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Based on observation and interview, the facility failed to maintain the interior finish flame spread rating for a walk-in refrigerator refrigerant supply line room.

Finding:

On April 20, 2011, at 2:00 p.m., the evaluator conducted an inspection of the facility and observed a room located outside the kitchen back door. The room contained a refrigerant supply line for the walk-in refrigerator. The refrigerant supply line penetrated the wall and the evaluator observed a two inch unsealed penetration around the supply line.

An interview was held with the Building Engineer and he stated that the unsealed penetration in the wall would be properly sealed as soon as possible.

Based on observation and interview, the facility failed to ensure that all the exit and exit discharge doors released upon activation of the fire sprinkler or smoke alarms at all times.

Finding:

On April 21, 2011, at 10:00 a.m., the evaluator conducted an inspection of a locked unit in the facility. All the exit doors and smoke compartment doors are magnetically locked at all times. Upon activation of the fire sprinklers or smoke alarms the doors should release for a safe and expeditious evacuation of the patients and staff.

The evaluator witnessed the testing of the smoke detectors located in the Children Unit (TCU) and observed that an exit door and an exit discharge door did not release upon activation of the smoke alarm.

An interview was held with the Building Engineer and he stated that the two doors would be serviced as soon as possible.

Based on observation and interview the facility failed to ensure that the smoke barrier walls were maintain with at least an one half hour fire resistance rating and construction.

Finding:

On April 21, 2011, at 2:00 p.m., the evaluator conducted an inspection of the smoke barrier walls located directly over the smoke compartment walls.

The evaluator inspected and checked the smoke barrier wall located over the "ITU" smoke compartment doors. There was a bundle of wires going through the smoke barrier wall and the evaluator observed a large two-inch unsealed penetration used for the electrical wires.

The evaluator inspected the smoke barrier wall located in the "NTC" and observed an 1-1/2 inch unsealed gap around a " red box " used for electrical wiring.

An interview was held with the Building Engineer and he stated that the unsealed penetrations would be sealed as soon as possible.

Based on observation and interview, the facility failed to maintain the exit access, located outside the Children Unit, at all times.

Finding:

On April 20, 2011, at 10:30 a.m., the evaluator conducted an inspection of the Children's Unit and observed twenty stackable chairs and a bench stored near the locked metal gate enclosure used as a fire exit access in case of a fire and/or evacuation emergency.

An interview was held with the Building Engineer and he stated that the chairs would be removed as soon as possible.

Based on observation and interview, the facility failed to maintain the exit access corridors clear and unobstructed.

Finding:

On April 20, 2011, at 10:45 a.m., the evaluator conducted an inspection of the Children's Unit and observed that a table, four arm chairs and three stackable chairs were held near the fire exit.

An interview was held with the Building Engineer and he stated that the equipment would be removed and relocated as soon as possible.

In case of a fire or evacuation emergency, the exit access corridor shall remain clear and unobstructed at all times.

Fire drills in health care occupancies shall include the transmission of a fire alarm signal and simulation of emergency fire conditions. Drills shall be conducted quarterly on each shift to familiarize facility personnel (nurses, interns, maintenance engineers, and administrative staff) with the signals and emergency action required under varied conditions. When drills are conducted between 9:00 p.m. (2100 hours) and 6:00 a.m. (0600 hours), a coded announcement shall be permitted to be used instead of audible alarms.

Based on interview and record review, the facility failed to conduct fire drills at least quarterly on each shift, evaluate and document if the staff were familiar with the fire emergency procedure, and simulate and/or validate that the staff would be able to respond to an emergency fire condition and safely evacuate or relocate the patients to a safe area or to an adjacent smoke compartment.

Finding:

On April 20, 2011, the evaluator conducted a review of the facility's fire drills for three shifts covering a one year period which revealed the following:

Nocturnal shift -1 out of 4 quarters was attended only by the Adolescent Unit;
PM shift - 4th quarter was not attended by any shift, 3rd quarter was attended only by the TCU, 2nd quarter was attended by NTC and Del Sol, 1st quarter was attended by Del Sol and NTC;
AM shift - 1st quarter was attended by ITU, PHP, UTC, and CTS; 2nd quarter was only attended by Youth Services, 3rd shift was attended by Youth Services, Dietary, CRU, WTC, and ITC.

