HospitalInspections.org

Based on observation and document review, the facility failed to establish all wall coverings' interior finish flame spread rating to establish compliance.

Findings include:

Administrative and Outpatient Clinic (West Charleston) - Rooms #6, #26, #28, and #41 had wood paneling. The facility did not have flame spread documentation to establish the flame spread rating values and compliance for the wood paneling.

Based on observation and document review, the facility failed to establish that all wall coverings within the facility conformed to proper flame spread rating.

Findings include:

- Section B: The Recovery Cafe's kitchen area had Fiberglass Reinforced Plastic (FRP) on its walls (floor-to-ceiling). The facility did not have documentation for review to establish that the FRP had the proper flame spread rating.

Based on observation, the facility failed to ensure that all corridor doors were free from impediments to closure.

Findings include:

The following corridor doors had impediments to closure making them incapable of resisting the transfer of smoke:

- Section E - Room #E170 corridor door was held open with chair.

Based on observation, the facility failed to ensure that all corridor doors were free of impediments to closure.

Findings include:

The following corridor doors could not close to resist the passage of smoke:

- Section C - Room #C179 corridor door was held open with a door chock.
- Section D - Room #D178 corridor door was held open with a cabinet.

Based on observation, the facility failed to ensure that all egress markings were properly installed.

Findings include:

Section C - In the office suite area, the egress marking did not have the chevron tab removed to properly direct occupants to the exit.

Based on observation, the facility failed to ensure that egress markings were installed as needed.

Findings include:

Administrative Outpatient Clinic (West Charleston) - Near Room #64, no exit sign was posted to direct occupants to the corridor's north exit (which accesses a east-west corridor to an exterior exit).

Based on observation, the facility failed to maintain the required fire-barrier rating for hazardous rooms.

Findings include:

- Section E - The E Unit's soiled holding room's corridor door was only 20-minute fire-rated (must be 45-minute rated).

- Section G - The G Unit's soiled holding room's corridor door was only 20-minute fire-rated (must be 45-minute rated).

39.2.1.1 All means of egress shall be in accordance with Chapter 7 and this chapter.

7.2.1.5.1 Doors shall be arranged to be opened readily from the egress side whenever the building is occupied. Locks, if provided, shall not require the use of a key, tool or special knowledge or effort for operation from the egress side.
Exception No. 1: This requirement shall not apply where otherwise provided in Chapters 18 through 23.
Exception No. 2: Exterior doors shall be permitted to have key-operated locks from the egress side provided that the following criteria have been met:
(a) Permission to use this exceptions provided in Chapters 12 through 42 for the specific occupancy.
(b) On or adjacent to the door, there is readily visible, durable sign in letters not less than 1 inch high on a contrasting background that reads as follows: THIS DOOR TO REMAIN UNLOCKED WHEN THE BUILDING IS OCCUPIED.
(c) The locking devise is the type that is readily distinguishable as locked.
(d) A key is immediately available to any occupant inside the building when it is locked.
Exception No. 2 shall be permitted to be revoked by the authority having jurisdiction for cause.
Exception No. 3: Where permitted in Chapters 12 through 42, key operations shall be permitted, provided that the key cannot be removed when the door is locked from the side from which egress is to be made.


Based on observation and staff interview, the facility failed to ensure key locked exterior egress doors conformed to the code.

Findings include:

East Las Vegas Clinic (Outpatient Building) - The north lobby's exterior exit door and the south lobby's exterior exit door were key-locked. The three accompanying facility staff members indicated that they did not have keys for either of these exterior exit doors. No signage was posted, no key was immediately available for egress, and no permission was granted in the existing business chapter of the Life Safety Code.

Note: The building has multiple tenants.

39.7.2 Extinguisher Training. Designated employees of business occupancies shall be periodically instructed in the use of portable fire extinguishers.

Based on document review, the facility failed to establish that staff had been trained on portable fire extinguisher use.

Findings include:

The facility did not have documentation to demonstrate that any outpatient staff had been trained on the use of portable fire extinguishers.

Based on observation and interview, the facility failed to ensure that staff was trained in their fire safety policy.

Findings include:

Interview on 09/20/10, with Unit D Staff revealed the following:

- Medical Records Staff Member indicated that she was on the unit in the mornings. She stated she would "help with closing the doors" in response to a fire event. She also did not know where the manual pull station was located.

- Nursing Staff Member stated she would "page for help." She had to search her keys to determine the one that would activate the manual pull station, this took approximately 1.5 minutes.

- Agency Staff Member indicated that he had been at the facility since July 2010. He stated, "He was instructed to go to the charge nurse to get his instructions in event of a fire." He also indicated that he would go to the chart nurse even if he found the fire, or if he discovered someone was in the same room as the fire.

On 09/23/10, a fire drill was conducted on Unit D with the following results:

- A Nursing Staff Member that was approached to initiate the fire drill delayed in her response for approximately 1.5 minutes. This staff member turn to other staff members to get guidance as to what to do prior to activating the manual fire alarm.

- As part of the facility's written fire safety plan, staff were to line up the patients to ready them to go out the door and evacuate to the courtyard. Patients were lined up, however no evacuation occurred.

Based on observation, the facility failed to ensure that fire sprinkler protective coverage was installed in all required locations.

Findings include:

Building 3 - The elevator machine room was not equipped with a fire sprinkler coverage.

Based on observation, the facility failed to maintain the fire sprinkler system.

Findings include:

The following problems were identified for the support and outpatient buildings:

Downtown Las Vegas Clinic (Outpatient Building) - The fire department connection was found unprotected. The bifurcated connection was missing both of its protective covers/end caps.

Based on observation and document review, the facility failed to establish that draperies within the facility conformed to NFPA 701.

Findings include:

- Section A: The Gymnasium Office had black draperies hanging over the viewing panel to the Gymnasium. The facility did not have documentation for review to establish that the draperies had been tested and met NFPA 701 standard for fire retardancy.

- Section B: The Supply Office had 42 inch long draperies strung along two walls of the room use to cover supplies on shelving. The facility did not have documentation for review to establish that the draperies had been tested and met NFPA 701 standard for fire retardancy.

Based on observation, the facility failed to ensure that waste containers were limited to no more than 32-gallons or placed in an adequately fire-barrier protected (hazardous) room with fire sprinkler protection.

Findings include:

- Section C - In the Nourishment Room was a 44-gallon waste container.
- Section C - In the corridor near Room #126 was a 44-gallon waste container.

