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Based on observations made on August 24, 2010, the facility failed to maintain the fire and smoke resistive rating of wall assemblies in a building of Type V (111) construction.

The findings include:

The Laboratory suite was examined at 11:55 a.m. on August 24, 2010. The wall assemblies had not been maintained for fire resistance as noted by:

a) two open holes in a wall assembly in the room containing the fume hood had not sealed and

b) an open abandoned junction box in the main Laboratory room was missing a protective cover plate.

Based on observations made on August 24, 2010, the facility failed to assure that there were no impediments to closing a corridor door and failed to assure that the mechanisms for keeping a door closed were functioning properly.

The findings include:

Hold-open devices that release when the door is pushed or pulled shall be permitted (this does not apply to doors in an exit passageway, stairway enclosure, horizontal exit, smoke barrier, fire barrier or hazardous area enclosure) per section 19.3.6.3.3 of the Life Safety Code. Doors cannot be blocked open by furniture, door stops, chocks or devices that necessitate manual releasing action to close the door.

1. The corridor door to the Administrator's office area was propped open with a wood chock as observed at 1:05 p.m. on August 24, 2010.

Doors shall be provided with a means suitable for keeping the door closed that is acceptable to the authority having jurisdiction. The device used shall be capable of keeping the door fully closed if a force of 5 pounds of force is applied at the latch edge of the door per section 19.3.6.3.2 of the Life Safety Code.

2. The corridor door from the reception office to the corridor adjoining the Critical Access Hospital nurse's station was exercised at 1:30 p.m. on August 24, 2010. The door did not close due to binding with the frame on the lower portion of the door.

3. The south corridor door of the Physical Therapy suite was exercised at 1:39 p.m. on August 24, 2010. The door did not close due to binding with the frame on the upper portion of the door.

4. The corridor door to the oxygen storage room on the Riverside Lane wing of the Nursing Home was exercised at 1:43 p.m. on August 24, 2010. The door did not close and latch with the efforts of the self-closure device due to the throwbolt failing to engage into the strike plate of the door frame.

Based on observations made on August 24, 2010, the facility failed to assure that a self-closure device on a door protecting a hazardous area worked properly and failed to assure that the same door was smoke resistant.

The findings include:

1. The corridor door to the soiled utility closet across from room 15 in the Critical Access Hospital was exercised at 11:17 a.m. on August 24, 2010. The self-closure device on this door did not exert sufficient force to close and latch the door.

2. The corridor door to the soiled utility closet across from room 15 in the Critical Access Hospital was examined at 11:17 a.m. on August 24, 2010. Two open holes drilled through the upper portion of the door were not sealed to prevent the passage of smoke.

Based on observations and interviews with staff made on August 24, 2010, the facility failed to assure that a means of egress to the public way was readily available at all times by the issuance of keys to all staff or other means available to all staff to unlock a gate.

The findings include:

Doors (and gates) located in the means of egress that are permitted to be locked under other provisions of this chapter shall have adequate provisions made for the rapid removal of occupants by means such as remote control of locks, keying of all locks to keys carried by staff at all times, or other such reliable means available to the staff at all times per section 19.2.2.2.5 of the Life Safety Code. Only one such locking device shall be permitted on each door (or gate).

Exit discharges from both the dining room and the corridor leading to the Nursing Home in the Critical Access Hospital (CAH) open onto a patio area that is shared by the exit discharge from the Sun Rise Lane of the Nursing Home (NH) as observed at 10:38 a.m. on August 24, 2010. The exit discharges lead to the public way, which is a parking lot. The gate from the patio to the parking lot was observed to have a keyed padlock on it. In discussions with the maintenance staff a key for the padlock was located at the CAH and NH nurse's station but was not carried by all staff at all times. There was no other remote means of controlling this lock (such as interconnection to the fire alarm system) or other reliable means available to staff at all times (such as a combination lock with the numbers posted or carried by staff at all times).

Based on observations made on August 24, 2010, the facility failed to maintain the sprinkler system and/or its components in accordance with the standards of NFPA 25, 1998 edition.

The findings include:

Sprinklers shall be free of corrosion, foreign material, paint and physical damage and shall be installed in the proper orientation (e.g., upright, pendant, or sidewall) per section 2-2.1.1 of NFPA 25.

The kitchen suite was examined at 10:46 a.m. on August 24, 2010. The two ceiling sprinkler heads in closest proximity to the kitchen range had accumulations of cooking residue or other material coating them.

Based on observations made on August 24, 2010, the facility failed to assure that cylinders of nonflammable gases were properly secured from falling over or being knocked down.

