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Based on random observation during the survey walk-through, not all portions of the building are of fire resistive construction in accordance with 19.1.6.2. These deficiencies could affect any patients, staff, or visitors in the building by permitting the building structure to be compromised during fire conditions.

Findings include:

A. Steel angles supporting the roofs of Exit Stair enclosures were observed to not be covered by fire proofing materials in accordance with the building's designated construction type. Locations observed include:

1. 11:36 AM April 8, 2013, East Exit Stair.

2. 1:25 PM April 8, 2013, West Exit Stair.

Based on random observation during the survey walk-through, not all exit stair shafts are constructed or maintained as fire resistive assemblies in accordance with 19.3.1.1. These deficiencies could affect any building occupants using the exit stairs because the stair enclosure could be compromised by smoke or fire, or by allowing a condition at which they could fall through the guardrails.

Findings include:

A. At 11:47 AM on April 8, 2013, the Third Floor Equipment Room, which is not a normally occupied space, was observed to communicate directly with the Third Floor landing of the Center Exit Stair, as prohibited by 7.1.3.2.1(d).
B. At 11:53 AM on April 8, 2013, the distance between guardrails in the Center Exit Stair enclosure was observed to be in excess of 4" as prohibited by 7.2.2.4.6(3). During an interview conducted in that Exit Stair at that time, the provider's Maintenance Supervisor confirmed that this condition also exists at:

1. The East Exit Stair.
2. The West Exit Stair.

Based on random observation during the survey walk-through, not all exit accesses are arranged so that exits are readily accessible at all times in accordance with 19.2.1. These deficiencies could affect any patients, staff, or visitors in the building by preventing them from reaching an exit under fire conditions.

Findings include:

A. At 1:47 PM on April 8, 2013, 4 doors in the Second Floor former ICU (now Outpatient Stage II Recovery) were observed which reduce the adjacent Corridor to less than half its required width, when in the open (90 degree) position, as prohibited by 7.2.1.4.4.

Based on random observation during the survey walk-through, not all designated or required horizontal exits or fire barriers are constructed or maintained as fire resistive assemblies. These deficiencies could affect any patients, staff, or visitors in the building by allowing smoke or fire to pass between fire compartments.

Findings include:

A. On April 8, 2013, the following deficiencies were observed in the 2 hour fire barrier at the east side of the First Floor Annex Equipment Room, which serves as a portion of the 2 hour fire rated separation between the Hospital and the Nursing Home:
1. 2:20 PM: The fire rated door was observed to not be self-closing as required by 8.2.3.2.3.1(1).
2. 2:21 PM: Pipe and other penetrations were observed which are not sealed against the passage of fire as required by 8.2.4.2.4.2.
B. At 2:31 PM on April 8, 2013, the glazed opening in the 1 hour fire rated wall (which forms a portion of the enclosure for the sprinklered fire compartment which permits the Center Exit Stair to discharge interior to the building) at the east side of the First Floor Emergency Department Waiting Room was observed to be in excess of 1,296 square inches as prohibited by NFPA 80 1999 1-7.4.
C. At 10:33 AM on April 9, 2013, the rolling fire shutter in the 1 hour fire rated wall (which forms a portion of the enclosure for the sprinklered fire compartment which permits the Center Exit Stair to discharge interior to the building) at the west side of the First Floor Physical Therapy Department failed to close upon activation of the building fire alarm system as required by 8.2.3.2.3.1(1).

Based on random observation during the survey walk-through, and document review, the facility's written plan for the protection of patients is not complete as required by 19.7.1.1. These deficiencies could affect any patients, staff, or visitors in the building because the failure to identify key life safety components could result in the failure to protect them properly.

Findings include:

A. At 10:50 AM on April 9, 2013, a series of apparent errors were observed in the Life Safety Plans dated July 20, 2009; these plans are thus not sufficiently accurate to comply with 19.7.1.1. Apparent errors include:
1. The Center Exit Stair is shown as being provided with a fire rated Exit Passageway, and is not shown as discharging into a sprinklered, separated fire compartment.

2. The 2 hour fire separation which exists between the Hospital and the Nursing Home is not shown at the east fire rated wall of the First Floor Annex Equipment Room.