Based on observation, the facility failed to ensure openings between smoke compartments were protected.

Findings include:

Section D - Room #D166 had two unprotected conduit openings.

Based on observation, the facility failed to ensure that openings between smoke compartments were protected.

Findings include:

Section G - In the Data Room were nine unprotected conduits.

Based on observation, the facility failed to ensure that openings between smoke compartments were protected.

Findings include:

Section H - In the Data Room were seven unprotected conduits.

NFPA 99, Section 3-4.4.1.1 Maintenance and Testing of Alternative Power Source and Transfer Switches.
(b)1. Test Criteria. Generator sets shall be tested twelve (12) times a year with testing intervals between not less than 20 days or exceeding 40 days. Generator sets serving emergency and equipment systems shall be in accordance with NFPA 110, Standards for Emergency and Standby Power Systems.

NFPA 110, Chapter 8 Routine Maintenance and Operational Testing

8.1* General.
8.1.1 The routine maintenance and operational testing program shall be based on all of the following:
(1) Manufacturer's recommendations
(2) Instruction manuals
(3) Minimum requirements of this chapter
(4) The authority having jurisdiction
8.1.2 Consideration shall be given to temporarily providing a portable or alternate source whenever the emergency generator is out of service.

8.2* Manuals, Special Tools, and Spare Parts.
8.2.1 At least two sets of instruction manuals for all major components of the EPSS shall be supplied by the manufacturer(s) of the EPSS and shall contain the following:
(1) A detailed explanation of the operation of the system
(2) Instructions for routine maintenance
(3) Detailed instructions for repair of the EPS and other major components of the EPSS
(4) An illustrated parts list and part numbers
(5) Illustrated and schematic drawings of electrical wiring systems, including operating and safety devices, control panels, instrumentation, and annunciators
8.2.2 For Level 1 systems, instruction manuals shall be kept in a secure, convenient location, one set near the equipment, and the other set in a separate location.
8.2.3 Special tools and testing devices necessary for routine maintenance shall be available for use when needed.
8.2.4 Replacement for parts identified by experience as high mortality items shall be maintained in a secure location(s) on the premises.
8.2.4.1 Consideration shall be given to stocking spare parts as recommended by the manufacturer.

8.3 Maintenance and Operational Testing.
8.3.1* The EPSS shall be maintained to ensure to a reasonable degree that the system is capable of supplying service within the time specified for the type and for the time duration specified for the class.
8.3.2 A routine maintenance and operational testing program shall be initiated immediately after the EPSS has passed acceptance tests or after completion of repairs that impact the operational reliability of the system.
8.3.2.1 The operational test shall be initiated at an automatic transfer switch and shall include testing of each EPSS component on which maintenance or repair has been performed, including the transfer of each automatic and manual transfer switch to the alternate power source, for a period of not less than 30 minutes under operating temperature.
8.3.3 A written schedule for routine maintenance and operational testing of the EPSS shall be established.
8.3.4 A written record of the EPSS inspections, tests, exercising, operation, and repairs shall be maintained on the premises.
8.3.4.1 The written record shall include the following:
(1) The date of the maintenance report
(2) Identification of the servicing personnel
(3) Notation of any unsatisfactory condition and the corrective action taken, including parts replaced
(4) Testing of any repair for the time as recommended by the manufacturer
8.3.5* Transfer switches shall be subjected to a maintenance program that includes all of the following operations:
(1) Checking of connections
(2) Inspection or testing for evidence of overheating and excessive contact erosion
(3) Removal of dust and dirt
(4) Replacement of contacts when required
8.3.6* Storage batteries, including electrolyte levels, used in connection with Level 1 and Level 2 systems shall be inspected weekly and shall be maintained in full compliance with manufacturer's specifications.
8.3.6.1 Maintenance of lead-acid batteries shall include the monthly checking and recording of electrolyte specific gravity.
8.3.6.2 Defective batteries shall be replaced immediately upon discovery of defects.

8.4 Operational Inspection and Testing.
8.4.1* Level 1 and Level 2 EPSSs, including all appurtenant components, shall be inspected weekly and exercised under load at least monthly.
8.4.1.1 If the generator set is used for standby power or for peak load shaving, such use shall be recorded and shall be permitted to be substituted for scheduled operations and testing of the generator set, providing the same record as required by 8.3.4.
8.4.2* Generator sets in Level 1 and Level 2 service shall be exercised at least once monthly, for a minimum of 30 minutes, using one of the following methods:
(1) Under operating temperature conditions and at not less than 30 percent of the EPS nameplate kW rating
(2) Loading that maintains the minimum exhaust gas temperatures as recommended by the manufacturer
8.4.2.1 The date and time of day for required testing shall be decided by the owner, based on facility operations.
8.4.2.2 Equivalent loads used for testing shall be automatically replaced with the emergency loads in case of failure of the primary source.
8.4.2.3* Diesel-powered EPS installations that do not meet the requirements of 8.4.2 shall be exercised monthly with the available EPSS load and exercised annually with supplemental loads at 25 percent of nameplate rating for 30 minutes, followed by 50 percent of nameplate rating for 30 minutes, followed by 75 percent of nameplate rating for 60 minutes, for a total of 2 continuous hours.
8.4.3 Load tests of generator sets shall include complete cold starts.
8.4.4 Time delays shall be set as follows:
(1) Time delay on start:
a. 1 second minimum
b. 0.5 second minimum for gas turbine units
(2) Time delay on transfer to emergency: no minimum required
(3) Time delay on restoration to normal: 5 minutes minimum
(4) Time delay on shutdown: 5 minutes minimum
8.4.5 Level 1 and Level 2 transfer switches shall be operated monthly.
8.4.5.1 The monthly test of a transfer switch shall consist of electrically operating the transfer switch from the standard position to the alternate position and then a return to the standard position.
8.4.6* EPSS circuit breakers for Level 1 system usage, including main and feed breakers between the EPS and the transfer switch load terminals, shall be exercised annually with the EPS in the " off " position.
8.4.6.1 Medium- and high-voltage circuit breakers for Level 1 system usage shall be exercised every 6 months and shall be tested under simulated overload conditions every 2 years.
8.4.7 The routine maintenance and operational testing program shall be overseen by a properly instructed individual.
8.4.8* The EPSS shall be tested for the duration of its assigned class (see Section 4.2), or for a duration agreed to by the authority having jurisdiction for at least 4 hours, at least once within every 36-48 months.
8.4.8.1 The load shall be the EPSS system load running at the time of the test. The test shall be initiated by opening all switches or breakers supplying normal power to the EPSS.
8.4.8.2 A power interruption to non-EPSS loads shall not be required.


