interview, the facility failed to maintain 1 of approximately 8 sets of smoke barrier doors in proper working condition. This deficient practice would affect approximately 3 residents within the facility. The facility had a capacity of 25 residents and a census of 7 residents.

Findings include:

Observation and interview on 12/5/11, revealed the 1st Floor Surgery Clinic Hallway Door from the Nurse's Station failed to close and latch properly into the door frame with the swing of the door closer when tested. The Facility Maintenance Director confirmed this finding on the date of inspection.

Based on observations and staff interview, the facility failed to provide separation of 6 of approximately 15 hazardous areas from other compartments in accordance with National Fire Protection Association (NFPA) Standard 101, The Life Safety Code, 2000 edition, 19.3.2.1. This deficient practice would affect approximately 7 residents within the affected zones. The facility had a capacity of 25 residents and a census of 7 residents.


Findings include:

Observations and interview on 12/5/11, revealed the following:

1. The Basement Purchasing Office revealed the door failed to close and latch properly into the door frame with the swing of the door closer when tested.

2. The 1st Floor Surgery Storage Room revealed a vertical hole (approximately 1/2 inch in size) located in the ceiling lid of the room.

3. The Basement North Mechanical Room revealed multiple penetrations (approximately 2 inches in size to approximately 3 feet in size each) in the fire resistant protective covering for the Steel "I" Beams throughout the room.

4. The Basement North Elevator Room revealed the door failed to close and latch properly into the door frame with the swing of the door closer when tested.

5. The 3rd Floor Data Server Room revealed a vertical cable penetration (approximately 1/2 inch in size) located in the ceiling lid.

6. The 2nd Floor '64 Addition Nurse's Station Mechanical Room revealed a pipe bundle penetration (approximately 1 inch in size) located in the ceiling lid.

The Facility Maintenance Director confirmed these findings on the date of inspection.

Based on observations and interview, the facility failed to maintain 2 means of egress in 1 of 6 smoke zones easily accessible at all times. This deficient practice would affect approximately 6 residents and 4 staff members within the affected zone. The facility had a capacity of 25 residents and census of 7 residents.

Findings include:

Observations and interview on 12/5/11, revealed the following:

1. The 2nd Floor '64 Addition Medication Mixing Room door revealed a hasp and latch device on this door.

2. The 2nd Floor '64 Addition Corridor revealed multiple lifts and storage in the corridor at the time of inspection.

The Facility Maintenance Director confirmed these findings on the date of inspection.

Based on observations and interview, the facility failed to maintain 3 exit signs in 1 of 6 smoke zones in proper working condition. This deficient practice would affect approximately 5 staff members within the affected zones. The facility had a capacity of 25 residents and a census of 7 residents.

Findings include:

Observations and interview on 12/5/11, revealed the following:

1. The 1st Floor Kitchen revealed the North Exit sign failed to be illuminated at the time of inspection.

2. The 1st Floor Kitchen revealed the South Exit sign failed to be illuminated at the time of inspection.

The Facility Maintenance Director confirmed these findings on the date of inspection.

Based on observations, record review, and interview, the facility failed to maintain the building's fire alarm system in accordance with the National Fire Protection Association (NFPA) Standard 72, National Fire Alarm Code, 1999 edition. This deficient practice would affect all residents throughout the facility. The facility had a capacity of 25 residents and a census of 7 residents.

Findings include:

Observations, record review, and interview on 12/5/11, revealed the following:

1. The 1st Floor Surgery Storage Room revealed a heat detector (1 of 1 heat detector) was damaged.

2. The 3rd Floor IT Storage room revealed a heat detector (1 of 1 heat detector) was damaged.

3. Record review of the facility's Fire Alarm Inspection Reports revealed the Inspection Reports did not provide a list of the locations, serial numbers, or indications stating if the devices had passed or failed the inspection for the initiating and supervisory devices for the Fire Alarm System.

The Facility Maintenance Director confirmed these findings on the date of inspection.

Based on observations and interview, the facility failed to maintain the building's sprinkler system in accordance with the National Fire Protection Association (NFPA) Standard 25, Standard for the Inspections, Testing, and Maintenance for Sprinkler Systems, 1999 edition. This deficient practice would affect approximately 5 residents within the affected zones. The facility had a capacity of 25 residents and a census of 7 residents.

Findings include:

Observations and interview on 12/5/11, revealed the following:

1. The 1st Floor Medical Records revealed a dirty sprinkler head located by the 2 hour fire wall.

2. The Surgery Clinic Hallway to the Surgery Pass Through revealed the sprinkler head next to the Pass Through door had a unknown white substance on the sprinkler head.

The Facility Maintenance Director confirmed these findings on the date of inspection.

