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Based on observation, the facility failed to ensure there are no impediment to the closing of corridor doors, as evidenced by a door that was impeded from latching upon self-closure. This failure affected 1 of 8 smoke compartments on the second floor and could result in the potential spread of fire and or smoke in the event of a fire.

Findings:

During a tour of the facility with hospital staff on 1/7/2013 through 1/10/2013, the corridor doors were observed.

Palomar Medical Center, 1/8/2013:
At 3:10 p.m., the latching device to the environmental service room 2-S129 was taped and the door failed to latch upon self closure. The room is located in the surgery suite.

Based on observation, the facility failed to maintain the integrity of their corridor doors. This was evidenced by doors protecting corridor that failed to close and positive latch upon self-closure. This could result in fire to travel throughout the facility in the event of a fire in the room and fail to resist the passage of smoke. This affected 1 of 6 floors (the 6th Floor) in the West Tower, 2 of 10 floors (the 2nd and 4th Floors) in the McLeod Tower, and 1 of 4 floors (the 2nd Floor) in the Adams Wing at Palomar Health Downtown Campus.

Findings:

During a tour of the facility with the Hospital Staff on 1/7/2013 through 1/10/2013, the facility corridor doors were observed.

Palomar Health Downtown Campus, 1/7/2013:
1. At 1:55 p.m., the door opening into the corridor from Room 646, located on the 6th Floor in the West Tower, failed to close and positive latch.

2. At 2:22 p.m., the door opening into the corridor from Room 405, located on the 4th Floor in the McLeod Tower, failed to close and positive latch when held open at its fullest extent and released to close by means of its equipped self-closing device.

3. At 2:24 p.m., the door opening into the corridor from Room 407, located on the 4th Floor in the McLeod Tower, failed to close and positive latch when held open at its fullest extent and released to close by means of its equipped self-closing device.

4. At 2:25 p.m., the door opening into the corridor from Room 409, located on the 4th Floor in the McLeod Tower, failed to close and positive latch when held open at its fullest extent and released to close by means of its equipped self-closing device.

5. At 2:26 p.m., the door opening into the corridor from Room 410, located on the 4th Floor in the McLeod Tower, failed to close and positive latch when held open at its fullest extent and released to close by means of its equipped self-closing device.

6. At 2:28 p.m., the door opening into the corridor from Room 412, located on the 4th Floor in the McLeod Tower, failed to close and positive latch when held open at its fullest extent and released to close by means of its equipped self-closing device.

7. At 2:30 p.m., the door opening into the corridor from Room 413, located on the 4th Floor in the McLeod Tower, failed to close and positive latch when held open at its fullest extent and released to close by means of its equipped self-closing device.

8. At 2:35 p.m., the door opening into the corridor from Room 419, located on the 4th Floor in the McLeod Tower, failed to close and positive latch when held open at its fullest extent and released to close by means of its equipped self-closing device.

9. At 2:37 p.m., the door opening into the corridor from Room 421, located on the 4th Floor in the McLeod Tower, failed to close and positive latch when held open at its fullest extent and released to close by means of its equipped self-closing device.

1/8/2013:
10. At 11:43 a.m., the door opening into the corridor from Room 208, located on the 2nd Floor in the McLeod Tower, had a paper wedged underneath the door that prevented the door from closing.


21101


Palomar Health Downtown Campus, 1/9/2013:
11. At 10:57 a.m., the corridor door to the kitchen dish washing area, located on the 2nd Floor in the Adams Wing, failed to fully close and latch upon self-closure.

Based on observation, the facility failed to maintain the integrity of the smoke barrier walls, as evidenced by an unsealed penetration in a smoke barrier wall. This failure affected 2 of 10 smoke compartments in the lower level and had the potential to allow the spread of smoke and or fire from one compartment to the adjoining compartment.

Findings:

During a tour of the facility with hospital staff on 1/7/2013 through 1/10/2013, the smoke barriers were observed.

Palomar Medical Center, 1/8/2013:
At 10:37 a.m., there was a 3-inch by 6-inch hole in the left side of the smoke barrier wall located above the entrance to the sterile processing department.

Based on observation, the facility failed to maintain their smoke barrier walls. This was evidenced by unsealed penetrations in smoke barrier walls. This had the potential to allow the spread of smoke from one smoke compartment to another smoke compartment in the event of a fire, potentially harming patients, visitors, and staff. This affected 2 of 6 floors (the 3rd and 4th Floors) in the West Tower and 2 of 4 floors (the 2nd and 3rd Floors) in the Adams Wing at Palomar Health Downtown Campus.

NFPA 101, Life Safety Code, 2000 Edition
8.3.2 Continuity. Smoke barriers required by this Code shall be continuous from an outside wall to an outside wall, from a floor to a floor, or from a smoke barrier to a smoke barrier or a combination thereof. Such barriers shall be continuous through all concealed spaces, such as those found above a ceiling, including interstitial spaces.

Findings:

During a tour of the facility with the Hospital Staff on 1/7/2013 through 1/10/2013, the smoke barrier walls were observed.

Palomar Health Downtown Campus, 1/8/2013:
1. At 9:24 a.m., the smoke barrier wall by the entrance into the PACU, located on the 4th Floor in the West Tower, had a penetration above the drop-down ceiling. The penetration measured approximately 1-inch diameter.


21101


Palomar Health Downtown Campus, 1/9/2013:
2. At 1:21 p.m., there was an approximately 1-inch diameter penetration in the left side of the smoke barrier wall located next to Elevator-9. The wall is located on the 3rd Floor in the Adams Wing.

3. At 2:00 p.m., there was an approximately 3/4-inch penetration around a duct in the center of the smoke barrier wall and a conduit that was not sealed in the right side of the wall. The wall was located on the 3rd Floor in the West Tower, Express Care Department.

4. At 2:19 p.m., there was an approximately 3-inch diameter penetration in the right side of the smoke barrier wall entering the kitchen that is located on the 2nd Floor in the Adams Wing.

Based on observation, the facility failed to ensure that spaces under the stairways were not used for storage. This was evidenced by multiple items being stored in the stairway's landing. This had the potential for interfering with egress during a fire emergency, rendering the stairway unsafe or non-usable for residents, staff, and visitors. This affected 3 of 3 floors in the South Wing at Palomar Health Downtown Campus.

NFPA 101, Life Safety Code, 2000 Edition
7.2.2.5.3 Usable Space. There shall be no enclosed, usable space within an exit enclosure, including under stairs, nor shall any open space within the enclosure be used for any purpose that has the potential to interfere with egress.

Findings:

During a tour of the facility with the Hospital Staff on 1/7/2013 through 1/10/2013, the stairwells egress were observed.

Palomar Health Downtown Campus, 1/7/2013:
At 3:45 p.m., Stairway-10, located in the South Wing, had several items stored underneath the stairs landing on the 3rd Floor. These items included stands for medical gas cylinders, cart with wheels, two weighing scales, five stationary bikes, gurney, and a rowing exercise machine.

Based on observation and record review, the facility failed to maintain their emergency lighting. This was evidenced by emergency lighting units that failed to illuminate when tested. This had the potential for delaying evacuation and causing injury to patients, staff, and visitors. This affected 1 of 6 floors (the 7th Floor) in the West Tower and 1 of 10 floors (the 6th Floor) in the McLeod Tower at Palomar Health Downtown Campus.