On April 19, 2011, at 9:40 a.m., the evaluator conducted an inspection of the Youth Services area. The evaluator interviewed staff 1 and he looked around him and stated, in reference to a locked portable fire extinguisher cabinet; " I do not have a key for the cabinet? Or do I, oh yes I do have a key."

A review of the documentation revealed a fire drill check-off list, no written evaluation of the fire drill, all three shifts did not participated every quarter, and no documented evidence of varied fire emergency response or condition such as an immediate or complete evacuation.

NFPA 1, 2000 Edition, Chapter 7, Fire Protection System, 7-7.4.3.3.1 Systems Detectors.
The detectors shall be tested in place to ensure smoke entry into the sensing chamber and an alarm response. Testing with smoke or listed aerosol approved by the manufacturer shall be permitted as acceptable test methods. Other methods approved by the manufacturer that ensure smoke entry into the sensing chamber shall be permitted.

Based on interview, the facility failed to ensure that the smoke detectors are tested based on the manufacturers recommendation.

Finding:

On April 21, 2011, at 9:35 a.m., the evaluator witnessed the test of the fire alarm and smoke detectors.

An interview was held with the Building Engineer and he stated that the facility usually had an outside company check the smoke detectors and that the smoke detectors were checked with a magnet.

The smoke detectors shall be tested by methods approved by the manufacturer in regards to the smoke sensing chamber and an alarm response.

NFPA 72, 7-3.2 Testing shall be performed in accordance with scheduled in Chapter 7 or more often if required by the authority having jurisdiction. Table 7-3.2 Testing shall apply. 15 (l) Valve Tamper Switches Semiannually.

Based on observation, record review, and interview, the facility failed to ensure that the two post indicator valves (PIV) tamper switches were tested on a semiannually basis and were connected to the building fire alarm with at least a local alarm sound.

Finding:

On April 21, 2011, at 10:19 a.m., the evaluator conducted an inspection of the fire alarm and fire sprinkler system.

The evaluator observed the Building Engineer test the fire sprinkler system. Part of the fire sprinkler system includes the post indicator valve (PIV). The PIV has a small window which reveals whether the fire sprinkler water supply is either open or closed. The PIV normally is held in an open position unless the fire sprinkler system requires service or has been tampered with. If the PIV is closed or tampered with, a local alarm will alert the occupants that fire sprinklers water supply has been shut off.
The two fire sprinkler post indicator valves (PIV) were located outside the facility. One by one, the Building Engineer directed a staff member to shut off the two PIV's. The evaluator checked the fire alarm panel located in the front lobby. The Building Engineer was told when the PIV was shut off and the evaluator observed that the fire alarm panel tamper button only lit and no audible alarm sounded.
The evaluator conducted a review of the fire sprinkler service and maintenance record which did not have documented evidence that the PIV tamper alarm was tested on a semiannual basis.
An interview was held with the Building Engineer and he stated that the two tamper switch buttons or indicators did not sound when the post indicator valve was shut off.

In case the fire sprinkler PIV was shut off for repair or tampered with, it is required that the tamper indicator lights up at the fire alarm panel and there is at least a local audible alarm to alert the staff.

Based on observation and interview, the facility failed to inspect and maintain the kitchen fire sprinklers as often as necessary.

Finding:

The evaluator conducted an inspection of the kitchen fire sprinkler system. The evaluator observed four fire sprinklers covered with an accumulation of grease.

An interview was held with the Building Engineer and he stated that he would have the fire sprinklers cleaned as soon as possible.

Based on observation, record review and interview, the facility failed to develop and implement a smoking policy with all the required provisions such as metal containers with self-closing cover devices.

Finding:

On April 19, 2011, the evaluator inspected the facility and observed the Del Sol Unit smoking area and observed no metal containers with self-closing devices and the patients were also discarding the spent cigarettes onto the ground and into an adjacent plastic trash can filled with combustibles.

The evaluator inspected all the facility's four smoking areas and all the areas did not have any metal containers with self-closing devices or a container to empty the spent cigarettes. The cigarette ashtrays or containers were filled with discarded cigarettes.

A review of the smoking policy did not contain a smoking regulation with the required provisions including (3) ashtrays of noncombustible material and safe design are provided in all areas where smoking is permitted and (4) metal containers with self-closing cover devices into which ashtrays can be emptied are readily available to all areas where smoking was permitted. The policy and procedure document read "Procedure (b) Fire retardant containers, such as floor urns, will be provided in designated smoking areas and must be utilized at all times."