Based on document review and staff interview, fire drills are not held at varying times and varying conditions in accordance with 19.7.1.2. These deficiencies could affect any patients, staff, or visitors in the building because staff members may not be properly prepared for a fire emergency, and because the connection between the Hospital and the Monitoring Agency may not be intact.

Findings include:

A. Based on a review of Fire Drill Records, conducted at 9:27 AM on April 9, 2013, fire drills for the Second Shift are not conducted at varying times as required by 19.7.1.2. During the calendar years 2012 and 2013, fire drills for the following quarters were conducted at the similar times listed:

1. February 27, 2012: 11:30 PM.

2. May 27, 2012: 11:30 PM.

3. August 23, 2012: 11:00 PM.

4. November 19, 2012: 11:00 PM.

5. February 25, 2013: 11:25 PM.

B. During an interview held in his Office on the at 9:28 AM on April 9, 2013, the provider's Maintenance Supervisor confirmed that Second Shift fire drills do not include the transmission of a fire alarm signal as required by 19.7.1.2.

Based on random observation during the survey walk-through, not all portions of the building fire alarm system are installed in accordance with 19.3.4. This deficiency could affect any patients, staff, or visitors in the cited Corridor because they may not be made aware of a fire emergency.

Findings include:

A. At 10:22 AM on April 9, 2013, the fire alarm notification in the Third Floor West Corridor was not audible as required by 9.6.3.8. and NFPA 72 1999 4-3.3.2.

Based on random observation during the survey walk-through, not all portions of the facility's air conditioning and ventilating systems are installed in accordance with NFPA 90A. These deficiencies could affect any patients, staff, or visitors in the building because smoke or fire could be permitted to pass between building stories.

Findings include:

A. On April 8, 2013, the following conditions were observed at a ventilation shaft on the south side of the Third Floor Equipment Room:

1. At 11:49 AM, unsealed pipe penetrations and an unrated metal plate were observed in the ventilation shaft wall as prohibited by 8.2.4.2.4.

2. At 11:50 AM, the duct penetration from the exhaust fan into the ventilation shaft was observed to lack a fire damper required by NFPA 90A 1999 3-3.2.

B. During an interview held in his Office at 9:39 AM on April 9, 2013, the provider's Maintenance Supervisor confirmed that fire dampers are not tested every 4 years as required by NFPA 90A 1999 3-4.7.

Based on staff interview, not all portions of the facility's commercial cooking equipment are installed and maintained in accordance with NFPA 96. This deficiency could affect any patients, staff, or visitors in the building because a fire could develop in the uncleaned ductwork

Findings include:

A. During an interview conducted in his Office at 9:35 AM on April 9, 2013, the provider's Maintenance Supervisor confirmed that the Kitchen exhaust hood ductwork is not inspected and cleaned periodically as required by NFPA 96 1998 8-3.1.

Based on random observation during the survey walk-through, not all egress paths are maintained free of obstructions or impediments to full instant use in the case of fire or other emergency in accordance with 19.2.3.3. These deficiencies could affect any patients, staff, or visitors in the cited areas by preventing their egress from the building.

Findings include:

A. Carts, furnishings, and equipment were observed in exit access corridors that obstruct egress as prohibited by 19.2.3.3. and 7.1.10.2.1. Locations and items observed include:

1. 1:45 PM April 8, 2013: Linen cart in Second Floor Surgical Department East Corridor.

2. 9:08 AM April 9, 2013: Chairs at south side of Nurses' Station in First Floor Emergency Department Corridor.

Based on random observation during the survey walk-through, not all medical gas piping systems are installed and maintained in accordance with NFPA 99. This deficiency could affect any staff in the immediate area by permitting medical gases to contribute to a fire, and any patients in the building by allowing the medical gas systems to be compromised during a fire condition.

A. At 8:25 AM on April 9, 2013, the door to the First Floor Medical Gas Manifold Room was observed to lack a minimum 3/4 hour fire resistance rating required by 8.2.3.2.3.1(2) and NFPA 99 1999 4-3.1.1.2.

Based on random observation during the survey walk-through, document review, and staff interview, the facility is not in compliance with a series of Life Safety and other code requirements that are not documented under other K-Tags.