The findings include:

Freestanding cylinders of nonflammable gases shall be properly chained or supported in a cylinder cart or stand or by means of racks or fastenings to protect them from falling over or being knocked down per sections 8-3.1.11.2(h) and 4-3.5.2.1(b27) of NFPA 99, 1999 edition.

A "K" size cylinder of Helium was freestanding in the medical gas manifold room as observed at 10:30 a.m. on August 24, 2010.

Based on observations made on August 24, 2010, the facility failed to assure that smoke dampers closed upon the activation of the fire alarm system.

The findings include:

The smoke dampers located in the duct work of the smoke barriers on the patient sleeping wings of the Critical Access Hospital were determined to be interconnected to fire alarm system. The fire alarm system was activated at 3:05 p.m. on August 24, 2010. Two of the five smoke dampers that were monitored during the alarm activation did not close. They were:

a) the smoke damper closest to the wall of room 5 on the west patient wing and

b) the damper closest to the drinking fountain wall on the east patient wing.

Based on observations made on August 24, 2010, the facility failed to post a "No Smoking" sign(s) within 50 feet of the helicopter landing pad.

The findings include:

No smoking shall be permitted within 50 feet of the helicopter landing pad edge per section 2-5 of NFPA 418, 1995 edition. "No Smoking" signs shall be erected at access/egress points to the landing pad.

The facility had a helicopter landing pad located on the ground level to the northeast of the building as observed at 1:25 p.m. on August 24, 2010. The required "No Smoking" sign(s) was not posted within 50 feet of the access/egress point to the landing pad.

Based on observations made on August 24, 2010, the facility failed to maintain a medical gas master alarm annunciator panel in accordance with the standards of NFPA 99, 1999 edition.

The findings include:

In facilities with piped in medical gases a master alarm system consisting of two or more alarm panels located in two separate locations shall be maintained per sections 4-3.1.2.2 (a) and (b) of NFPA 99. Each of the master alarm panels shall include a means to visually indicate a lamp or LED failure and shall visually and audibly indicate if the wiring to the sensor or switch is disconnected.

The "Ohio Gas" master alarm annunciator located at the Critical Access Hospital nurse's station was examined at 11:06 a.m. on August 24, 2010. The lamp for the "Light On Normal" indicator to confirm that wiring to the panel has not been disconnected was found to be burned out and in need of replacement.

Based on observations made on August 24, 2010, the facility failed to post a precautionary sign at a location where oxygen was being administered or ready for use.

The findings include:


In accordance with Section 19.7.4 Smoking. Smoking regulations shall be adopted and shall include not less than the following provisions:
(1) Smoking shall be prohibited in any room, ward, or compartment where flammable liquids, combustible gases, or oxygen is used or stored and in any other hazardous location, and such areas shall be posted with signs that read NO SMOKING or shall be posted with the international symbol for no smoking. Exception: In health care occupancies where smoking is prohibited and signs are prominently placed at all major entrances, secondary signs with language that prohibits smoking shall not be required.
(2) Smoking by patients classified as not responsible shall be prohibited.
Exception: The requirement of 19.7.4(2) shall not apply where the patient is under direct supervision.
(3) Ashtrays of noncombustible material and safe design shall be provided in all areas where smoking is permitted.
(4) Metal containers with self-closing cover devices into which ashtrays can be emptied shall be readily available to all areas where smoking is permitted.

An "E" size cylinder of oxygen was available for use in Nursing Home room 36 as observed at 2:45 p.m. on August 24, 2010. There was no "No Smoking, Oxygen In Use" or similar language sign posted at this location. It was noted that the main entry door to the Nursing Home did not have a "No Smoking" sign, thus a sign was necessary to be posted at each location where oxygen was being administered or ready for use.

Based on observations made on August 24, 2010, the facility failed to maintain the electrical system and/or its components in accordance with the standards of NFPA 70, 1999 edition and/or interpretations from the Centers for Medicare and Medicaid Services (CMS).

The findings include:

Flexible cords shall not be run through doorways, windows or similar openings per Article 400-8 of NFPA 70.

1. The flexible cord for a pedestal fan in use in the kitchen area was run through the doorway of the dietary office as observed at 10:51 a.m. on August 24, 2010.

The width of the working space in front of the electric equipment shall be the width of the equipment or 30 inches, whichever is greater per Article 110-26 of NFPA 70 . In all cases, the work space shall permit at least a 90 degree opening of equipment doors or hinged panels. The work space shall be clear and extend from the grade, floor, or platform to the height required by 110-26. Working space required by this Article shall not be used for storage.