An interview was held with the Building Engineer and he stated that he would take care of the concern as soon as possible.

(1) NFPA 99, Chapter 4, 4-5, 4-5.5.2.2 Storage of Cylinders and Containers Level 3.
(a) Facility authorities, in consultation with facility staff and other trained personnel, shall provide and enforce regulations for the storage and handling of cylinders and containers of oxygen and nitrous oxide in storage rooms of approved construction, and for the safe handling of these agents in treatment locations.
(b) Nonflammable Gases.
1. Storage shall be planned so that cylinders can be used in the order in which they are received from the supplier.
2. If stored within the same enclosure, empty cylinders shall be segregated from full cylinders. Empty cylinders shall be marked to avoid confusion and delay if a full cylinder is needed hurriedly.

Based on observation and interview, the facility failed to ensure that the full and empty oxygen cylinders were separated and identified for safe handling and access.

Finding:

On April 20, 2011, at 11:00 a.m., the evaluator conducted an inspection of the facility oxygen cylinder storage room. The evaluator observed one storage rack with both full and empty oxygen cylinders.

An interview was held with the Building Engineer and he stated that another rack to separate the oxygen cylinders would be made available as soon as possible.

(2) NFPA 1, Fire Prevention Code 2000 Edition Chapter 7 Protection System, 7-7, Protection, alarm, and communication 7-7.4.4*
Detector sensitivity shall be checked within 1 year after installation and every alternate year thereafter. After the second required calibration test, if sensitivity tests indicate that the detector has remained within its listed and marked sensitivity range (or 4 percent obscuration light gray smoke, if not marked), the length of time between calibration tests shall be permitted to be extended to a maximum of 5 years. If the frequency is extended, records of detector-caused nuisance alarms and subsequent trends of these alarms shall be maintained. In zones or in areas where nuisance alarms show any increase over the previous year, calibration tests shall be performed.
To ensure that each smoke detector is within its listed and marked sensitivity range, it shall be tested using any of the following methods:
(1) Calibrated test method
(2) Manufacturer ' s calibrated sensitivity test instrument
(3) Listed control equipment arranged for the purpose
(4) Smoke detector/control unit arrangement whereby the detector causes a signal at the control unit where its sensitivity is outside its listed sensitivity range
(5) Other calibrated sensitivity test methods approved by the authority having jurisdiction

Detectors found to have a sensitivity outside the listed and marked sensitivity range shall be cleaned and recalibrated or be replaced.

Based on record review and interview, the facility failed to test the facility's smoke detectors for sensitivity.

Finding:

On April 21, 2011, the evaluator conducted a review of the fire alarm system including the smoke detectors. The evaluator requested documentation that the smoke detectors were tested for smoke sensitivity.

An interview was held with the Building Engineer and he stated that the smoke detectors had not been tested for sensitivity and he was not familiar with the test.

(3) NFPA 99, Standard for Health Care Facilities 1999 Edition, Chapter 7 Electrical Equipment, 7-5 Performance, Criteria and Testing 7-5.2.2.1 Patient Care Area. The leakage current for facility-owned appliances (e.g., housekeeping or maintenance appliances) that are used in a patient care vicinity and are likely to contact the patient shall be measured. The leakage current shall be less than 500 microamperes. Tests shall be made with Switch A in Figure 7-5.1.3.5 in the open position for two-wire equipment that is not double-insulated.
Household or office appliances not commonly equipped with grounding conductors in their power cords shall be permitted provided they are not located within the patient care vicinity. For example, electric typewriters, pencil sharpeners, and clocks at nurses' stations, or electric clocks or TVs that are normally outside the patient care vicinity but might be in a patient's room, shall not be required to have grounding conductors in their power cords.

Based on observation and interview, the facility failed to ensure that electrical equipment used in the patient care vicinity was tested for leakage current as often as needed.

Finding:

On April 21, 2011, the evaluator conducted an inspection of the facility and observed a day room used by the patients. There were two microwave ovens on the counter top.

The evaluator requested documentation that the microwaves were tested for voltage leakage. An interview was held with the Building Engineer and he stated that only the medical equipment had been tested.