Based on observations and interview, the facility failed to maintain 4 of approximately 6 fire extinguishers in 2 of 6 smoke zones in accordance with the National Fire Protection Association (NFPA) 10, Standard for Portable Fire Extinguishers, 1998 edition. This deficient practice would affect approximately 5 staff members and approximately 4 residents within the affected zones. The facility had a capacity of 25 residents and a census of 7 residents.

Findings include:

Observations and interview on 12/5/11, revealed the following:

1. The 1st Floor Main Lobby revealed the fire extinguisher was being blocked by a plant.

2. The 1st Floor West Exit revealed the fire extinguisher was installed at a height over approximately 5 feet off the ground.

3. The 3rd Floor Data Server Room revealed the fire extinguisher was obstructed by storage.

4. The 2nd Floor '64 Addition revealed the fire extinguisher located by Room 207 was obstructed by a lift device.

The Facility Maintenance Director confirmed these findings on the date of inspection.

Based on record review and interview, the facility failed to install the HVAC (Heating, Ventilation, and Air Conditioning) in accordance with the National Fire Protection Association (NFPA) 90A, Standard for the Installation of Air Conditioning and Ventilation Systems, 1999 edition. This deficient practice would affect all residents throughout the facility. The facility had a capacity of 25 residents and a census of 7 residents.

Findings include:

Record review and interview on 12/5/11, revealed the Medical Surgery Center, the In-Patient Area, the 3rd Floor, and the Conference Room Corridor were equipped with Forced Air supply in the Corridors and the Cooridor Rooms were not supplied with return air. This constituted the use of the corridor as a return air plenum which is in violation of the NPFA 90A and NFPA 99. Interview with the Facility Maintenance Director confirmed the facility was under a waiver for this deficiency.

Based on observation and interview, the facility failed to maintain the commercial cooking range hood system in accordance with the National Fire Protection Association (NFPA) 96, Standard for Ventilation Control and Fire Protection of Commercial Cooking Operations, 1998 edition Section 3-2.5. This deficient practice would affect approximately 4 staff members within the affected zones. The facility had a capacity of 25 residents and a census of 7 residents.

Findings include:

Observation and interview on 12/5/11, revealed the following:

1. The Kitchen Range Hood/Ansul System revealed the Pull Station was obstructed by a cooler in the Kitchen.

2. The Kitchen Range Hood revealed 2 of 3 baffles in the Hood were installed horizontally and not vertically.

The Facility Maintenance Director confirmed these findings on the date of inspection.

Based on observations and interview, the facility failed to maintain ceiling smoke tiles for proper smoke separation in 2 of approximately 35 rooms within 2 of 6 smoke zones. This deficient practice would affect approximately 3 residents within the facility. The facility had a capacity of 25 residents and a census of 7 residents on the date of inspection.

Findings include:

Observation and interview on 12/5/11, revealed the following:

1. The 1st Floor '74 Addition Lab Storage Closet revealed 1 ceiling smoke tile was not properly placed in the ceiling smoke tile grid.

2. The 3rd Floor Data Server Room revealed a missing ceiling smoke tile.

The Facility Maintenance Director confirmed these findings on the date of inspection.

Based on observation and interview, the facility failed to maintain the building's electrical system in accordance with the National Fire Protection Association (NFPA) Standard 70, National Electrical Code, 1999 edition. This deficient practice would affect approximately 3 residents within the affected zone. The facility had a capacity of 25 residents and had a census of 7 residents.

Findings include:

Observation and interview on 12/5/11, revealed an open electrical junction box located above the suspended ceiling in the 1st Floor Conference Room Corridor. The Facility Maintenance Director confirmed this finding on the date of inspection.

Based on record review and interview, the facility failed to provide proper documentation for the fire watch policy for the sprinkler system outage policy. This deficient practice would affect all residents throughout the facility. The facility had a capacity of 25 residents and a census of 7 residents.

Findings include:

Record review and interview on 12/5/11, revealed the facility failed to provide the Iowa Department of Inspections and Appeals, the facility's Insurance Company, and the Local Fire Department as Authorities Having Jurisdiction as part of the Fire Watch Policy. The phone numbers for these Authorities Having Jurisdiction were not provide. The Facility Maintenance Director confirmed this finding on the date of inspection.

Based on record review and interview, the facility failed to provide proper documentation for the fire watch policy for the fire alarm system outage policy. This deficient practice would affect all residents throughout the facility. The facility had a capacity of 25 residents and a census of 7 residents.

Findings include:

Record review and interview on 12/5/11, revealed the facility failed to provide the Iowa Department of Inspections and Appeals, the facility's Insurance Company, and the Local Fire Department as Authorities Having Jurisdiction as a part of the Fire Watch Policy. The phone numbers for these Authorities Having Jurisdiction were not provide. The Facility Maintenance Director confirmed this finding on the date of inspection.