Findings include:

A. Due to the number, variety, and severity of the life safety deficiencies observed during the survey walk-through, the provider shall institute appropriate interim life safety measures until all cited deficiencies are corrected. The provider shall include, as an attachment to its Plan of Correction (PoC) and referenced therein, a detailed narrative and proposed schedule for all such measures. The narrative shall describe all measures to be implemented, as well as the frequency with which they are to be conducted, and shall indicate the manner in which the measures are to be documented. The narrative shall also include comments related to changes in the interim life safety measures to remain in place as work toward the completion of its PoC progresses.

Based on document review and staff interview, the emergency generator is not inspected and tested in accordance with NFPA 99. These deficiencies could affect any patients, staff, or visitors in the building because the emergency generator may not function under power outage conditions.

Findings include:

A. During the document review process, it was determined that the emergency generator is not tested under load for 30 minutes each month, as required by NFPA 99 1999 3-4.4.1.1. and NFPA 110 1999 6-4.2. This determination was confirmed by the provider's Maintenance Supervisor during an interview held in his Office at 9:40 AM on April 9, 2013.

B. During the document review process, it was determined that transfer switches are not operated monthly as required by NFPA 110 1999 6-4.5. This determination was confirmed by the provider's Maintenance Supervisor during an interview held in his Office at 9:41 AM on April 9, 2013.

Based on random observation during the survey walk-through and staff interview, the facility's Type 1 Emergency Electrical System (EES) is not divided into the Life Safety Branch, the Critical Branch, and the Equipment Branch as required by NFPA 99. These deficiencies could affect any patients, staff, or visitors in the building because the EES could become compromised.

Findings include:

A. The facility's Type 1 EES was observed to not be divided into a Life Safety, Critical, and Equipment Branch as required by NFPA 99 1999 3-4.2.2.2. and NFPA 70 1999 517-30. All Electrical Panels listed below were observed to serve electrical loads which are required to be served by different branches of the EES. Electrical Panels at which this condition was observed include, but are not limited to:
1. 11:57 AM April 8, 2013, Panel EX1, located in the Third Floor Center Equipment Room.

2. 1:56 PM April 8, 2013, Panel LPE-20, located in the Second Floor West Corridor.
3. 2:42 PM April 8, 2013, Panel X1, located in the First Floor Electrical Room.
4. 2:43 PM April 8, 2013, Panel X, also located in the First Floor Electrical Room.
5. 2:45 PM April 8, 2013, Panel HER, located in the First Floor Emergency Department Electrical Room.

6. 2:46 PM, Panel EER, also located in the First Floor Emergency Department Electrical Room.

7. 8:19 AM April 9, 2013, Panel XP5, located in the First Floor Boiler Room.

8. 8:20 AM, April 9, 2013, Panel XP6, also located in the First Floor Boiler Room.

B. The facility's Type 1 EES was observed to lack a separate transfer switch for each branch of the system (Life Safety, Critical, and Equipment) as required by NFPA 99 1999 3-4.2.2.1. and NFPA 70 1999 517-30(b)(4). During an interview held in his Office at 8:05 AM on April 9, 2013, the provider's Maintenance Supervisor confirmed that the facility has only 2 transfer switches, and that each of these serves a combination of Life Safety, Critical, and Equipment Branch loads.

Based on random observation during the survey walk-through and staff interview, not all portions of the building electrical system are installed in accordance with NFPA 70 1999. These deficiencies could affect any patients being treated in the cited areas because emergency power may not be available under certain conditions, or may affect any patients, staff, or visitors in the building because the fire alarm system could become compromised.

Findings include:

A. During an interview conducted in Second Floor Patient Sleeping Room 236 at 2:04 PM on April 8, 2013, the provider's Maintenance Supervisor confirmed that not all patient headwall locations in Patient Sleeping Rooms are provided with at least 1 circuit from the Critical Branch of the building's Type 1 Emergency Electrical System as required by NFPA 70 1999 517-18(a). Locations observed include all Second Floor Patient Sleeping Room headwall locations except the west beds in the 4-Bed Patient Sleeping Room immediately east of the Nurses' Station.

B. At 8:20 AM on April 9, 2013, First Floor Boiler Room Electrical Panel XP6 was observed to not be provided with an accurate Panel Directory as required by NFPA 70 1999 384-13. This Panel was observed to be provided with 2 Panel Directories. On 1 Directory, Circuit 1 is identified as serving the building fire alarm system, on the other Directory the building fire alarm system is identified as being served by Circuit 5.