NFPA 101 Life Safety Code, 2000 edition
7.9.3 Periodic Testing of Emergency Lighting Equipment.
A Functional test shall be conducted on every required emergency lighting system at 30-day intervals for not less than 30 seconds. An annual test shall be conducted on every required battery-powered emergency lighting system for not less than 1.5 hours. Equipment shall be fully operational for the duration of the test. Written records of visual inspections and tests shall be kept by the owner for inspection by the authority having jurisdiction.

Findings:

During a tour of the facility with the Hospital Staff on 1/7/2013 through 1/10/2013, the emergency lighting units were tested and maintenance records were reviewed.

Palomar Health Downtown Campus, 1/7/2013:
1. At 1:40 p.m., the emergency light (labeled "1591") installed at the Nursing Station, located on the 7th Floor in the West Tower, failed to illuminate when tested. The testing log provided by the facility had the "illuminate" and "battery" marked with circles around the pass and the fail options, and with scratch marks on the fail option.

2. At 1:47 p.m., the emergency light (labeled "20295") installed at the Nursing Station by Room 627, located on the 6th Floor in the McLeod Tower, failed to illuminate when tested. The testing log provided by the facility had the "illuminate" and "battery" marked with circles around the fail options and with the following comment "Has Been disconnected."

Based on observation, the facility failed to maintain visible exit signs. This was evidenced by exit signs installed that did not illuminate. This could potentially delay evacuation in the event of a power outage and an emergency evacuation. This affected 1 of 10 floors (the 9th Floor) in the McLeod Tower and 1 of 6 floors (the 3rd Floor) in the West Tower at Palomar Health Downtown Campus.

NFPA 101, Life Safety Code, 2000 Edition
19.2.10.1 Means of egress shall have signs in accordance with Section 7.10.

7.10.1.4 Exit Access. Access to exits shall be marked by approved, readily visible signs in all cases where the exit or way to reach the exit is not readily apparent to the occupants. Sign placement shall be such that no point in an exit access corridor is in excess of 100 ft (30 m) from the nearest externally illuminated sign and is not in excess of the marked rating for internally illuminated signs.

7.10.5.2 Continuous Illumination. Every sign required to be illuminated by 7.10.6.3 and 7.10.7 shall be continuously illuminated as required under the provisions of Section 7.8.

Findings:

During a tour of the facility with the Hospital Staff on 1/7/2013 through 1/10/2013, the exit signs were observed.

Palomar Health Downtown Campus, 1/7/2013:
1. At 12:02 p.m., the exit sign in the corridor by Room 924 Exam Office, located on the 9th Floor in the McLeod Tower, failed to illuminate.

1/8/2013:
2. At 11:05 a.m., there were two non-illuminating papered exit signs installed in the Medical Records Office, located on the 3rd Floor in the West Tower. The way to reach the exits were not readily apparent during power outage.

Based on observation and record review, the facility failed to ensure that the fire alarm system was properly maintained. This was evidenced by a smoke detector covered with tape, fire alarm devices that failed when tested, and no record of repairs done on devices that failed during the annual fire alarm inspection. This had the potential for occupants to not be alerted of a fire, resulting in harm to patients, visitors and staff. This affected 1 of 4 floors (the 2nd Floor) in the Adams Wing, 4 of 10 floors (the 1st, 2nd, 8th, and 9th Floors) in the McLeod Tower, 3 of 6 floors (the 3rd, 5th, and 7th Floors) in the West Tower, and 1 of 3 floors (the 5th Floor) in the South Wing at Palomar Health Downtown Campus.

NFPA 72, National Fire Alarm Code, 1999 Edition
7-2.2 Fire alarm systems and other systems and equipment that are associated with fire alarm systems and accessory equipment shall be tested according to Table 7-2.2.

Findings:

During a tour of the facility with the Hospital Engineering Staff on 1/7/2013 through 1/10/2013, the fire alarm system was tested and documents for the system were reviewed.

Palomar Health Downtown Campus, 1/8/2013
1. At 11:40 a.m., the smoke detector installed in Room 204, located in the Mental Health Unit that is on the 2nd Floor in the McLeod Tower, was observed to be covered with tape. The Facility Manager stated that the smoke detector had been covered with tape when they painted the room.

1/9/2013:
2. At 11:02 a.m., the chime-strobe device installed in the conference room by the kitchen, located on the 2nd Floor in the Adams Wing, failed to sound an alarm when a pull station was activated in the area.

3. At 4:00 p.m., the facility's fire alarm system annual inspection report was reviewed. The report, dated 3/21/12, identified the following devices as failed with no documentation that showed that the items had been corrected:
i. The PSD smoke detector (5:M1-41-29), installed in the communication area, located on the 3rd Floor in the West Tower.
ii. The PSD smoke detector (3:M1-49), installed in service elevator area, located on the 2nd Floor in the McLeod Tower.
iii. The PSD smoke detector (6:M1-55), installed in Elevator-6 Landing, located on the 5th Floor in the South Wing.
iv. The PSD smoke detector (7:M3-25-9), installed in the corridor by Room 748, located on the 7th Floor in the West Tower.
v. The chime-strobe audio (MT1-2A/V), installed in the corridor by Stairwell-5 to lobby, located on the 1st Floor in the McLeod Tower.
vi. The chime-strobe audio (WT5-1A/V), installed by Elevator 1 & 2, located on the 5th Floor in the West Tower.
vii. The strobe visual (MT9-22V), installed in the dining and activity room, located on the 9th Floor in the McLeod Tower.


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Palomar Health Downtown Campus, 1/9/2013:
4. At 8:52 a.m., the chime strobe device MT8-2V failed to activate an audible alarm during the testing of the fire alarm system. The device is located next to Stairway-6 on the 8th Floor in the McLeod Tower.

5. At 10:45 a.m., the chimes-strobe device MT2-16A and device MT2-3A failed to activate audible alarms during the testing of the fire alarm system in the Mental Health Unit. These devices were located on the 2nd Floor in the McLeod Tower.

Based on observation, the facility failed to maintain their automatic sprinkler system. This was evidenced by sprinkler heads with foreign materials on or hanging from sprinkler heads. This could result in the ineffective disbursement of water by the sprinkler head in the event of a fire, resulting in injury to patients, visitors, and staff. This affected 1 of 3 floors (the 4th Floor) in the South Wing, 1 of 6 floors (the 3rd Floor) in the West Tower, and 1 of 4 floors (the 1st Floor) in the Adams Wing at Palomar Health Downtown Campus.

NFPA 101, Life Safety Code, 2000 Edition
9.7.5 Maintenance and Testing. All automatic sprinkler and standpipe systems required by this Code shall be inspected, tested, and maintained in accordance with NFPA 25, Standard for the Inspection, Testing, and Maintenance of Water-Based Fire Protection Systems.