Based on observation and interview, the facility failed to maintain the interior finish flame spread rating for a walk-in refrigerator refrigerant supply line room.

Finding:

On April 20, 2011, at 2:00 p.m., the evaluator conducted an inspection of the facility and observed a room located outside the kitchen back door. The room contained a refrigerant supply line for the walk-in refrigerator. The refrigerant supply line penetrated the wall and the evaluator observed a two inch unsealed penetration around the supply line.

An interview was held with the Building Engineer and he stated that the unsealed penetration in the wall would be properly sealed as soon as possible.

Based on observation and interview, the facility failed to ensure that all the exit and exit discharge doors released upon activation of the fire sprinkler or smoke alarms at all times.

Finding:

On April 21, 2011, at 10:00 a.m., the evaluator conducted an inspection of a locked unit in the facility. All the exit doors and smoke compartment doors are magnetically locked at all times. Upon activation of the fire sprinklers or smoke alarms the doors should release for a safe and expeditious evacuation of the patients and staff.

The evaluator witnessed the testing of the smoke detectors located in the Children Unit (TCU) and observed that an exit door and an exit discharge door did not release upon activation of the smoke alarm.

An interview was held with the Building Engineer and he stated that the two doors would be serviced as soon as possible.

Based on observation and interview the facility failed to ensure that the smoke barrier walls were maintain with at least an one half hour fire resistance rating and construction.

Finding:

On April 21, 2011, at 2:00 p.m., the evaluator conducted an inspection of the smoke barrier walls located directly over the smoke compartment walls.

The evaluator inspected and checked the smoke barrier wall located over the "ITU" smoke compartment doors. There was a bundle of wires going through the smoke barrier wall and the evaluator observed a large two-inch unsealed penetration used for the electrical wires.

The evaluator inspected the smoke barrier wall located in the "NTC" and observed an 1-1/2 inch unsealed gap around a " red box " used for electrical wiring.

An interview was held with the Building Engineer and he stated that the unsealed penetrations would be sealed as soon as possible.

Based on observation and interview, the facility failed to maintain the exit access, located outside the Children Unit, at all times.

Finding:

On April 20, 2011, at 10:30 a.m., the evaluator conducted an inspection of the Children's Unit and observed twenty stackable chairs and a bench stored near the locked metal gate enclosure used as a fire exit access in case of a fire and/or evacuation emergency.

An interview was held with the Building Engineer and he stated that the chairs would be removed as soon as possible.

Based on observation and interview, the facility failed to maintain the exit access corridors clear and unobstructed.

Finding:

On April 20, 2011, at 10:45 a.m., the evaluator conducted an inspection of the Children's Unit and observed that a table, four arm chairs and three stackable chairs were held near the fire exit.

An interview was held with the Building Engineer and he stated that the equipment would be removed and relocated as soon as possible.

In case of a fire or evacuation emergency, the exit access corridor shall remain clear and unobstructed at all times.

Fire drills in health care occupancies shall include the transmission of a fire alarm signal and simulation of emergency fire conditions. Drills shall be conducted quarterly on each shift to familiarize facility personnel (nurses, interns, maintenance engineers, and administrative staff) with the signals and emergency action required under varied conditions. When drills are conducted between 9:00 p.m. (2100 hours) and 6:00 a.m. (0600 hours), a coded announcement shall be permitted to be used instead of audible alarms.

Based on interview and record review, the facility failed to conduct fire drills at least quarterly on each shift, evaluate and document if the staff were familiar with the fire emergency procedure, and simulate and/or validate that the staff would be able to respond to an emergency fire condition and safely evacuate or relocate the patients to a safe area or to an adjacent smoke compartment.

Finding:

On April 20, 2011, the evaluator conducted a review of the facility's fire drills for three shifts covering a one year period which revealed the following:

Nocturnal shift -1 out of 4 quarters was attended only by the Adolescent Unit;
PM shift - 4th quarter was not attended by any shift, 3rd quarter was attended only by the TCU, 2nd quarter was attended by NTC and Del Sol, 1st quarter was attended by Del Sol and NTC;
AM shift - 1st quarter was attended by ITU, PHP, UTC, and CTS; 2nd quarter was only attended by Youth Services, 3rd shift was attended by Youth Services, Dietary, CRU, WTC, and ITC.