Based on random observation during the survey walk-through, not all portions of the building are of fire resistive construction in accordance with 19.1.6.2. These deficiencies could affect any patients, staff, or visitors in the building by permitting the building structure to be compromised during fire conditions.

Findings include:

A. Steel angles supporting the roofs of Exit Stair enclosures were observed to not be covered by fire proofing materials in accordance with the building's designated construction type. Locations observed include:

1. 11:36 AM April 8, 2013, East Exit Stair.

2. 1:25 PM April 8, 2013, West Exit Stair.

Based on random observation during the survey walk-through, not all exit stair shafts are constructed or maintained as fire resistive assemblies in accordance with 19.3.1.1. These deficiencies could affect any building occupants using the exit stairs because the stair enclosure could be compromised by smoke or fire, or by allowing a condition at which they could fall through the guardrails.

Findings include:

A. At 11:47 AM on April 8, 2013, the Third Floor Equipment Room, which is not a normally occupied space, was observed to communicate directly with the Third Floor landing of the Center Exit Stair, as prohibited by 7.1.3.2.1(d).
B. At 11:53 AM on April 8, 2013, the distance between guardrails in the Center Exit Stair enclosure was observed to be in excess of 4" as prohibited by 7.2.2.4.6(3). During an interview conducted in that Exit Stair at that time, the provider's Maintenance Supervisor confirmed that this condition also exists at:

1. The East Exit Stair.
2. The West Exit Stair.

Based on random observation during the survey walk-through, not all exit accesses are arranged so that exits are readily accessible at all times in accordance with 19.2.1. These deficiencies could affect any patients, staff, or visitors in the building by preventing them from reaching an exit under fire conditions.

Findings include:

A. At 1:47 PM on April 8, 2013, 4 doors in the Second Floor former ICU (now Outpatient Stage II Recovery) were observed which reduce the adjacent Corridor to less than half its required width, when in the open (90 degree) position, as prohibited by 7.2.1.4.4.

Based on random observation during the survey walk-through, not all designated or required horizontal exits or fire barriers are constructed or maintained as fire resistive assemblies. These deficiencies could affect any patients, staff, or visitors in the building by allowing smoke or fire to pass between fire compartments.

Findings include:

A. On April 8, 2013, the following deficiencies were observed in the 2 hour fire barrier at the east side of the First Floor Annex Equipment Room, which serves as a portion of the 2 hour fire rated separation between the Hospital and the Nursing Home:
1. 2:20 PM: The fire rated door was observed to not be self-closing as required by 8.2.3.2.3.1(1).
2. 2:21 PM: Pipe and other penetrations were observed which are not sealed against the passage of fire as required by 8.2.4.2.4.2.
B. At 2:31 PM on April 8, 2013, the glazed opening in the 1 hour fire rated wall (which forms a portion of the enclosure for the sprinklered fire compartment which permits the Center Exit Stair to discharge interior to the building) at the east side of the First Floor Emergency Department Waiting Room was observed to be in excess of 1,296 square inches as prohibited by NFPA 80 1999 1-7.4.
C. At 10:33 AM on April 9, 2013, the rolling fire shutter in the 1 hour fire rated wall (which forms a portion of the enclosure for the sprinklered fire compartment which permits the Center Exit Stair to discharge interior to the building) at the west side of the First Floor Physical Therapy Department failed to close upon activation of the building fire alarm system as required by 8.2.3.2.3.1(1).

Based on random observation during the survey walk-through, and document review, the facility's written plan for the protection of patients is not complete as required by 19.7.1.1. These deficiencies could affect any patients, staff, or visitors in the building because the failure to identify key life safety components could result in the failure to protect them properly.

Findings include:

A. At 10:50 AM on April 9, 2013, a series of apparent errors were observed in the Life Safety Plans dated July 20, 2009; these plans are thus not sufficiently accurate to comply with 19.7.1.1. Apparent errors include:
1. The Center Exit Stair is shown as being provided with a fire rated Exit Passageway, and is not shown as discharging into a sprinklered, separated fire compartment.

2. The 2 hour fire separation which exists between the Hospital and the Nursing Home is not shown at the east fire rated wall of the First Floor Annex Equipment Room.