NFPA 25, Standard for the Inspection, Testing, and Maintenance of Water-Based Fire Protection Systems, 1998 Edition
1-4.2 The responsibility for properly maintaining a water-based fire protection system shall be that of the owner(s) of the property. By means of periodic inspections, tests, and maintenance, the equipment shall be shown to be in good operating condition, or any defects or impairments shall be revealed.
Inspection, testing, and maintenance shall be implemented in accordance with procedures meeting or exceeding those established in this document and in accordance with the manufacturer's instructions. These tasks shall be performed by personnel who have developed competence through training and experience.
Exception: Where the owner is not the occupant, the owner shall be permitted to pass on the authority for inspecting, testing, and maintaining the fire protection systems to the occupant, management firm, or managing individual through specific provisions in the lease, written use agreement, or management contract.

2-2.1.1 Sprinklers shall be inspected from the floor level annually. Sprinklers shall be free of corrosion, foreign materials, paint, and physical damage and shall be installed in the proper orientation (e.g., upright, pendant, or sidewall). Any sprinkler shall be replaced that is painted, corroded, damaged, loaded, or in the improper orientation.

Findings:

During a tour of the facility with the Hospital Staff on 1/7/2013 through 1/10/2013, the sprinkler system was observed.

Palomar Health Downtown Campus, 1/7/2013:
1. At 3:40 p.m., the sprinkler head installed in the biohazard room by Room 447, located on the 4th Floor in the South Wing, had a piece of plastic material hanging from its deflector.

1/8/2013:
2. At 10:39 a.m., the sprinkler head installed in the soiled utility room for the Express Care, located on the 3rd Floor in the West Tower, had a piece of plastic material hanging from its deflector.


21101


Palomar Health Downtown Campus, 1/9/2013:
3. At 2:38 p.m., in the laundry chute room, located on the 1st Floor in the Adams Wing, 2 of 2 sprinkler heads had their deflectors covered with blue plastic. This was acknowledged by staff during the survey.

Based on observation, the facility failed to maintain their portable fire extinguishers readily accessible. This was evidenced by a fire extinguisher that was obstructed and not accessible to allow for the quick response to a fire. This could result in a delayed response to a fire and increase the risk of injury to patients, visitors, and staff. This affected 1 of 4 floors (the 4th Floor) in the Adams Wing at Palomar Health Downtown Campus.

NFPA 101, Life Safety Code, 2000 Edition
9.7.4 Manual Extinguishing Equipment.
9.7.4.1 Where required by the provisions of another section of this Code, portable fire extinguishers shall be installed, inspected, and maintained in accordance with NFPA 10, Standard for Portable Fire Extinguishers.

NFPA 10, Standard for Portable Fire Extinguishers, 1998 Edition
1-6.3 Fire extinguishers shall be conspicuously located where they will be readily accessible and immediately available in the event of fire. Preferably they shall be located along normal paths of travel, including exits from areas.

1-6.6 Fire extinguishers shall not be obstructed or obscured from view.
Exception: In large rooms, and in certain locations where visual obstruction cannot be completely avoided, means shall be provided to indicate the location.

Findings:

During a tour of the facility with the Hospital Engineering Staff on 1/7/2013 through 1/10/2013, the fire extinguishers were observed.

Palomar Health Downtown Campus, 1/7/2013:
At 2:57 p.m., the fire extinguisher in the corridor by Room 436, located on the 4th Floor in the Adams Wing, had a work station on wheels that obstructed the extinguisher from being readily accessible.

Based on observation, document review, and interview, the facility failed to maintain the kitchen hood exhaust systems. This was evidenced by the exhaust hood heavily contaminated with grease and by not maintaining a documented schedule that showed that the cleaning of the kitchen's exhaust hoods were frequent enough to meet the minimum required based on the type or volume of cooking. The failure to maintain the exhaust system could increase the potential risk of a grease fire. This affected 1 of 4 floors (the 2nd Floor) in the Adams Wing at Palomar Health Downtown Campus.

NFPA 96, Standard for Ventilation Control and Fire Protection of Commercial Cooking Operations, 1998 Edition
8-3 Cleaning
8-3.1 Hoods, grease removal devices, fans, ducts, and other appurtenances shall be cleaned to bare metal at frequent intervals prior to surfaces becoming heavily contaminated with grease or oily sludge. After the exhaust system in cleaned to bare metal, it shall not be coated with powder or other substance. The entire exhaust system shall be inspected by a properly trained, qualified, and certified company or person (s) acceptable to the authority having jurisdiction in accordance with Table 8-3.1.

Table 8-3.1 Exhaust System Inspection Schedule
Type or Volume of Cooking Frequency
Systems serving solid fuel cooking operations, Frequency - Monthly
Systems serving high-volume cooking operations, such as 24 hour cooking, charbroiling or wok cooking, Frequency - Quarterly
Systems serving moderate-volume cooking operations, Frequency - Semiannually
Systems serving low-volume cooking operations, such as churches, day camps, seasonal businesses, or senior centers, Frequency - Annually

8-3.1.1 Upon inspection, if found to be contaminated with deposits from grease-laden vapors, the entire exhaust system shall be cleaned by a properly trained, qualified, and certified company person (s) acceptable to the authority having jurisdiction in accordance with Section 8-3.

8-3.1.2 When a vent cleaning service is used, a certificate showing date of inspection or cleaning shall be maintained on premises. After cleaning is completed, the vent cleaning contractor shall place or display within the kitchen area a label indicating the date cleaned and the name of the servicing company. It shall also indicate areas not cleaned.

Findings:

During a tour of the facility with the Hospital Engineering Staff on 1/7/2013 through 1/10/2013, the kitchen exhaust system and cooking areas were observed, documents were reviewed, and staff were interviewed.

Palomar Health Downtown Campus, 1/9/2013:
At 4:11 p.m., the exhaust hood above the grill in the kitchen cooking area, located on the 2nd Floor in the Adams Wing, was layered with grease. The entire exhaust hood area including the sprinklers and sprinkler pipes in the hood were contaminated with a layer of grease. The sticker/label located on the outside of the hood area documented the date the exhaust hood was last cleaned on 1/2012.

At 4:38 p.m., during document review, the facility failed to provide cleaning frequency schedules and documentation from a certified company or person responsible for the cleaning of the exhaust hood located above the grill. During interview, the Facility Manager stated that he would contact the vendor and request the records for the most recent cleaning of the hood.


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Palomar Health Downtown Campus, 1/10/2013
At 9:45 a.m., the kitchen's exhaust hood cleaning documents were reviewed. The Facility Manager provided monthly preventive maintenance schedules that stated that the assigned staff member will verify that the outside contractor will clean grease exhaust system and ducts. The facility failed to provide the records from the outside contractor that showed that the exhaust system above the grill had been cleaned since 1/2012. The last two inspections (2/23/2012 and 8/23/2012) of the kitchen's fire suppression system noted that the exhaust system required cleaning.

Based on observation, the facility failed to properly store their medical gas cylinders. This was evidenced by medical gas cylinders that were stored by combustible materials and electrical receptacles and by oxygen cylinders that were not individually secured. This could cause harm to patients, visitors, and staff in the event the cylinder fell on something or someone and may result in fire or explosion. This affected 2 of 6 floors (the 3rd and 4th Floors) in the West Tower at Palomar Health Downtown Campus.