Based on interview and document review, the facility failed to establish that weekly generator inspections had occurred over the past 12-months.

Findings include:

The facility did not have documented evidence that the generator (Olympian) had been inspected weekly (Section 8.4.1 above). Maintenance Staff indicated that the generator was set to a timer and ran weekly, however they did not routinely inspect the generators weekly.

NFPA 99, Section 3-4.4.1.1 Maintenance and Testing of Alternative Power Source and Transfer Switches.
(b)1. Test Criteria. Generator sets shall be tested twelve (12) times a year with testing intervals between not less than 20 days or exceeding 40 days. Generator sets serving emergency and equipment systems shall be in accordance with NFPA 110, Standards for Emergency and Standby Power Systems.


NFPA 110, Chapter 8 Routine Maintenance and Operational Testing
Section 8.4 Operational Inspection and Testing.
Section 8.4.1* Level 1 and Level 2 EPSSs, including all appurtenant components, shall be inspected weekly and exercised under load at least monthly.


Based on interview and document review, the facility failed to establish that weekly generator inspections had occurred over the past 12-months.

Findings include:

The facility did not have documented evidence that the generator (Generac) had been inspected weekly (Section 8.4.1 above). Maintenance Staff indicated that the generator was set to a timer and ran weekly, however they did not routinely inspect the generators weekly.

NFPA 99, Section 3-4.4.1.1 Maintenance and Testing of Alternative Power Source and Transfer Switches.
(b)1. Test Criteria. Generator sets shall be tested twelve (12) times a year with testing intervals between not less than 20 days or exceeding 40 days. Generator sets serving emergency and equipment systems shall be in accordance with NFPA 110, Standards for Emergency and Standby Power Systems.

NFPA 110, Chapter 8 Routine Maintenance and Operational Testing
Section 8.4 Operational Inspection and Testing.
Section 8.4.1* Level 1 and Level 2 EPSSs, including all appurtenant components, shall be inspected weekly and exercised under load at least monthly.


Based on interview and document review, the facility failed to establish that weekly generator inspections had occurred over the past 12-months.

Findings include:

The facility did not have documented evidence that the generator (Olympian) had been inspected weekly (Section 8.4.1 above). Maintenance Staff indicated that the generator was set to a timer and ran weekly, however they did not routinely inspect the generators weekly.

NFPA 101
Chapter 18-5.1.1 Utilities shall comply with the provisions of Section 9-1
Chapter 9-1.2 Electrical wiring and equipment installed shall be in accordance with NFPA 70, National Electric Code.
Exception: Existing installations may be continued in service subject to approval by the authority having jurisdiction.

NFPA 70

EXTENSION CORDS:
NFPA 70, Section 400-8 Unless specifically permitted in Section 400-7, flexible cords and cables shall not be used for the following:
(a) As a substitute for fixed wiring of a structure
NFPA 70, Section 305-4(h) Protection from Accidental Damage. Flexible cords and cables shall be protected from accidental damage. Sharp corners and projections shall be avoided. Where passing through doorways or other pinch points, protections shall be provided to avoid damage.


Based on observation, the facility failed to ensure that the electrical installations within the building conformed to NFPA 70, National Electrical Code.

Findings include:

The below listed locations had the following electrical problems:

-Section C - Office #C164 was using a power strip as permanent wiring for a refrigerator.

NFPA 101
Chapter 18-5.1.1 Utilities shall comply with the provisions of Section 9-1
Chapter 9-1.2 Electrical wiring and equipment installed shall be in accordance with NFPA 70, National Electric Code.
Exception: Existing installations may be continued in service subject to approval by the authority having jurisdiction.

NFPA 70

EXTENSION CORDS:
NFPA 70, Section 400-8 Unless specifically permitted in Section 400-7, flexible cords and cables shall not be used for the following:
(a) As a substitute for fixed wiring of a structure
NFPA 70, Section 305-4(h) Protection from Accidental Damage. Flexible cords and cables shall be protected from accidental damage. Sharp corners and projections shall be avoided. Where passing through doorways or other pinch points, protections shall be provided to avoid damage.


Based on observation, the facility failed to ensure that the electrical installations within the building conformed to NFPA 70, National Electrical Code.

Findings include:

The below listed locations had the following electrical problems:

1) Second Level, in the combined Office/Electrical Rooms, the electrical room's (fire-rated room) door was held open with a two-drawer sized file cabinet.
2) Second Level, in the combined Office/Electrical Rooms, the electrical room's doorway had an electrical power cord running through it and the power cord was plugged into an electrical outlet.
3) Second Level, in the combined Office/Electrical Rooms, the above mentioned electrical power cord in #2 above was being used as permanent wiring. A coffee maker and a toaster was connected to the power cord.

NFPA 101
Chapter 19-5.1.1 Utilities shall comply with the provisions of Section 9-1
Chapter 9-1.2 Electrical wiring and equipment installed shall be in accordance with NFPA 70, National Electric Code.
Exception: Existing installations may be continued in service subject to approval by the authority having jurisdiction.

NFPA 70

COVERS:
NFPA 70, Section 370-25 Covers and Canopies. In completed installations, each box shall have a cover, faceplate, or fixed canopy.

NFPA 70, Section 410-56(d) Faceplates. Metal faceplates shall be ferrous metal not less than 0.030 inch in thickness or nonferrous metal not less than 0.040 inch in thickness. Metal faceplates shall be grounded. Faceplates of insulating material shall be noncombustible, and not less than 0.10 inch in thickness but shall be permitted to be less than 0.10 inch in thickness if formed or reinforced to provide adequate mechanical strength.


Based on observation, the facility failed to ensure that the electrical installations within the building conformed to NFPA 70, National Electrical Code.

Findings include:

The below listed locations had the following electrical problems:

At the east-west and north-south junction of the corridor north of the receptionist area, on the staff side of the building, had an uncovered electrical J-box on the upper portion of the corridor wall.

NFPA 101
Chapter 39-5.1 Utilities shall comply with the provisions of Section 9-1
Chapter 9-1.2 Electrical wiring and equipment installed shall be in accordance with NFPA 70, National Electric Code.
Exception: Existing installations may be continued in service subject to approval by the authority having jurisdiction.