On April 19, 2011, at 9:40 a.m., the evaluator conducted an inspection of the Youth Services area. The evaluator interviewed staff 1 and he looked around him and stated, in reference to a locked portable fire extinguisher cabinet; " I do not have a key for the cabinet? Or do I, oh yes I do have a key."

A review of the documentation revealed a fire drill check-off list, no written evaluation of the fire drill, all three shifts did not participated every quarter, and no documented evidence of varied fire emergency response or condition such as an immediate or complete evacuation.

NFPA 1, 2000 Edition, Chapter 7, Fire Protection System, 7-7.4.3.3.1 Systems Detectors.
The detectors shall be tested in place to ensure smoke entry into the sensing chamber and an alarm response. Testing with smoke or listed aerosol approved by the manufacturer shall be permitted as acceptable test methods. Other methods approved by the manufacturer that ensure smoke entry into the sensing chamber shall be permitted.

Based on interview, the facility failed to ensure that the smoke detectors are tested based on the manufacturers recommendation.

Finding:

On April 21, 2011, at 9:35 a.m., the evaluator witnessed the test of the fire alarm and smoke detectors.

An interview was held with the Building Engineer and he stated that the facility usually had an outside company check the smoke detectors and that the smoke detectors were checked with a magnet.

The smoke detectors shall be tested by methods approved by the manufacturer in regards to the smoke sensing chamber and an alarm response.

NFPA 72, 7-3.2 Testing shall be performed in accordance with scheduled in Chapter 7 or more often if required by the authority having jurisdiction. Table 7-3.2 Testing shall apply. 15 (l) Valve Tamper Switches Semiannually.

Based on observation, record review, and interview, the facility failed to ensure that the two post indicator valves (PIV) tamper switches were tested on a semiannually basis and were connected to the building fire alarm with at least a local alarm sound.

Finding:

On April 21, 2011, at 10:19 a.m., the evaluator conducted an inspection of the fire alarm and fire sprinkler system.

The evaluator observed the Building Engineer test the fire sprinkler system. Part of the fire sprinkler system includes the post indicator valve (PIV). The PIV has a small window which reveals whether the fire sprinkler water supply is either open or closed. The PIV normally is held in an open position unless the fire sprinkler system requires service or has been tampered with. If the PIV is closed or tampered with, a local alarm will alert the occupants that fire sprinklers water supply has been shut off.
The two fire sprinkler post indicator valves (PIV) were located outside the facility. One by one, the Building Engineer directed a staff member to shut off the two PIV's. The evaluator checked the fire alarm panel located in the front lobby. The Building Engineer was told when the PIV was shut off and the evaluator observed that the fire alarm panel tamper button only lit and no audible alarm sounded.
The evaluator conducted a review of the fire sprinkler service and maintenance record which did not have documented evidence that the PIV tamper alarm was tested on a semiannual basis.
An interview was held with the Building Engineer and he stated that the two tamper switch buttons or indicators did not sound when the post indicator valve was shut off.

In case the fire sprinkler PIV was shut off for repair or tampered with, it is required that the tamper indicator lights up at the fire alarm panel and there is at least a local audible alarm to alert the staff.

Based on observation and interview, the facility failed to inspect and maintain the kitchen fire sprinklers as often as necessary.

Finding:

The evaluator conducted an inspection of the kitchen fire sprinkler system. The evaluator observed four fire sprinklers covered with an accumulation of grease.

An interview was held with the Building Engineer and he stated that he would have the fire sprinklers cleaned as soon as possible.

Based on observation, record review and interview, the facility failed to develop and implement a smoking policy with all the required provisions such as metal containers with self-closing cover devices.

Finding:

On April 19, 2011, the evaluator inspected the facility and observed the Del Sol Unit smoking area and observed no metal containers with self-closing devices and the patients were also discarding the spent cigarettes onto the ground and into an adjacent plastic trash can filled with combustibles.

The evaluator inspected all the facility's four smoking areas and all the areas did not have any metal containers with self-closing devices or a container to empty the spent cigarettes. The cigarette ashtrays or containers were filled with discarded cigarettes.

A review of the smoking policy did not contain a smoking regulation with the required provisions including (3) ashtrays of noncombustible material and safe design are provided in all areas where smoking is permitted and (4) metal containers with self-closing cover devices into which ashtrays can be emptied are readily available to all areas where smoking was permitted. The policy and procedure document read "Procedure (b) Fire retardant containers, such as floor urns, will be provided in designated smoking areas and must be utilized at all times."