NFPA 101, Life Safety Code, 2000 Edition
19.3.2.4 Medical Gas. Medical gas storage and administration areas shall be protected in accordance with NFPA 99, Standard for Health Care Facilities.

NFPA 99, Health Care Facilities, 1999 Edition
4-3.1.1.1. Cylinder and Container Management. Cylinders in service and in storage shall be individually secured and located to prevent falling or being knocked over.

4-3.1.1.2 Storage Requirements (Location, Construction, Arrangement).
(a) Nonflammable Gases (Any Quantity; In-Storage, Connected, or Both)
4. The electric installation in storage locations or manifold enclosures for nonflammable medical gases shall comply with the standards of NFPA 70, National Electrical Code, for ordinary locations. Electric wall fixtures, switches, and receptacles shall be installed in fixed locations not less than 152 cm (5 ft) above the floor as a precaution against their physical damage.
5. Storage locations for oxygen and nitrous oxide shall be kept free of flammable materials [see also 4-3.1.1.2(a)7].
7. Combustible materials, such as paper, cardboard, plastics, and fabrics shall not be stored or kept near supply system cylinders or manifolds containing oxygen or nitrous oxide. Racks for cylinder storage shall be permitted to be of wooden construction. Wrappers shall be removed prior to storage.

Findings:

During a tour of the facility with the Hospital Engineering Staff on 1/7/2013 through 1/10/2013, the medical gas cylinders were observed.

Palomar Health Downtown Campus, 1/8/2013:
1. At 9:12 a.m., the location where the medical gases were stored in the PACU by the recovery area, located on the 4th Floor in the West Tower, had combustible materials and electrical receptacles within 1.5-feet. The medical gases included two carbon dioxide cylinders, nine oxygen cylinders, and one compressed gas cylinder.

2. At 10:52 a.m., there were three oxygen gas cylinders observed to be standing upright and not individually secured in the EMS crew room. The room was located by the ambulance entrance on the 3rd Floor in the West Tower.

Based on observation, the facility failed to maintain the ensure that extension cords were not used in place of permanent wiring. This was evidenced by the use of extension cords with no overcurrent protection. This failure affected 1 of 8 smoke compartments on the first floor and could increase the risk of an electrical fire.

NFPA 101, Life Safety Code, (2000) Edition, SECTION 9.1. UTILITIES
9.1.2 Electric. Electrical wiring and equipment shall be in accordance with NFPA 70, National electrical Code, unless existing installations, which shall be permitted to be continued in service, subject to approval by the authoring having jurisdiction.

NFPA 70, National Electrical Code, (1999) Edition
400-8. Uses Not Permitted. Unless specifically permitted in Section 400-7, flexible cords and cables shall not be used for the following:
(1) As a substitute for the fixed wiring of a structure

Findings:

During a tour of the facility with hospital staff on 1/7/2013 through 1/10/2013, the electrical wiring and equipment was observed.

Palomar Medical Center, 1/8/2013:
1. At 9:51 a.m., there was a white extension cord in use that had no overcurrent protection in sleep room 1-S117.

2. At 9:54 a.m., there was a white extension cord in use that had no overcurrent protection in sleep room 1-S115.

Based on observation, the facility failed to maintain electrical safety. This was evidenced by multi-outlet adapters used in patient areas as substitutes for fixed wired electrical outlets with multiple equipments plugged into them, damaged receptacle wall outlets, outlets with no faceplate covers, and the use of multi-outlet adapters that exceeded permitted load capacity. This deficient practice had the potential for increasing the risk of an electrical fire and electric shock, resulting in harm to patients, visitors and staff. This affected 3 of 10 floors (the Lobby, 4th, and 9th Floors) in the McLeod Tower, 2 of 4 floors (the 1st and 4th Floors) in the Adams Wing, 1 of 3 floors (the 4th Floor) in the South Wing, and 1 of 6 floors (the 4th Floor) in the West Tower at Palomar Health Downtown Campus.

NFPA 99, Health Care Facilities, 1999 Edition
3-3.2.1.2 All Patient Care Areas.
(d) Receptacles. 2. Minimum Number of Receptacles. The number of receptacles shall be determined by the intended use of the patient care area. There shall be sufficient receptacles located so as to avoid the need for extension cords or multiple outlet adapters.

NFPA 70, National Electrical Code, 1999 Edition
110-12. Mechanical Execution of Work. Electrical equipment shall be installed in a neat and workmanlike manner.

110-26. Spaces About Electrical Equipment. Sufficient access and working space shall be provided and maintained about all electric equipment to permit ready and safe operation and maintenance of such equipment. Enclosures housing electrical apparatus that are controlled by lock and key shall be considered accessible to qualified persons.

110-56. Energized Parts. Bare terminals of transformers, switches, motor controllers, and other equipment shall be enclosed to prevent accidental contact with energized parts.

210-23 Permissible Loads. In no case shall the load exceed the branch-circuit ampere rating. An individual branch circuit shall be permitted to supply any load for which it is rated. A branch circuit supplying two or more outlets or receptacles shall supply only the loads specified in (a) through (d) and as summarized in Section 210-24 and Table 210- 24.

370-25 In completed installations, each box shall have a cover, faceplate, or fixture canopy.

400-8. Uses Not Permitted. Unless specifically permitted in section 400-7, flexible cords and cables shall not be used for the following:
(1) As a substitute for a fixed wiring of a structure

Findings:

During a tour of the facility with the Hospital Engineering Staff on 1/7/2013 through 1/10/2013, the electrical equipments and devices were observed.

Palomar Health Downtown Campus, 1/7/2013:
1. At 12:07 p.m., there was a broken cover to a receptacle outlet in the PT Staff Room, located on the 9th Floor in the McLeod Tower.

2. At 2:41 p.m., there were items stored up against the four electrical panels in the soiled utility room, located next to the nursing station on the 4th Floor in the McLeod Tower. The items included two 30-gallon containers with combustibles and a confidential paper container.

3. At 3:09 p.m., there was a broken faceplate cover to a receptacle wall outlet in the telephone panel, located by the nursing station on the 4th Floor in the Adams Wing.

4. At 3:35 p.m., there was a broken faceplate cover to a receptacle wall outlet in the OB Classroom C0402, located on the 4th Floor in the South Wing.

1/8/2013:
5. At 8:49 a.m., there was a 20-AMP fixed wired electrical outlet that had two 15-AMP multi-outlet adapter connected to each other with medical devices plugged into them in OR-8, located on the 4th Floor in the West Tower. The devices included an Electronic Fetal Monitor, an Alternating Leg Pressure Pump, and a Cautery Unit.


21101


Palomar Health Downtown Campus, 1/9/2013:
6. At 2:52 p.m., there was a power strip plugged into a power strip under the environmental services director's desk. The office is located on the 1st Floor in the Adams Wing.

7. At 3:17 p.m., there was a power strip plugged into a power strip under the desk in the registration office. The office is located on the Lobby Level in the McLeod Tower.

Based on observation, the facility failed to maintain Alcohol Based Hand Rub (ABHR) dispensers away from an ignition source. This was evidence by an ABHR dispenser installed above a light switch. This had the potential for causing fire and harm to patients, visitors, and staff. This affected 1 of 4 floors (the 4th Floor) in the Adams Wing at Palomar Health Downtown Campus.