NFPA 70

COVERS:
NFPA 70, Section 370-25 Covers and Canopies. In completed installations, each box shall have a cover, faceplate, or fixed canopy.

MARKING PANELBOARDS:
NFPA 70, 384-13 Panelboards General. All panelboards shall have a rating not less than the minimum feeder capacity required for the load computed in accordance with Article 220. Panelboards shall be durably marked by the manufacturer with the voltage and the current rating and the number of phases for which they are designed and with the manufacturer's name or trademark in such a manner so as to be visible after installation, without disturbing the interior parts or wiring. All panelboards circuits and circuit modifications shall be legibly identified as to purpose or use on a circuit directory located on the face or inside of the panel.

EXTENSION CORDS:
NFPA 70, Section 400-8 Unless specifically permitted in Section 400-7, flexible cords and cables shall not be used for the following:
(a) As a substitute for fixed wiring of a structure
NFPA 70, Section 305-4(h) Protection from Accidental Damage. Flexible cords and cables shall be protected from accidental damage. Sharp corners and projections shall be avoided. Where passing through doorways or other pinch points, protections shall be provided to avoid damage.

GFI:
NFPA 70, Section 517-20(a) Wet Locations. All receptacles and fixed equipment within the area of the wet location shall have ground-fault circuit-interrupter protection for personnel if interruption of power under fault conditions can be tolerated, or be served by an isolated power system if such interruption cannot be tolerated.

ITEMS NEAR ELECTRICAL EQUIPMENT
NFPA 70, Section 110-26 (a) (1) Depth of Working Space. The depth of working space in the direction of access to live parts shall not be less than indicated in Table 110-26(a). Distances shall be measured from the live parts is such are exposed or from the enclosure front or opening is such are enclosed.
Nominal Voltage to Ground of 0 -150 = 3 feet
Nominal Voltage to Ground of 150 - 600 = 4 feet

NFPA 70, Section 422-17 Protection of Combustible Material. Each electrically heated appliance that is intended by size, weight, and service to be located in a fixed position shall be placed so as to provide ample protection between the appliance and adjacent combustible material.

WIRING PROTECTION:
NFPA 70, Section 300-4(c) Protection Against Physical Damage. Cables Through Spaces Behind Panels Designed to Allow Access. Cables or raceway-type wiring methods, installed behind panels designed to allow access, shall be supported to their applicable articles [Section 725-5 Low Voltage Cables and/or Section 800-5 Data Communication].

RECEPTACLES:
NFPA 220-3(b)(9). Computation of Branch Circuit Loads. Branch-circuit loads shall be computed as shown in (a) through (c). (b)(9) Receptacle Outlets. Except as covered in (10), receptacle outlets shall be computed at not less than 180 volts amperes for each single or each multiple receptacle on one strap. A single piece of equipment consisting of a multiple receptacle comprised of four or more receptacles shall be computed at not less than 90 volt-amperes per receptacle. The provision shall not be applicable to the receptacle outlets specified in Sections 210-11(c)(1) and (2). (Note: Equates to roughly 10 duplex outlets (20 outlets) per 15 amp circuit breaker and 13 duplex outlets (26 outlets) per 20 amp circuit breaker.)


Based on observation, interview and document review, the facility failed to ensure that the electrical installations within the building conformed to NFPA 70, National Electrical Code.

Findings include:

The below listed locations had the following electrical problems:

1) Administrative and Outpatient Building (West Charleston) - The computer room (part of the old gymnasium) had 17 computers and 17 monitors (34 fixtures/outlets) serviced by one 20 amp circuit breaker as identified on the circuit breaker's electrical panel labeling chart.

Note: The facility must be mindful to ensure that the capacity for the circuits do not get overloaded. Mapping of the circuits within the building is strongly recommended for monitoring and re-assigning electrical appliances as needed.

2) Administrative and Outpatient Building (West Charleston) - In the Human Resources suite (room with six staff seating) was an uncovered/unprotected electrical J-box.

3) Administrative and Outpatient Building (West Charleston) - On the Human Resources hallway, in the janitor data room, data equipment was connected to a power strip that was in turn connected to Uninterrupted Power Supply (UPS) that was sitting on a chair. Also, the power strip was hanging between the data cord and the UPS and was being used as permanent wiring.

4) Administrative and Outpatient Building (West Charleston) - Near Room #30 was a missing cover plate for the power assist door.

5) Administrative and Outpatient Building (West Charleston) - In the treatment room by the lobby marked with Biohazard label on the door, a refrigerator's power cord was connected to a power strip which in turn was connected to wall outlet. The power strip was being used as permanent wiring.

6) Administrative and Outpatient Building (West Charleston) - Building Department Office (Room #15), a power strip was being used as permanent wiring between the wall outlet and the connected equipment.

7) Administrative and Outpatient Building (West Charleston) - In the Storage/Electrical Room #3, shelving with items on the shelves was positioned in front of (and bellow) the electrical panelboard.

8) Administrative and Outpatient Building (West Charleston) - In the Telephone Room (Room #64) had two power strips being used as permanent wiring. Both power strips were connected to a wall outlet and supplied power to two appliances each. Also in this room was a missing outlet cover plate.

9) Dietary Building (West Charleston) - In the cold food preparation room, a extension cord rolled on a retractable wheel attached to the ceiling was connected to a ceiling electrical outlet. The ceiling electrical outlet was not ground-fault interrupter (GFI) protected. The Maintenance Supervisor, nor the Dietary Manager, knew which circuit breaker supplied the ceiling outlet. Review of the electrical panelboards revealed that no GFI circuit breaker existed within the electrical panelboards.

10) Downtown Las Vegas Clinic (Outpatient Building) - In the Pharmacy a power strip was being used as permanent wiring. A power strip was connecting a refrigerator to the wall outlet.

11) Downtown Las Vegas Clinic (Outpatient Building) - In Room #207 a power strip was hanging off of a desk (protection of wiring).

Based on observation and document review, the facility failed to establish all wall coverings' interior finish flame spread rating to establish compliance.

Findings include:

Administrative and Outpatient Clinic (West Charleston) - Rooms #6, #26, #28, and #41 had wood paneling. The facility did not have flame spread documentation to establish the flame spread rating values and compliance for the wood paneling.

Based on observation and document review, the facility failed to establish that all wall coverings within the facility conformed to proper flame spread rating.