Based on document review and staff interview, fire drills are not held at varying times and varying conditions in accordance with 19.7.1.2. These deficiencies could affect any patients, staff, or visitors in the building because staff members may not be properly prepared for a fire emergency, and because the connection between the Hospital and the Monitoring Agency may not be intact.

Findings include:

A. Based on a review of Fire Drill Records, conducted at 9:27 AM on April 9, 2013, fire drills for the Second Shift are not conducted at varying times as required by 19.7.1.2. During the calendar years 2012 and 2013, fire drills for the following quarters were conducted at the similar times listed:

1. February 27, 2012: 11:30 PM.

2. May 27, 2012: 11:30 PM.

3. August 23, 2012: 11:00 PM.

4. November 19, 2012: 11:00 PM.

5. February 25, 2013: 11:25 PM.

B. During an interview held in his Office on the at 9:28 AM on April 9, 2013, the provider's Maintenance Supervisor confirmed that Second Shift fire drills do not include the transmission of a fire alarm signal as required by 19.7.1.2.

Based on random observation during the survey walk-through, not all portions of the building fire alarm system are installed in accordance with 19.3.4. This deficiency could affect any patients, staff, or visitors in the cited Corridor because they may not be made aware of a fire emergency.

Findings include:

A. At 10:22 AM on April 9, 2013, the fire alarm notification in the Third Floor West Corridor was not audible as required by 9.6.3.8. and NFPA 72 1999 4-3.3.2.

Based on random observation during the survey walk-through, not all portions of the facility's air conditioning and ventilating systems are installed in accordance with NFPA 90A. These deficiencies could affect any patients, staff, or visitors in the building because smoke or fire could be permitted to pass between building stories.

Findings include:

A. On April 8, 2013, the following conditions were observed at a ventilation shaft on the south side of the Third Floor Equipment Room:

1. At 11:49 AM, unsealed pipe penetrations and an unrated metal plate were observed in the ventilation shaft wall as prohibited by 8.2.4.2.4.

2. At 11:50 AM, the duct penetration from the exhaust fan into the ventilation shaft was observed to lack a fire damper required by NFPA 90A 1999 3-3.2.

B. During an interview held in his Office at 9:39 AM on April 9, 2013, the provider's Maintenance Supervisor confirmed that fire dampers are not tested every 4 years as required by NFPA 90A 1999 3-4.7.

Based on staff interview, not all portions of the facility's commercial cooking equipment are installed and maintained in accordance with NFPA 96. This deficiency could affect any patients, staff, or visitors in the building because a fire could develop in the uncleaned ductwork

Findings include:

A. During an interview conducted in his Office at 9:35 AM on April 9, 2013, the provider's Maintenance Supervisor confirmed that the Kitchen exhaust hood ductwork is not inspected and cleaned periodically as required by NFPA 96 1998 8-3.1.

Based on random observation during the survey walk-through, not all egress paths are maintained free of obstructions or impediments to full instant use in the case of fire or other emergency in accordance with 19.2.3.3. These deficiencies could affect any patients, staff, or visitors in the cited areas by preventing their egress from the building.

Findings include:

A. Carts, furnishings, and equipment were observed in exit access corridors that obstruct egress as prohibited by 19.2.3.3. and 7.1.10.2.1. Locations and items observed include:

1. 1:45 PM April 8, 2013: Linen cart in Second Floor Surgical Department East Corridor.

2. 9:08 AM April 9, 2013: Chairs at south side of Nurses' Station in First Floor Emergency Department Corridor.

Based on random observation during the survey walk-through, not all medical gas piping systems are installed and maintained in accordance with NFPA 99. This deficiency could affect any staff in the immediate area by permitting medical gases to contribute to a fire, and any patients in the building by allowing the medical gas systems to be compromised during a fire condition.

A. At 8:25 AM on April 9, 2013, the door to the First Floor Medical Gas Manifold Room was observed to lack a minimum 3/4 hour fire resistance rating required by 8.2.3.2.3.1(2) and NFPA 99 1999 4-3.1.1.2.

Based on random observation during the survey walk-through, document review, and staff interview, the facility is not in compliance with a series of Life Safety and other code requirements that are not documented under other K-Tags.