Findings:

During a tour of the facility with the Hospital Staff on 1/7/2013 through 1/10/2013, the ABHR dispensers were observed.

Palomar Health Downtown Campus, 1/7/2013:
At 2:59 p.m., the ABHR dispenser in Room 438, located on the 4th Floor in the Adams Wing, was installed above an electrical light switch.

Based on observation, the facility failed to ensure there are no impediment to the closing of corridor doors, as evidenced by a door that was impeded from latching upon self-closure. This failure affected 1 of 8 smoke compartments on the second floor and could result in the potential spread of fire and or smoke in the event of a fire.

Findings:

During a tour of the facility with hospital staff on 1/7/2013 through 1/10/2013, the corridor doors were observed.

Palomar Medical Center, 1/8/2013:
At 3:10 p.m., the latching device to the environmental service room 2-S129 was taped and the door failed to latch upon self closure. The room is located in the surgery suite.

Based on observation, the facility failed to maintain the integrity of their corridor doors. This was evidenced by doors protecting corridor that failed to close and positive latch upon self-closure. This could result in fire to travel throughout the facility in the event of a fire in the room and fail to resist the passage of smoke. This affected 1 of 6 floors (the 6th Floor) in the West Tower, 2 of 10 floors (the 2nd and 4th Floors) in the McLeod Tower, and 1 of 4 floors (the 2nd Floor) in the Adams Wing at Palomar Health Downtown Campus.

Findings:

During a tour of the facility with the Hospital Staff on 1/7/2013 through 1/10/2013, the facility corridor doors were observed.

Palomar Health Downtown Campus, 1/7/2013:
1. At 1:55 p.m., the door opening into the corridor from Room 646, located on the 6th Floor in the West Tower, failed to close and positive latch.

2. At 2:22 p.m., the door opening into the corridor from Room 405, located on the 4th Floor in the McLeod Tower, failed to close and positive latch when held open at its fullest extent and released to close by means of its equipped self-closing device.

3. At 2:24 p.m., the door opening into the corridor from Room 407, located on the 4th Floor in the McLeod Tower, failed to close and positive latch when held open at its fullest extent and released to close by means of its equipped self-closing device.

4. At 2:25 p.m., the door opening into the corridor from Room 409, located on the 4th Floor in the McLeod Tower, failed to close and positive latch when held open at its fullest extent and released to close by means of its equipped self-closing device.

5. At 2:26 p.m., the door opening into the corridor from Room 410, located on the 4th Floor in the McLeod Tower, failed to close and positive latch when held open at its fullest extent and released to close by means of its equipped self-closing device.

6. At 2:28 p.m., the door opening into the corridor from Room 412, located on the 4th Floor in the McLeod Tower, failed to close and positive latch when held open at its fullest extent and released to close by means of its equipped self-closing device.

7. At 2:30 p.m., the door opening into the corridor from Room 413, located on the 4th Floor in the McLeod Tower, failed to close and positive latch when held open at its fullest extent and released to close by means of its equipped self-closing device.

8. At 2:35 p.m., the door opening into the corridor from Room 419, located on the 4th Floor in the McLeod Tower, failed to close and positive latch when held open at its fullest extent and released to close by means of its equipped self-closing device.

9. At 2:37 p.m., the door opening into the corridor from Room 421, located on the 4th Floor in the McLeod Tower, failed to close and positive latch when held open at its fullest extent and released to close by means of its equipped self-closing device.

1/8/2013:
10. At 11:43 a.m., the door opening into the corridor from Room 208, located on the 2nd Floor in the McLeod Tower, had a paper wedged underneath the door that prevented the door from closing.


21101


Palomar Health Downtown Campus, 1/9/2013:
11. At 10:57 a.m., the corridor door to the kitchen dish washing area, located on the 2nd Floor in the Adams Wing, failed to fully close and latch upon self-closure.

Based on observation, the facility failed to maintain the integrity of the smoke barrier walls, as evidenced by an unsealed penetration in a smoke barrier wall. This failure affected 2 of 10 smoke compartments in the lower level and had the potential to allow the spread of smoke and or fire from one compartment to the adjoining compartment.

Findings:

During a tour of the facility with hospital staff on 1/7/2013 through 1/10/2013, the smoke barriers were observed.

Palomar Medical Center, 1/8/2013:
At 10:37 a.m., there was a 3-inch by 6-inch hole in the left side of the smoke barrier wall located above the entrance to the sterile processing department.

Based on observation, the facility failed to maintain their smoke barrier walls. This was evidenced by unsealed penetrations in smoke barrier walls. This had the potential to allow the spread of smoke from one smoke compartment to another smoke compartment in the event of a fire, potentially harming patients, visitors, and staff. This affected 2 of 6 floors (the 3rd and 4th Floors) in the West Tower and 2 of 4 floors (the 2nd and 3rd Floors) in the Adams Wing at Palomar Health Downtown Campus.

NFPA 101, Life Safety Code, 2000 Edition
8.3.2 Continuity. Smoke barriers required by this Code shall be continuous from an outside wall to an outside wall, from a floor to a floor, or from a smoke barrier to a smoke barrier or a combination thereof. Such barriers shall be continuous through all concealed spaces, such as those found above a ceiling, including interstitial spaces.

Findings:

During a tour of the facility with the Hospital Staff on 1/7/2013 through 1/10/2013, the smoke barrier walls were observed.

Palomar Health Downtown Campus, 1/8/2013:
1. At 9:24 a.m., the smoke barrier wall by the entrance into the PACU, located on the 4th Floor in the West Tower, had a penetration above the drop-down ceiling. The penetration measured approximately 1-inch diameter.


21101


Palomar Health Downtown Campus, 1/9/2013:
2. At 1:21 p.m., there was an approximately 1-inch diameter penetration in the left side of the smoke barrier wall located next to Elevator-9. The wall is located on the 3rd Floor in the Adams Wing.

3. At 2:00 p.m., there was an approximately 3/4-inch penetration around a duct in the center of the smoke barrier wall and a conduit that was not sealed in the right side of the wall. The wall was located on the 3rd Floor in the West Tower, Express Care Department.

4. At 2:19 p.m., there was an approximately 3-inch diameter penetration in the right side of the smoke barrier wall entering the kitchen that is located on the 2nd Floor in the Adams Wing.

Based on observation, the facility failed to ensure that spaces under the stairways were not used for storage. This was evidenced by multiple items being stored in the stairway's landing. This had the potential for interfering with egress during a fire emergency, rendering the stairway unsafe or non-usable for residents, staff, and visitors. This affected 3 of 3 floors in the South Wing at Palomar Health Downtown Campus.

NFPA 101, Life Safety Code, 2000 Edition
7.2.2.5.3 Usable Space. There shall be no enclosed, usable space within an exit enclosure, including under stairs, nor shall any open space within the enclosure be used for any purpose that has the potential to interfere with egress.

Findings:

During a tour of the facility with the Hospital Staff on 1/7/2013 through 1/10/2013, the stairwells egress were observed.

Palomar Health Downtown Campus, 1/7/2013:
At 3:45 p.m., Stairway-10, located in the South Wing, had several items stored underneath the stairs landing on the 3rd Floor. These items included stands for medical gas cylinders, cart with wheels, two weighing scales, five stationary bikes, gurney, and a rowing exercise machine.