Findings include:

- Section B: The Recovery Cafe's kitchen area had Fiberglass Reinforced Plastic (FRP) on its walls (floor-to-ceiling). The facility did not have documentation for review to establish that the FRP had the proper flame spread rating.

Based on observation, the facility failed to ensure that all corridor doors were free from impediments to closure.

Findings include:

The following corridor doors had impediments to closure making them incapable of resisting the transfer of smoke:

- Section E - Room #E170 corridor door was held open with chair.

Based on observation, the facility failed to ensure that all corridor doors were free of impediments to closure.

Findings include:

The following corridor doors could not close to resist the passage of smoke:

- Section C - Room #C179 corridor door was held open with a door chock.
- Section D - Room #D178 corridor door was held open with a cabinet.

Based on observation, the facility failed to ensure that all egress markings were properly installed.

Findings include:

Section C - In the office suite area, the egress marking did not have the chevron tab removed to properly direct occupants to the exit.

Based on observation, the facility failed to ensure that egress markings were installed as needed.

Findings include:

Administrative Outpatient Clinic (West Charleston) - Near Room #64, no exit sign was posted to direct occupants to the corridor's north exit (which accesses a east-west corridor to an exterior exit).

Based on observation, the facility failed to maintain the required fire-barrier rating for hazardous rooms.

Findings include:

- Section E - The E Unit's soiled holding room's corridor door was only 20-minute fire-rated (must be 45-minute rated).

- Section G - The G Unit's soiled holding room's corridor door was only 20-minute fire-rated (must be 45-minute rated).

39.2.1.1 All means of egress shall be in accordance with Chapter 7 and this chapter.

7.2.1.5.1 Doors shall be arranged to be opened readily from the egress side whenever the building is occupied. Locks, if provided, shall not require the use of a key, tool or special knowledge or effort for operation from the egress side.
Exception No. 1: This requirement shall not apply where otherwise provided in Chapters 18 through 23.
Exception No. 2: Exterior doors shall be permitted to have key-operated locks from the egress side provided that the following criteria have been met:
(a) Permission to use this exceptions provided in Chapters 12 through 42 for the specific occupancy.
(b) On or adjacent to the door, there is readily visible, durable sign in letters not less than 1 inch high on a contrasting background that reads as follows: THIS DOOR TO REMAIN UNLOCKED WHEN THE BUILDING IS OCCUPIED.
(c) The locking devise is the type that is readily distinguishable as locked.
(d) A key is immediately available to any occupant inside the building when it is locked.
Exception No. 2 shall be permitted to be revoked by the authority having jurisdiction for cause.
Exception No. 3: Where permitted in Chapters 12 through 42, key operations shall be permitted, provided that the key cannot be removed when the door is locked from the side from which egress is to be made.


Based on observation and staff interview, the facility failed to ensure key locked exterior egress doors conformed to the code.

Findings include:

East Las Vegas Clinic (Outpatient Building) - The north lobby's exterior exit door and the south lobby's exterior exit door were key-locked. The three accompanying facility staff members indicated that they did not have keys for either of these exterior exit doors. No signage was posted, no key was immediately available for egress, and no permission was granted in the existing business chapter of the Life Safety Code.

Note: The building has multiple tenants.

39.7.2 Extinguisher Training. Designated employees of business occupancies shall be periodically instructed in the use of portable fire extinguishers.

Based on document review, the facility failed to establish that staff had been trained on portable fire extinguisher use.

Findings include:

The facility did not have documentation to demonstrate that any outpatient staff had been trained on the use of portable fire extinguishers.

Based on observation and interview, the facility failed to ensure that staff was trained in their fire safety policy.

Findings include:

Interview on 09/20/10, with Unit D Staff revealed the following:

- Medical Records Staff Member indicated that she was on the unit in the mornings. She stated she would "help with closing the doors" in response to a fire event. She also did not know where the manual pull station was located.

- Nursing Staff Member stated she would "page for help." She had to search her keys to determine the one that would activate the manual pull station, this took approximately 1.5 minutes.

- Agency Staff Member indicated that he had been at the facility since July 2010. He stated, "He was instructed to go to the charge nurse to get his instructions in event of a fire." He also indicated that he would go to the chart nurse even if he found the fire, or if he discovered someone was in the same room as the fire.

On 09/23/10, a fire drill was conducted on Unit D with the following results:

- A Nursing Staff Member that was approached to initiate the fire drill delayed in her response for approximately 1.5 minutes. This staff member turn to other staff members to get guidance as to what to do prior to activating the manual fire alarm.

- As part of the facility's written fire safety plan, staff were to line up the patients to ready them to go out the door and evacuate to the courtyard. Patients were lined up, however no evacuation occurred.

Based on observation, the facility failed to ensure that fire sprinkler protective coverage was installed in all required locations.

Findings include:

Building 3 - The elevator machine room was not equipped with a fire sprinkler coverage.

Based on observation, the facility failed to maintain the fire sprinkler system.

Findings include:

The following problems were identified for the support and outpatient buildings:

Downtown Las Vegas Clinic (Outpatient Building) - The fire department connection was found unprotected. The bifurcated connection was missing both of its protective covers/end caps.

Based on observation and document review, the facility failed to establish that draperies within the facility conformed to NFPA 701.

Findings include:

- Section A: The Gymnasium Office had black draperies hanging over the viewing panel to the Gymnasium. The facility did not have documentation for review to establish that the draperies had been tested and met NFPA 701 standard for fire retardancy.

- Section B: The Supply Office had 42 inch long draperies strung along two walls of the room use to cover supplies on shelving. The facility did not have documentation for review to establish that the draperies had been tested and met NFPA 701 standard for fire retardancy.

Based on observation, the facility failed to ensure that waste containers were limited to no more than 32-gallons or placed in an adequately fire-barrier protected (hazardous) room with fire sprinkler protection.

Findings include:

- Section C - In the Nourishment Room was a 44-gallon waste container.
- Section C - In the corridor near Room #126 was a 44-gallon waste container.

Based on observation, the facility failed to ensure openings between smoke compartments were protected.

Findings include:

Section D - Room #D166 had two unprotected conduit openings.

Based on observation, the facility failed to ensure that openings between smoke compartments were protected.

Findings include:

Section G - In the Data Room were nine unprotected conduits.

Based on observation, the facility failed to ensure that openings between smoke compartments were protected.

Findings include:

Section H - In the Data Room were seven unprotected conduits.