2. The clean linen room located across from room 15 in the Critical Access Hospital houses an electrical panel board (panel B). An air mattress secured within its carrying case was being stored directly in front of the access to this panel board as observed at 11:22 a.m. on August 24, 2010.

3. The MDS office on the Riverside Lane wing of the Nursing Home houses an electrical panel board (panel NH-NW). Several boxes and other items were placed directly in front of the access to this panel board as observed at 1:47 p.m. on August 24, 2010.

The limited use of circuit breaker protected power strips is acceptable by CMS provided that no major appliances such as air conditioners, refrigerators, microwaves, heating units and oxygen concentrators are connected to the power strip.

4. A window air conditioner was plugged into a power strip in room 11 of the Nursing Home as observed at 2:02 p.m. on August 24, 2010.

5. A window air conditioner was plugged into a power strip in the Director of Nurse's office in the Nursing Home as observed at 2:15 p.m. on August 24, 2010.

No overcurrent device shall be connected in series with any conductor that is intentionally grounded per Article 240-22 of NFPA 70. Note: UL listing guidelines for relocatable power taps/power strips, being XBYS, notes that these strips are not intended to be in series connected or daisy chained to other power strips or extension cords.

6. The staff coordinator's office located within the Nursing Home was examined at 2:13 p.m. on August 24, 2010. A long multiple outlet power strip was in use for charging portable radios. Another power strip was plugged into the long power strip with an additional power strip being plugged into the power strip coming off of the long power strip, resulting in power strips being in series.

Equipment intended to interrupt current at fault levels (Ground-Fault Circuit-Interrupter (GFCI) receptacles) shall have an interrupting rating sufficient for the nominal circuit voltage and the current available at the line terminals of the equipment per Articles 110-3 and 110-9 of NFPA 70. Such equipment (GFCI receptacles) shall be listed or labeled and shall break and restore current when the test and reset buttons are exercised.

7. A GFCI receptacle in the Nursing Home library room was tested at 2:10 p.m. on August 24, 2010. The device "test" button was exercised and a buzzing sound was exhibited when the test button was pushed. An independent testing device made specifically for GFCI receptacles was then used and the receptacle did not break current when this device interrupted the circuit.

Based on observations made on August 24, 2010, the facility failed to maintain the fire and smoke resistive rating of wall assemblies in a building of Type V (111) construction.

The findings include:

The Laboratory suite was examined at 11:55 a.m. on August 24, 2010. The wall assemblies had not been maintained for fire resistance as noted by:

a) two open holes in a wall assembly in the room containing the fume hood had not sealed and

b) an open abandoned junction box in the main Laboratory room was missing a protective cover plate.

Based on observations made on August 24, 2010, the facility failed to assure that there were no impediments to closing a corridor door and failed to assure that the mechanisms for keeping a door closed were functioning properly.

The findings include:

Hold-open devices that release when the door is pushed or pulled shall be permitted (this does not apply to doors in an exit passageway, stairway enclosure, horizontal exit, smoke barrier, fire barrier or hazardous area enclosure) per section 19.3.6.3.3 of the Life Safety Code. Doors cannot be blocked open by furniture, door stops, chocks or devices that necessitate manual releasing action to close the door.

1. The corridor door to the Administrator's office area was propped open with a wood chock as observed at 1:05 p.m. on August 24, 2010.

Doors shall be provided with a means suitable for keeping the door closed that is acceptable to the authority having jurisdiction. The device used shall be capable of keeping the door fully closed if a force of 5 pounds of force is applied at the latch edge of the door per section 19.3.6.3.2 of the Life Safety Code.

2. The corridor door from the reception office to the corridor adjoining the Critical Access Hospital nurse's station was exercised at 1:30 p.m. on August 24, 2010. The door did not close due to binding with the frame on the lower portion of the door.

3. The south corridor door of the Physical Therapy suite was exercised at 1:39 p.m. on August 24, 2010. The door did not close due to binding with the frame on the upper portion of the door.

4. The corridor door to the oxygen storage room on the Riverside Lane wing of the Nursing Home was exercised at 1:43 p.m. on August 24, 2010. The door did not close and latch with the efforts of the self-closure device due to the throwbolt failing to engage into the strike plate of the door frame.

Based on observations made on August 24, 2010, the facility failed to assure that a self-closure device on a door protecting a hazardous area worked properly and failed to assure that the same door was smoke resistant.

The findings include:

1. The corridor door to the soiled utility closet across from room 15 in the Critical Access Hospital was exercised at 11:17 a.m. on August 24, 2010. The self-closure device on this door did not exert sufficient force to close and latch the door.