Based on observation and record review, the facility failed to maintain their emergency lighting. This was evidenced by emergency lighting units that failed to illuminate when tested. This had the potential for delaying evacuation and causing injury to patients, staff, and visitors. This affected 1 of 6 floors (the 7th Floor) in the West Tower and 1 of 10 floors (the 6th Floor) in the McLeod Tower at Palomar Health Downtown Campus.

NFPA 101 Life Safety Code, 2000 edition
7.9.3 Periodic Testing of Emergency Lighting Equipment.
A Functional test shall be conducted on every required emergency lighting system at 30-day intervals for not less than 30 seconds. An annual test shall be conducted on every required battery-powered emergency lighting system for not less than 1.5 hours. Equipment shall be fully operational for the duration of the test. Written records of visual inspections and tests shall be kept by the owner for inspection by the authority having jurisdiction.

Findings:

During a tour of the facility with the Hospital Staff on 1/7/2013 through 1/10/2013, the emergency lighting units were tested and maintenance records were reviewed.

Palomar Health Downtown Campus, 1/7/2013:
1. At 1:40 p.m., the emergency light (labeled "1591") installed at the Nursing Station, located on the 7th Floor in the West Tower, failed to illuminate when tested. The testing log provided by the facility had the "illuminate" and "battery" marked with circles around the pass and the fail options, and with scratch marks on the fail option.

2. At 1:47 p.m., the emergency light (labeled "20295") installed at the Nursing Station by Room 627, located on the 6th Floor in the McLeod Tower, failed to illuminate when tested. The testing log provided by the facility had the "illuminate" and "battery" marked with circles around the fail options and with the following comment "Has Been disconnected."

Based on observation, the facility failed to maintain visible exit signs. This was evidenced by exit signs installed that did not illuminate. This could potentially delay evacuation in the event of a power outage and an emergency evacuation. This affected 1 of 10 floors (the 9th Floor) in the McLeod Tower and 1 of 6 floors (the 3rd Floor) in the West Tower at Palomar Health Downtown Campus.

NFPA 101, Life Safety Code, 2000 Edition
19.2.10.1 Means of egress shall have signs in accordance with Section 7.10.

7.10.1.4 Exit Access. Access to exits shall be marked by approved, readily visible signs in all cases where the exit or way to reach the exit is not readily apparent to the occupants. Sign placement shall be such that no point in an exit access corridor is in excess of 100 ft (30 m) from the nearest externally illuminated sign and is not in excess of the marked rating for internally illuminated signs.

7.10.5.2 Continuous Illumination. Every sign required to be illuminated by 7.10.6.3 and 7.10.7 shall be continuously illuminated as required under the provisions of Section 7.8.

Findings:

During a tour of the facility with the Hospital Staff on 1/7/2013 through 1/10/2013, the exit signs were observed.

Palomar Health Downtown Campus, 1/7/2013:
1. At 12:02 p.m., the exit sign in the corridor by Room 924 Exam Office, located on the 9th Floor in the McLeod Tower, failed to illuminate.

1/8/2013:
2. At 11:05 a.m., there were two non-illuminating papered exit signs installed in the Medical Records Office, located on the 3rd Floor in the West Tower. The way to reach the exits were not readily apparent during power outage.

Based on observation and record review, the facility failed to ensure that the fire alarm system was properly maintained. This was evidenced by a smoke detector covered with tape, fire alarm devices that failed when tested, and no record of repairs done on devices that failed during the annual fire alarm inspection. This had the potential for occupants to not be alerted of a fire, resulting in harm to patients, visitors and staff. This affected 1 of 4 floors (the 2nd Floor) in the Adams Wing, 4 of 10 floors (the 1st, 2nd, 8th, and 9th Floors) in the McLeod Tower, 3 of 6 floors (the 3rd, 5th, and 7th Floors) in the West Tower, and 1 of 3 floors (the 5th Floor) in the South Wing at Palomar Health Downtown Campus.

NFPA 72, National Fire Alarm Code, 1999 Edition
7-2.2 Fire alarm systems and other systems and equipment that are associated with fire alarm systems and accessory equipment shall be tested according to Table 7-2.2.

Findings:

During a tour of the facility with the Hospital Engineering Staff on 1/7/2013 through 1/10/2013, the fire alarm system was tested and documents for the system were reviewed.

Palomar Health Downtown Campus, 1/8/2013
1. At 11:40 a.m., the smoke detector installed in Room 204, located in the Mental Health Unit that is on the 2nd Floor in the McLeod Tower, was observed to be covered with tape. The Facility Manager stated that the smoke detector had been covered with tape when they painted the room.

1/9/2013:
2. At 11:02 a.m., the chime-strobe device installed in the conference room by the kitchen, located on the 2nd Floor in the Adams Wing, failed to sound an alarm when a pull station was activated in the area.

3. At 4:00 p.m., the facility's fire alarm system annual inspection report was reviewed. The report, dated 3/21/12, identified the following devices as failed with no documentation that showed that the items had been corrected:
i. The PSD smoke detector (5:M1-41-29), installed in the communication area, located on the 3rd Floor in the West Tower.
ii. The PSD smoke detector (3:M1-49), installed in service elevator area, located on the 2nd Floor in the McLeod Tower.
iii. The PSD smoke detector (6:M1-55), installed in Elevator-6 Landing, located on the 5th Floor in the South Wing.
iv. The PSD smoke detector (7:M3-25-9), installed in the corridor by Room 748, located on the 7th Floor in the West Tower.
v. The chime-strobe audio (MT1-2A/V), installed in the corridor by Stairwell-5 to lobby, located on the 1st Floor in the McLeod Tower.
vi. The chime-strobe audio (WT5-1A/V), installed by Elevator 1 & 2, located on the 5th Floor in the West Tower.
vii. The strobe visual (MT9-22V), installed in the dining and activity room, located on the 9th Floor in the McLeod Tower.


21101


Palomar Health Downtown Campus, 1/9/2013:
4. At 8:52 a.m., the chime strobe device MT8-2V failed to activate an audible alarm during the testing of the fire alarm system. The device is located next to Stairway-6 on the 8th Floor in the McLeod Tower.

5. At 10:45 a.m., the chimes-strobe device MT2-16A and device MT2-3A failed to activate audible alarms during the testing of the fire alarm system in the Mental Health Unit. These devices were located on the 2nd Floor in the McLeod Tower.

Based on observation, the facility failed to maintain their automatic sprinkler system. This was evidenced by sprinkler heads with foreign materials on or hanging from sprinkler heads. This could result in the ineffective disbursement of water by the sprinkler head in the event of a fire, resulting in injury to patients, visitors, and staff. This affected 1 of 3 floors (the 4th Floor) in the South Wing, 1 of 6 floors (the 3rd Floor) in the West Tower, and 1 of 4 floors (the 1st Floor) in the Adams Wing at Palomar Health Downtown Campus.

NFPA 101, Life Safety Code, 2000 Edition
9.7.5 Maintenance and Testing. All automatic sprinkler and standpipe systems required by this Code shall be inspected, tested, and maintained in accordance with NFPA 25, Standard for the Inspection, Testing, and Maintenance of Water-Based Fire Protection Systems.