NFPA 99, Section 3-4.4.1.1 Maintenance and Testing of Alternative Power Source and Transfer Switches.
(b)1. Test Criteria. Generator sets shall be tested twelve (12) times a year with testing intervals between not less than 20 days or exceeding 40 days. Generator sets serving emergency and equipment systems shall be in accordance with NFPA 110, Standards for Emergency and Standby Power Systems.

NFPA 110, Chapter 8 Routine Maintenance and Operational Testing

8.1* General.
8.1.1 The routine maintenance and operational testing program shall be based on all of the following:
(1) Manufacturer's recommendations
(2) Instruction manuals
(3) Minimum requirements of this chapter
(4) The authority having jurisdiction
8.1.2 Consideration shall be given to temporarily providing a portable or alternate source whenever the emergency generator is out of service.

8.2* Manuals, Special Tools, and Spare Parts.
8.2.1 At least two sets of instruction manuals for all major components of the EPSS shall be supplied by the manufacturer(s) of the EPSS and shall contain the following:
(1) A detailed explanation of the operation of the system
(2) Instructions for routine maintenance
(3) Detailed instructions for repair of the EPS and other major components of the EPSS
(4) An illustrated parts list and part numbers
(5) Illustrated and schematic drawings of electrical wiring systems, including operating and safety devices, control panels, instrumentation, and annunciators
8.2.2 For Level 1 systems, instruction manuals shall be kept in a secure, convenient location, one set near the equipment, and the other set in a separate location.
8.2.3 Special tools and testing devices necessary for routine maintenance shall be available for use when needed.
8.2.4 Replacement for parts identified by experience as high mortality items shall be maintained in a secure location(s) on the premises.
8.2.4.1 Consideration shall be given to stocking spare parts as recommended by the manufacturer.

8.3 Maintenance and Operational Testing.
8.3.1* The EPSS shall be maintained to ensure to a reasonable degree that the system is capable of supplying service within the time specified for the type and for the time duration specified for the class.
8.3.2 A routine maintenance and operational testing program shall be initiated immediately after the EPSS has passed acceptance tests or after completion of repairs that impact the operational reliability of the system.
8.3.2.1 The operational test shall be initiated at an automatic transfer switch and shall include testing of each EPSS component on which maintenance or repair has been performed, including the transfer of each automatic and manual transfer switch to the alternate power source, for a period of not less than 30 minutes under operating temperature.
8.3.3 A written schedule for routine maintenance and operational testing of the EPSS shall be established.
8.3.4 A written record of the EPSS inspections, tests, exercising, operation, and repairs shall be maintained on the premises.
8.3.4.1 The written record shall include the following:
(1) The date of the maintenance report
(2) Identification of the servicing personnel
(3) Notation of any unsatisfactory condition and the corrective action taken, including parts replaced
(4) Testing of any repair for the time as recommended by the manufacturer
8.3.5* Transfer switches shall be subjected to a maintenance program that includes all of the following operations:
(1) Checking of connections
(2) Inspection or testing for evidence of overheating and excessive contact erosion
(3) Removal of dust and dirt
(4) Replacement of contacts when required
8.3.6* Storage batteries, including electrolyte levels, used in connection with Level 1 and Level 2 systems shall be inspected weekly and shall be maintained in full compliance with manufacturer's specifications.
8.3.6.1 Maintenance of lead-acid batteries shall include the monthly checking and recording of electrolyte specific gravity.
8.3.6.2 Defective batteries shall be replaced immediately upon discovery of defects.

8.4 Operational Inspection and Testing.
8.4.1* Level 1 and Level 2 EPSSs, including all appurtenant components, shall be inspected weekly and exercised under load at least monthly.
8.4.1.1 If the generator set is used for standby power or for peak load shaving, such use shall be recorded and shall be permitted to be substituted for scheduled operations and testing of the generator set, providing the same record as required by 8.3.4.
8.4.2* Generator sets in Level 1 and Level 2 service shall be exercised at least once monthly, for a minimum of 30 minutes, using one of the following methods:
(1) Under operating temperature conditions and at not less than 30 percent of the EPS nameplate kW rating
(2) Loading that maintains the minimum exhaust gas temperatures as recommended by the manufacturer
8.4.2.1 The date and time of day for required testing shall be decided by the owner, based on facility operations.
8.4.2.2 Equivalent loads used for testing shall be automatically replaced with the emergency loads in case of failure of the primary source.
8.4.2.3* Diesel-powered EPS installations that do not meet the requirements of 8.4.2 shall be exercised monthly with the available EPSS load and exercised annually with supplemental loads at 25 percent of nameplate rating for 30 minutes, followed by 50 percent of nameplate rating for 30 minutes, followed by 75 percent of nameplate rating for 60 minutes, for a total of 2 continuous hours.
8.4.3 Load tests of generator sets shall include complete cold starts.
8.4.4 Time delays shall be set as follows:
(1) Time delay on start:
a. 1 second minimum
b. 0.5 second minimum for gas turbine units
(2) Time delay on transfer to emergency: no minimum required
(3) Time delay on restoration to normal: 5 minutes minimum
(4) Time delay on shutdown: 5 minutes minimum
8.4.5 Level 1 and Level 2 transfer switches shall be operated monthly.
8.4.5.1 The monthly test of a transfer switch shall consist of electrically operating the transfer switch from the standard position to the alternate position and then a return to the standard position.
8.4.6* EPSS circuit breakers for Level 1 system usage, including main and feed breakers between the EPS and the transfer switch load terminals, shall be exercised annually with the EPS in the " off " position.
8.4.6.1 Medium- and high-voltage circuit breakers for Level 1 system usage shall be exercised every 6 months and shall be tested under simulated overload conditions every 2 years.
8.4.7 The routine maintenance and operational testing program shall be overseen by a properly instructed individual.
8.4.8* The EPSS shall be tested for the duration of its assigned class (see Section 4.2), or for a duration agreed to by the authority having jurisdiction for at least 4 hours, at least once within every 36-48 months.
8.4.8.1 The load shall be the EPSS system load running at the time of the test. The test shall be initiated by opening all switches or breakers supplying normal power to the EPSS.
8.4.8.2 A power interruption to non-EPSS loads shall not be required.


Based on interview and document review, the facility failed to establish that weekly generator inspections had occurred over the past 12-months.

Findings include:

The facility did not have documented evidence that the generator (Olympian) had been inspected weekly (Section 8.4.1 above). Maintenance Staff indicated that the generator was set to a timer and ran weekly, however they did not routinely inspect the generators weekly.