An interview was held with the Building Engineer and he stated that he would take care of the concern as soon as possible.

(1) NFPA 99, Chapter 4, 4-5, 4-5.5.2.2 Storage of Cylinders and Containers Level 3.
(a) Facility authorities, in consultation with facility staff and other trained personnel, shall provide and enforce regulations for the storage and handling of cylinders and containers of oxygen and nitrous oxide in storage rooms of approved construction, and for the safe handling of these agents in treatment locations.
(b) Nonflammable Gases.
1. Storage shall be planned so that cylinders can be used in the order in which they are received from the supplier.
2. If stored within the same enclosure, empty cylinders shall be segregated from full cylinders. Empty cylinders shall be marked to avoid confusion and delay if a full cylinder is needed hurriedly.

Based on observation and interview, the facility failed to ensure that the full and empty oxygen cylinders were separated and identified for safe handling and access.

Finding:

On April 20, 2011, at 11:00 a.m., the evaluator conducted an inspection of the facility oxygen cylinder storage room. The evaluator observed one storage rack with both full and empty oxygen cylinders.

An interview was held with the Building Engineer and he stated that another rack to separate the oxygen cylinders would be made available as soon as possible.

(2) NFPA 1, Fire Prevention Code 2000 Edition Chapter 7 Protection System, 7-7, Protection, alarm, and communication 7-7.4.4*
Detector sensitivity shall be checked within 1 year after installation and every alternate year thereafter. After the second required calibration test, if sensitivity tests indicate that the detector has remained within its listed and marked sensitivity range (or 4 percent obscuration light gray smoke, if not marked), the length of time between calibration tests shall be permitted to be extended to a maximum of 5 years. If the frequency is extended, records of detector-caused nuisance alarms and subsequent trends of these alarms shall be maintained. In zones or in areas where nuisance alarms show any increase over the previous year, calibration tests shall be performed.
To ensure that each smoke detector is within its listed and marked sensitivity range, it shall be tested using any of the following methods:
(1) Calibrated test method
(2) Manufacturer ' s calibrated sensitivity test instrument
(3) Listed control equipment arranged for the purpose
(4) Smoke detector/control unit arrangement whereby the detector causes a signal at the control unit where its sensitivity is outside its listed sensitivity range
(5) Other calibrated sensitivity test methods approved by the authority having jurisdiction

Detectors found to have a sensitivity outside the listed and marked sensitivity range shall be cleaned and recalibrated or be replaced.

Based on record review and interview, the facility failed to test the facility's smoke detectors for sensitivity.

Finding:

On April 21, 2011, the evaluator conducted a review of the fire alarm system including the smoke detectors. The evaluator requested documentation that the smoke detectors were tested for smoke sensitivity.

An interview was held with the Building Engineer and he stated that the smoke detectors had not been tested for sensitivity and he was not familiar with the test.

(3) NFPA 99, Standard for Health Care Facilities 1999 Edition, Chapter 7 Electrical Equipment, 7-5 Performance, Criteria and Testing 7-5.2.2.1 Patient Care Area. The leakage current for facility-owned appliances (e.g., housekeeping or maintenance appliances) that are used in a patient care vicinity and are likely to contact the patient shall be measured. The leakage current shall be less than 500 microamperes. Tests shall be made with Switch A in Figure 7-5.1.3.5 in the open position for two-wire equipment that is not double-insulated.
Household or office appliances not commonly equipped with grounding conductors in their power cords shall be permitted provided they are not located within the patient care vicinity. For example, electric typewriters, pencil sharpeners, and clocks at nurses' stations, or electric clocks or TVs that are normally outside the patient care vicinity but might be in a patient's room, shall not be required to have grounding conductors in their power cords.

Based on observation and interview, the facility failed to ensure that electrical equipment used in the patient care vicinity was tested for leakage current as often as needed.

Finding:

On April 21, 2011, the evaluator conducted an inspection of the facility and observed a day room used by the patients. There were two microwave ovens on the counter top.

The evaluator requested documentation that the microwaves were tested for voltage leakage. An interview was held with the Building Engineer and he stated that only the medical equipment had been tested.