NFPA 25, Standard for the Inspection, Testing, and Maintenance of Water-Based Fire Protection Systems, 1998 Edition
1-4.2 The responsibility for properly maintaining a water-based fire protection system shall be that of the owner(s) of the property. By means of periodic inspections, tests, and maintenance, the equipment shall be shown to be in good operating condition, or any defects or impairments shall be revealed.
Inspection, testing, and maintenance shall be implemented in accordance with procedures meeting or exceeding those established in this document and in accordance with the manufacturer's instructions. These tasks shall be performed by personnel who have developed competence through training and experience.
Exception: Where the owner is not the occupant, the owner shall be permitted to pass on the authority for inspecting, testing, and maintaining the fire protection systems to the occupant, management firm, or managing individual through specific provisions in the lease, written use agreement, or management contract.

2-2.1.1 Sprinklers shall be inspected from the floor level annually. Sprinklers shall be free of corrosion, foreign materials, paint, and physical damage and shall be installed in the proper orientation (e.g., upright, pendant, or sidewall). Any sprinkler shall be replaced that is painted, corroded, damaged, loaded, or in the improper orientation.

Findings:

During a tour of the facility with the Hospital Staff on 1/7/2013 through 1/10/2013, the sprinkler system was observed.

Palomar Health Downtown Campus, 1/7/2013:
1. At 3:40 p.m., the sprinkler head installed in the biohazard room by Room 447, located on the 4th Floor in the South Wing, had a piece of plastic material hanging from its deflector.

1/8/2013:
2. At 10:39 a.m., the sprinkler head installed in the soiled utility room for the Express Care, located on the 3rd Floor in the West Tower, had a piece of plastic material hanging from its deflector.


21101


Palomar Health Downtown Campus, 1/9/2013:
3. At 2:38 p.m., in the laundry chute room, located on the 1st Floor in the Adams Wing, 2 of 2 sprinkler heads had their deflectors covered with blue plastic. This was acknowledged by staff during the survey.

Based on observation, the facility failed to maintain their portable fire extinguishers readily accessible. This was evidenced by a fire extinguisher that was obstructed and not accessible to allow for the quick response to a fire. This could result in a delayed response to a fire and increase the risk of injury to patients, visitors, and staff. This affected 1 of 4 floors (the 4th Floor) in the Adams Wing at Palomar Health Downtown Campus.

NFPA 101, Life Safety Code, 2000 Edition
9.7.4 Manual Extinguishing Equipment.
9.7.4.1 Where required by the provisions of another section of this Code, portable fire extinguishers shall be installed, inspected, and maintained in accordance with NFPA 10, Standard for Portable Fire Extinguishers.

NFPA 10, Standard for Portable Fire Extinguishers, 1998 Edition
1-6.3 Fire extinguishers shall be conspicuously located where they will be readily accessible and immediately available in the event of fire. Preferably they shall be located along normal paths of travel, including exits from areas.

1-6.6 Fire extinguishers shall not be obstructed or obscured from view.
Exception: In large rooms, and in certain locations where visual obstruction cannot be completely avoided, means shall be provided to indicate the location.

Findings:

During a tour of the facility with the Hospital Engineering Staff on 1/7/2013 through 1/10/2013, the fire extinguishers were observed.

Palomar Health Downtown Campus, 1/7/2013:
At 2:57 p.m., the fire extinguisher in the corridor by Room 436, located on the 4th Floor in the Adams Wing, had a work station on wheels that obstructed the extinguisher from being readily accessible.

Based on observation, document review, and interview, the facility failed to maintain the kitchen hood exhaust systems. This was evidenced by the exhaust hood heavily contaminated with grease and by not maintaining a documented schedule that showed that the cleaning of the kitchen's exhaust hoods were frequent enough to meet the minimum required based on the type or volume of cooking. The failure to maintain the exhaust system could increase the potential risk of a grease fire. This affected 1 of 4 floors (the 2nd Floor) in the Adams Wing at Palomar Health Downtown Campus.

NFPA 96, Standard for Ventilation Control and Fire Protection of Commercial Cooking Operations, 1998 Edition
8-3 Cleaning
8-3.1 Hoods, grease removal devices, fans, ducts, and other appurtenances shall be cleaned to bare metal at frequent intervals prior to surfaces becoming heavily contaminated with grease or oily sludge. After the exhaust system in cleaned to bare metal, it shall not be coated with powder or other substance. The entire exhaust system shall be inspected by a properly trained, qualified, and certified company or person (s) acceptable to the authority having jurisdiction in accordance with Table 8-3.1.

Table 8-3.1 Exhaust System Inspection Schedule
Type or Volume of Cooking Frequency
Systems serving solid fuel cooking operations, Frequency - Monthly
Systems serving high-volume cooking operations, such as 24 hour cooking, charbroiling or wok cooking, Frequency - Quarterly
Systems serving moderate-volume cooking operations, Frequency - Semiannually
Systems serving low-volume cooking operations, such as churches, day camps, seasonal businesses, or senior centers, Frequency - Annually

8-3.1.1 Upon inspection, if found to be contaminated with deposits from grease-laden vapors, the entire exhaust system shall be cleaned by a properly trained, qualified, and certified company person (s) acceptable to the authority having jurisdiction in accordance with Section 8-3.

8-3.1.2 When a vent cleaning service is used, a certificate showing date of inspection or cleaning shall be maintained on premises. After cleaning is completed, the vent cleaning contractor shall place or display within the kitchen area a label indicating the date cleaned and the name of the servicing company. It shall also indicate areas not cleaned.

Findings:

During a tour of the facility with the Hospital Engineering Staff on 1/7/2013 through 1/10/2013, the kitchen exhaust system and cooking areas were observed, documents were reviewed, and staff were interviewed.

Palomar Health Downtown Campus, 1/9/2013:
At 4:11 p.m., the exhaust hood above the grill in the kitchen cooking area, located on the 2nd Floor in the Adams Wing, was layered with grease. The entire exhaust hood area including the sprinklers and sprinkler pipes in the hood were contaminated with a layer of grease. The sticker/label located on the outside of the hood area documented the date the exhaust hood was last cleaned on 1/2012.

At 4:38 p.m., during document review, the facility failed to provide cleaning frequency schedules and documentation from a certified company or person responsible for the cleaning of the exhaust hood located above the grill. During interview, the Facility Manager stated that he would contact the vendor and request the records for the most recent cleaning of the hood.


29626


Palomar Health Downtown Campus, 1/10/2013
At 9:45 a.m., the kitchen's exhaust hood cleaning documents were reviewed. The Facility Manager provided monthly preventive maintenance schedules that stated that the assigned staff member will verify that the outside contractor will clean grease exhaust system and ducts. The facility failed to provide the records from the outside contractor that showed that the exhaust system above the grill had been cleaned since 1/2012. The last two inspections (2/23/2012 and 8/23/2012) of the kitchen's fire suppression system noted that the exhaust system required cleaning.