NFPA 99, Section 3-4.4.1.1 Maintenance and Testing of Alternative Power Source and Transfer Switches.
(b)1. Test Criteria. Generator sets shall be tested twelve (12) times a year with testing intervals between not less than 20 days or exceeding 40 days. Generator sets serving emergency and equipment systems shall be in accordance with NFPA 110, Standards for Emergency and Standby Power Systems.


NFPA 110, Chapter 8 Routine Maintenance and Operational Testing
Section 8.4 Operational Inspection and Testing.
Section 8.4.1* Level 1 and Level 2 EPSSs, including all appurtenant components, shall be inspected weekly and exercised under load at least monthly.


Based on interview and document review, the facility failed to establish that weekly generator inspections had occurred over the past 12-months.

Findings include:

The facility did not have documented evidence that the generator (Generac) had been inspected weekly (Section 8.4.1 above). Maintenance Staff indicated that the generator was set to a timer and ran weekly, however they did not routinely inspect the generators weekly.

NFPA 99, Section 3-4.4.1.1 Maintenance and Testing of Alternative Power Source and Transfer Switches.
(b)1. Test Criteria. Generator sets shall be tested twelve (12) times a year with testing intervals between not less than 20 days or exceeding 40 days. Generator sets serving emergency and equipment systems shall be in accordance with NFPA 110, Standards for Emergency and Standby Power Systems.

NFPA 110, Chapter 8 Routine Maintenance and Operational Testing
Section 8.4 Operational Inspection and Testing.
Section 8.4.1* Level 1 and Level 2 EPSSs, including all appurtenant components, shall be inspected weekly and exercised under load at least monthly.


Based on interview and document review, the facility failed to establish that weekly generator inspections had occurred over the past 12-months.

Findings include:

The facility did not have documented evidence that the generator (Generac) had been inspected weekly (Section 8.4.1 above). Maintenance Staff indicated that the generator was set to a timer and ran weekly, however they did not routinely inspect the generators weekly.

NFPA 99, Section 3-4.4.1.1 Maintenance and Testing of Alternative Power Source and Transfer Switches.
(b)1. Test Criteria. Generator sets shall be tested twelve (12) times a year with testing intervals between not less than 20 days or exceeding 40 days. Generator sets serving emergency and equipment systems shall be in accordance with NFPA 110, Standards for Emergency and Standby Power Systems.

NFPA 110, Chapter 8 Routine Maintenance and Operational Testing
Section 8.4 Operational Inspection and Testing.
Section 8.4.1* Level 1 and Level 2 EPSSs, including all appurtenant components, shall be inspected weekly and exercised under load at least monthly.


Based on interview and document review, the facility failed to establish that weekly generator inspections had occurred over the past 12-months.

Findings include:

The facility did not have documented evidence that the generator (Olympian) had been inspected weekly (Section 8.4.1 above). Maintenance Staff indicated that the generator was set to a timer and ran weekly, however they did not routinely inspect the generators weekly.

NFPA 101
Chapter 18-5.1.1 Utilities shall comply with the provisions of Section 9-1
Chapter 9-1.2 Electrical wiring and equipment installed shall be in accordance with NFPA 70, National Electric Code.
Exception: Existing installations may be continued in service subject to approval by the authority having jurisdiction.

NFPA 70

EXTENSION CORDS:
NFPA 70, Section 400-8 Unless specifically permitted in Section 400-7, flexible cords and cables shall not be used for the following:
(a) As a substitute for fixed wiring of a structure
NFPA 70, Section 305-4(h) Protection from Accidental Damage. Flexible cords and cables shall be protected from accidental damage. Sharp corners and projections shall be avoided. Where passing through doorways or other pinch points, protections shall be provided to avoid damage.


Based on observation, the facility failed to ensure that the electrical installations within the building conformed to NFPA 70, National Electrical Code.

Findings include:

The below listed locations had the following electrical problems:

-Section C - Office #C164 was using a power strip as permanent wiring for a refrigerator.

NFPA 101
Chapter 18-5.1.1 Utilities shall comply with the provisions of Section 9-1
Chapter 9-1.2 Electrical wiring and equipment installed shall be in accordance with NFPA 70, National Electric Code.
Exception: Existing installations may be continued in service subject to approval by the authority having jurisdiction.

NFPA 70

EXTENSION CORDS:
NFPA 70, Section 400-8 Unless specifically permitted in Section 400-7, flexible cords and cables shall not be used for the following:
(a) As a substitute for fixed wiring of a structure
NFPA 70, Section 305-4(h) Protection from Accidental Damage. Flexible cords and cables shall be protected from accidental damage. Sharp corners and projections shall be avoided. Where passing through doorways or other pinch points, protections shall be provided to avoid damage.


Based on observation, the facility failed to ensure that the electrical installations within the building conformed to NFPA 70, National Electrical Code.

Findings include:

The below listed locations had the following electrical problems:

1) Second Level, in the combined Office/Electrical Rooms, the electrical room's (fire-rated room) door was held open with a two-drawer sized file cabinet.
2) Second Level, in the combined Office/Electrical Rooms, the electrical room's doorway had an electrical power cord running through it and the power cord was plugged into an electrical outlet.
3) Second Level, in the combined Office/Electrical Rooms, the above mentioned electrical power cord in #2 above was being used as permanent wiring. A coffee maker and a toaster was connected to the power cord.

NFPA 101
Chapter 19-5.1.1 Utilities shall comply with the provisions of Section 9-1
Chapter 9-1.2 Electrical wiring and equipment installed shall be in accordance with NFPA 70, National Electric Code.
Exception: Existing installations may be continued in service subject to approval by the authority having jurisdiction.

NFPA 70

COVERS:
NFPA 70, Section 370-25 Covers and Canopies. In completed installations, each box shall have a cover, faceplate, or fixed canopy.

NFPA 70, Section 410-56(d) Faceplates. Metal faceplates shall be ferrous metal not less than 0.030 inch in thickness or nonferrous metal not less than 0.040 inch in thickness. Metal faceplates shall be grounded. Faceplates of insulating material shall be noncombustible, and not less than 0.10 inch in thickness but shall be permitted to be less than 0.10 inch in thickness if formed or reinforced to provide adequate mechanical strength.


Based on observation, the facility failed to ensure that the electrical installations within the building conformed to NFPA 70, National Electrical Code.