Findings include:

A. Due to the number, variety, and severity of the life safety deficiencies observed during the survey walk-through, the provider shall institute appropriate interim life safety measures until all cited deficiencies are corrected. The provider shall include, as an attachment to its Plan of Correction (PoC) and referenced therein, a detailed narrative and proposed schedule for all such measures. The narrative shall describe all measures to be implemented, as well as the frequency with which they are to be conducted, and shall indicate the manner in which the measures are to be documented. The narrative shall also include comments related to changes in the interim life safety measures to remain in place as work toward the completion of its PoC progresses.

Based on document review and staff interview, the emergency generator is not inspected and tested in accordance with NFPA 99. These deficiencies could affect any patients, staff, or visitors in the building because the emergency generator may not function under power outage conditions.

Findings include:

A. During the document review process, it was determined that the emergency generator is not tested under load for 30 minutes each month, as required by NFPA 99 1999 3-4.4.1.1. and NFPA 110 1999 6-4.2. This determination was confirmed by the provider's Maintenance Supervisor during an interview held in his Office at 9:40 AM on April 9, 2013.

B. During the document review process, it was determined that transfer switches are not operated monthly as required by NFPA 110 1999 6-4.5. This determination was confirmed by the provider's Maintenance Supervisor during an interview held in his Office at 9:41 AM on April 9, 2013.

Based on random observation during the survey walk-through and staff interview, the facility's Type 1 Emergency Electrical System (EES) is not divided into the Life Safety Branch, the Critical Branch, and the Equipment Branch as required by NFPA 99. These deficiencies could affect any patients, staff, or visitors in the building because the EES could become compromised.

Findings include:

A. The facility's Type 1 EES was observed to not be divided into a Life Safety, Critical, and Equipment Branch as required by NFPA 99 1999 3-4.2.2.2. and NFPA 70 1999 517-30. All Electrical Panels listed below were observed to serve electrical loads which are required to be served by different branches of the EES. Electrical Panels at which this condition was observed include, but are not limited to:
1. 11:57 AM April 8, 2013, Panel EX1, located in the Third Floor Center Equipment Room.

2. 1:56 PM April 8, 2013, Panel LPE-20, located in the Second Floor West Corridor.
3. 2:42 PM April 8, 2013, Panel X1, located in the First Floor Electrical Room.
4. 2:43 PM April 8, 2013, Panel X, also located in the First Floor Electrical Room.
5. 2:45 PM April 8, 2013, Panel HER, located in the First Floor Emergency Department Electrical Room.

6. 2:46 PM, Panel EER, also located in the First Floor Emergency Department Electrical Room.

7. 8:19 AM April 9, 2013, Panel XP5, located in the First Floor Boiler Room.

8. 8:20 AM, April 9, 2013, Panel XP6, also located in the First Floor Boiler Room.

B. The facility's Type 1 EES was observed to lack a separate transfer switch for each branch of the system (Life Safety, Critical, and Equipment) as required by NFPA 99 1999 3-4.2.2.1. and NFPA 70 1999 517-30(b)(4). During an interview held in his Office at 8:05 AM on April 9, 2013, the provider's Maintenance Supervisor confirmed that the facility has only 2 transfer switches, and that each of these serves a combination of Life Safety, Critical, and Equipment Branch loads.

Based on random observation during the survey walk-through and staff interview, not all portions of the building electrical system are installed in accordance with NFPA 70 1999. These deficiencies could affect any patients being treated in the cited areas because emergency power may not be available under certain conditions, or may affect any patients, staff, or visitors in the building because the fire alarm system could become compromised.

Findings include:

A. During an interview conducted in Second Floor Patient Sleeping Room 236 at 2:04 PM on April 8, 2013, the provider's Maintenance Supervisor confirmed that not all patient headwall locations in Patient Sleeping Rooms are provided with at least 1 circuit from the Critical Branch of the building's Type 1 Emergency Electrical System as required by NFPA 70 1999 517-18(a). Locations observed include all Second Floor Patient Sleeping Room headwall locations except the west beds in the 4-Bed Patient Sleeping Room immediately east of the Nurses' Station.

B. At 8:20 AM on April 9, 2013, First Floor Boiler Room Electrical Panel XP6 was observed to not be provided with an accurate Panel Directory as required by NFPA 70 1999 384-13. This Panel was observed to be provided with 2 Panel Directories. On 1 Directory, Circuit 1 is identified as serving the building fire alarm system, on the other Directory the building fire alarm system is identified as being served by Circuit 5.