Based on observation, the facility failed to properly store their medical gas cylinders. This was evidenced by medical gas cylinders that were stored by combustible materials and electrical receptacles and by oxygen cylinders that were not individually secured. This could cause harm to patients, visitors, and staff in the event the cylinder fell on something or someone and may result in fire or explosion. This affected 2 of 6 floors (the 3rd and 4th Floors) in the West Tower at Palomar Health Downtown Campus.

NFPA 101, Life Safety Code, 2000 Edition
19.3.2.4 Medical Gas. Medical gas storage and administration areas shall be protected in accordance with NFPA 99, Standard for Health Care Facilities.

NFPA 99, Health Care Facilities, 1999 Edition
4-3.1.1.1. Cylinder and Container Management. Cylinders in service and in storage shall be individually secured and located to prevent falling or being knocked over.

4-3.1.1.2 Storage Requirements (Location, Construction, Arrangement).
(a) Nonflammable Gases (Any Quantity; In-Storage, Connected, or Both)
4. The electric installation in storage locations or manifold enclosures for nonflammable medical gases shall comply with the standards of NFPA 70, National Electrical Code, for ordinary locations. Electric wall fixtures, switches, and receptacles shall be installed in fixed locations not less than 152 cm (5 ft) above the floor as a precaution against their physical damage.
5. Storage locations for oxygen and nitrous oxide shall be kept free of flammable materials [see also 4-3.1.1.2(a)7].
7. Combustible materials, such as paper, cardboard, plastics, and fabrics shall not be stored or kept near supply system cylinders or manifolds containing oxygen or nitrous oxide. Racks for cylinder storage shall be permitted to be of wooden construction. Wrappers shall be removed prior to storage.

Findings:

During a tour of the facility with the Hospital Engineering Staff on 1/7/2013 through 1/10/2013, the medical gas cylinders were observed.

Palomar Health Downtown Campus, 1/8/2013:
1. At 9:12 a.m., the location where the medical gases were stored in the PACU by the recovery area, located on the 4th Floor in the West Tower, had combustible materials and electrical receptacles within 1.5-feet. The medical gases included two carbon dioxide cylinders, nine oxygen cylinders, and one compressed gas cylinder.

2. At 10:52 a.m., there were three oxygen gas cylinders observed to be standing upright and not individually secured in the EMS crew room. The room was located by the ambulance entrance on the 3rd Floor in the West Tower.

Based on observation, the facility failed to maintain the ensure that extension cords were not used in place of permanent wiring. This was evidenced by the use of extension cords with no overcurrent protection. This failure affected 1 of 8 smoke compartments on the first floor and could increase the risk of an electrical fire.

NFPA 101, Life Safety Code, (2000) Edition, SECTION 9.1. UTILITIES
9.1.2 Electric. Electrical wiring and equipment shall be in accordance with NFPA 70, National electrical Code, unless existing installations, which shall be permitted to be continued in service, subject to approval by the authoring having jurisdiction.

NFPA 70, National Electrical Code, (1999) Edition
400-8. Uses Not Permitted. Unless specifically permitted in Section 400-7, flexible cords and cables shall not be used for the following:
(1) As a substitute for the fixed wiring of a structure

Findings:

During a tour of the facility with hospital staff on 1/7/2013 through 1/10/2013, the electrical wiring and equipment was observed.

Palomar Medical Center, 1/8/2013:
1. At 9:51 a.m., there was a white extension cord in use that had no overcurrent protection in sleep room 1-S117.

2. At 9:54 a.m., there was a white extension cord in use that had no overcurrent protection in sleep room 1-S115.

Based on observation, the facility failed to maintain electrical safety. This was evidenced by multi-outlet adapters used in patient areas as substitutes for fixed wired electrical outlets with multiple equipments plugged into them, damaged receptacle wall outlets, outlets with no faceplate covers, and the use of multi-outlet adapters that exceeded permitted load capacity. This deficient practice had the potential for increasing the risk of an electrical fire and electric shock, resulting in harm to patients, visitors and staff. This affected 3 of 10 floors (the Lobby, 4th, and 9th Floors) in the McLeod Tower, 2 of 4 floors (the 1st and 4th Floors) in the Adams Wing, 1 of 3 floors (the 4th Floor) in the South Wing, and 1 of 6 floors (the 4th Floor) in the West Tower at Palomar Health Downtown Campus.

NFPA 99, Health Care Facilities, 1999 Edition
3-3.2.1.2 All Patient Care Areas.
(d) Receptacles. 2. Minimum Number of Receptacles. The number of receptacles shall be determined by the intended use of the patient care area. There shall be sufficient receptacles located so as to avoid the need for extension cords or multiple outlet adapters.

NFPA 70, National Electrical Code, 1999 Edition
110-12. Mechanical Execution of Work. Electrical equipment shall be installed in a neat and workmanlike manner.

110-26. Spaces About Electrical Equipment. Sufficient access and working space shall be provided and maintained about all electric equipment to permit ready and safe operation and maintenance of such equipment. Enclosures housing electrical apparatus that are controlled by lock and key shall be considered accessible to qualified persons.

110-56. Energized Parts. Bare terminals of transformers, switches, motor controllers, and other equipment shall be enclosed to prevent accidental contact with energized parts.

210-23 Permissible Loads. In no case shall the load exceed the branch-circuit ampere rating. An individual branch circuit shall be permitted to supply any load for which it is rated. A branch circuit supplying two or more outlets or receptacles shall supply only the loads specified in (a) through (d) and as summarized in Section 210-24 and Table 210- 24.

370-25 In completed installations, each box shall have a cover, faceplate, or fixture canopy.

400-8. Uses Not Permitted. Unless specifically permitted in section 400-7, flexible cords and cables shall not be used for the following:
(1) As a substitute for a fixed wiring of a structure

Findings:

During a tour of the facility with the Hospital Engineering Staff on 1/7/2013 through 1/10/2013, the electrical equipments and devices were observed.

Palomar Health Downtown Campus, 1/7/2013:
1. At 12:07 p.m., there was a broken cover to a receptacle outlet in the PT Staff Room, located on the 9th Floor in the McLeod Tower.

2. At 2:41 p.m., there were items stored up against the four electrical panels in the soiled utility room, located next to the nursing station on the 4th Floor in the McLeod Tower. The items included two 30-gallon containers with combustibles and a confidential paper container.

3. At 3:09 p.m., there was a broken faceplate cover to a receptacle wall outlet in the telephone panel, located by the nursing station on the 4th Floor in the Adams Wing.

4. At 3:35 p.m., there was a broken faceplate cover to a receptacle wall outlet in the OB Classroom C0402, located on the 4th Floor in the South Wing.

1/8/2013:
5. At 8:49 a.m., there was a 20-AMP fixed wired electrical outlet that had two 15-AMP multi-outlet adapter connected to each other with medical devices plugged into them in OR-8, located on the 4th Floor in the West Tower. The devices included an Electronic Fetal Monitor, an Alternating Leg Pressure Pump, and a Cautery Unit.


21101


Palomar Health Downtown Campus, 1/9/2013:
6. At 2:52 p.m., there was a power strip plugged into a power strip under the environmental services director's desk. The office is located on the 1st Floor in the Adams Wing.

7. At 3:17 p.m., there was a power strip plugged into a power strip under the desk in the registration office. The office is located on the Lobby Level in the McLeod Tower.