Findings include:

The below listed locations had the following electrical problems:

At the east-west and north-south junction of the corridor north of the receptionist area, on the staff side of the building, had an uncovered electrical J-box on the upper portion of the corridor wall.

NFPA 101
Chapter 39-5.1 Utilities shall comply with the provisions of Section 9-1
Chapter 9-1.2 Electrical wiring and equipment installed shall be in accordance with NFPA 70, National Electric Code.
Exception: Existing installations may be continued in service subject to approval by the authority having jurisdiction.

NFPA 70

COVERS:
NFPA 70, Section 370-25 Covers and Canopies. In completed installations, each box shall have a cover, faceplate, or fixed canopy.

MARKING PANELBOARDS:
NFPA 70, 384-13 Panelboards General. All panelboards shall have a rating not less than the minimum feeder capacity required for the load computed in accordance with Article 220. Panelboards shall be durably marked by the manufacturer with the voltage and the current rating and the number of phases for which they are designed and with the manufacturer's name or trademark in such a manner so as to be visible after installation, without disturbing the interior parts or wiring. All panelboards circuits and circuit modifications shall be legibly identified as to purpose or use on a circuit directory located on the face or inside of the panel.

EXTENSION CORDS:
NFPA 70, Section 400-8 Unless specifically permitted in Section 400-7, flexible cords and cables shall not be used for the following:
(a) As a substitute for fixed wiring of a structure
NFPA 70, Section 305-4(h) Protection from Accidental Damage. Flexible cords and cables shall be protected from accidental damage. Sharp corners and projections shall be avoided. Where passing through doorways or other pinch points, protections shall be provided to avoid damage.

GFI:
NFPA 70, Section 517-20(a) Wet Locations. All receptacles and fixed equipment within the area of the wet location shall have ground-fault circuit-interrupter protection for personnel if interruption of power under fault conditions can be tolerated, or be served by an isolated power system if such interruption cannot be tolerated.

ITEMS NEAR ELECTRICAL EQUIPMENT
NFPA 70, Section 110-26 (a) (1) Depth of Working Space. The depth of working space in the direction of access to live parts shall not be less than indicated in Table 110-26(a). Distances shall be measured from the live parts is such are exposed or from the enclosure front or opening is such are enclosed.
Nominal Voltage to Ground of 0 -150 = 3 feet
Nominal Voltage to Ground of 150 - 600 = 4 feet

NFPA 70, Section 422-17 Protection of Combustible Material. Each electrically heated appliance that is intended by size, weight, and service to be located in a fixed position shall be placed so as to provide ample protection between the appliance and adjacent combustible material.

WIRING PROTECTION:
NFPA 70, Section 300-4(c) Protection Against Physical Damage. Cables Through Spaces Behind Panels Designed to Allow Access. Cables or raceway-type wiring methods, installed behind panels designed to allow access, shall be supported to their applicable articles [Section 725-5 Low Voltage Cables and/or Section 800-5 Data Communication].

RECEPTACLES:
NFPA 220-3(b)(9). Computation of Branch Circuit Loads. Branch-circuit loads shall be computed as shown in (a) through (c). (b)(9) Receptacle Outlets. Except as covered in (10), receptacle outlets shall be computed at not less than 180 volts amperes for each single or each multiple receptacle on one strap. A single piece of equipment consisting of a multiple receptacle comprised of four or more receptacles shall be computed at not less than 90 volt-amperes per receptacle. The provision shall not be applicable to the receptacle outlets specified in Sections 210-11(c)(1) and (2). (Note: Equates to roughly 10 duplex outlets (20 outlets) per 15 amp circuit breaker and 13 duplex outlets (26 outlets) per 20 amp circuit breaker.)


Based on observation, interview and document review, the facility failed to ensure that the electrical installations within the building conformed to NFPA 70, National Electrical Code.

Findings include:

The below listed locations had the following electrical problems:

1) Administrative and Outpatient Building (West Charleston) - The computer room (part of the old gymnasium) had 17 computers and 17 monitors (34 fixtures/outlets) serviced by one 20 amp circuit breaker as identified on the circuit breaker's electrical panel labeling chart.

Note: The facility must be mindful to ensure that the capacity for the circuits do not get overloaded. Mapping of the circuits within the building is strongly recommended for monitoring and re-assigning electrical appliances as needed.

2) Administrative and Outpatient Building (West Charleston) - In the Human Resources suite (room with six staff seating) was an uncovered/unprotected electrical J-box.

3) Administrative and Outpatient Building (West Charleston) - On the Human Resources hallway, in the janitor data room, data equipment was connected to a power strip that was in turn connected to Uninterrupted Power Supply (UPS) that was sitting on a chair. Also, the power strip was hanging between the data cord and the UPS and was being used as permanent wiring.

4) Administrative and Outpatient Building (West Charleston) - Near Room #30 was a missing cover plate for the power assist door.

5) Administrative and Outpatient Building (West Charleston) - In the treatment room by the lobby marked with Biohazard label on the door, a refrigerator's power cord was connected to a power strip which in turn was connected to wall outlet. The power strip was being used as permanent wiring.

6) Administrative and Outpatient Building (West Charleston) - Building Department Office (Room #15), a power strip was being used as permanent wiring between the wall outlet and the connected equipment.

7) Administrative and Outpatient Building (West Charleston) - In the Storage/Electrical Room #3, shelving with items on the shelves was positioned in front of (and bellow) the electrical panelboard.

8) Administrative and Outpatient Building (West Charleston) - In the Telephone Room (Room #64) had two power strips being used as permanent wiring. Both power strips were connected to a wall outlet and supplied power to two appliances each. Also in this room was a missing outlet cover plate.

9) Dietary Building (West Charleston) - In the cold food preparation room, a extension cord rolled on a retractable wheel attached to the ceiling was connected to a ceiling electrical outlet. The ceiling electrical outlet was not ground-fault interrupter (GFI) protected. The Maintenance Supervisor, nor the Dietary Manager, knew which circuit breaker supplied the ceiling outlet. Review of the electrical panelboards revealed that no GFI circuit breaker existed within the electrical panelboards.

10) Downtown Las Vegas Clinic (Outpatient Building) - In the Pharmacy a power strip was being used as permanent wiring. A power strip was connecting a refrigerator to the wall outlet.

11) Downtown Las Vegas Clinic (Outpatient Building) - In Room #207 a power strip was hanging off of a desk (protection of wiring).