2. The corridor door to the soiled utility closet across from room 15 in the Critical Access Hospital was examined at 11:17 a.m. on August 24, 2010. Two open holes drilled through the upper portion of the door were not sealed to prevent the passage of smoke.

Based on observations and interviews with staff made on August 24, 2010, the facility failed to assure that a means of egress to the public way was readily available at all times by the issuance of keys to all staff or other means available to all staff to unlock a gate.

The findings include:

Doors (and gates) located in the means of egress that are permitted to be locked under other provisions of this chapter shall have adequate provisions made for the rapid removal of occupants by means such as remote control of locks, keying of all locks to keys carried by staff at all times, or other such reliable means available to the staff at all times per section 19.2.2.2.5 of the Life Safety Code. Only one such locking device shall be permitted on each door (or gate).

Exit discharges from both the dining room and the corridor leading to the Nursing Home in the Critical Access Hospital (CAH) open onto a patio area that is shared by the exit discharge from the Sun Rise Lane of the Nursing Home (NH) as observed at 10:38 a.m. on August 24, 2010. The exit discharges lead to the public way, which is a parking lot. The gate from the patio to the parking lot was observed to have a keyed padlock on it. In discussions with the maintenance staff a key for the padlock was located at the CAH and NH nurse's station but was not carried by all staff at all times. There was no other remote means of controlling this lock (such as interconnection to the fire alarm system) or other reliable means available to staff at all times (such as a combination lock with the numbers posted or carried by staff at all times).

Based on observations made on August 24, 2010, the facility failed to maintain the sprinkler system and/or its components in accordance with the standards of NFPA 25, 1998 edition.

The findings include:

Sprinklers shall be free of corrosion, foreign material, paint and physical damage and shall be installed in the proper orientation (e.g., upright, pendant, or sidewall) per section 2-2.1.1 of NFPA 25.

The kitchen suite was examined at 10:46 a.m. on August 24, 2010. The two ceiling sprinkler heads in closest proximity to the kitchen range had accumulations of cooking residue or other material coating them.

Based on observations made on August 24, 2010, the facility failed to assure that cylinders of nonflammable gases were properly secured from falling over or being knocked down.

The findings include:

Freestanding cylinders of nonflammable gases shall be properly chained or supported in a cylinder cart or stand or by means of racks or fastenings to protect them from falling over or being knocked down per sections 8-3.1.11.2(h) and 4-3.5.2.1(b27) of NFPA 99, 1999 edition.

A "K" size cylinder of Helium was freestanding in the medical gas manifold room as observed at 10:30 a.m. on August 24, 2010.

Based on observations made on August 24, 2010, the facility failed to assure that smoke dampers closed upon the activation of the fire alarm system.

The findings include:

The smoke dampers located in the duct work of the smoke barriers on the patient sleeping wings of the Critical Access Hospital were determined to be interconnected to fire alarm system. The fire alarm system was activated at 3:05 p.m. on August 24, 2010. Two of the five smoke dampers that were monitored during the alarm activation did not close. They were:

a) the smoke damper closest to the wall of room 5 on the west patient wing and

b) the damper closest to the drinking fountain wall on the east patient wing.

Based on observations made on August 24, 2010, the facility failed to post a "No Smoking" sign(s) within 50 feet of the helicopter landing pad.

The findings include:

No smoking shall be permitted within 50 feet of the helicopter landing pad edge per section 2-5 of NFPA 418, 1995 edition. "No Smoking" signs shall be erected at access/egress points to the landing pad.

The facility had a helicopter landing pad located on the ground level to the northeast of the building as observed at 1:25 p.m. on August 24, 2010. The required "No Smoking" sign(s) was not posted within 50 feet of the access/egress point to the landing pad.

Based on observations made on August 24, 2010, the facility failed to maintain a medical gas master alarm annunciator panel in accordance with the standards of NFPA 99, 1999 edition.

The findings include:

In facilities with piped in medical gases a master alarm system consisting of two or more alarm panels located in two separate locations shall be maintained per sections 4-3.1.2.2 (a) and (b) of NFPA 99. Each of the master alarm panels shall include a means to visually indicate a lamp or LED failure and shall visually and audibly indicate if the wiring to the sensor or switch is disconnected.

The "Ohio Gas" master alarm annunciator located at the Critical Access Hospital nurse's station was examined at 11:06 a.m. on August 24, 2010. The lamp for the "Light On Normal" indicator to confirm that wiring to the panel has not been disconnected was found to be burned out and in need of replacement.

Based on observations made on August 24, 2010, the facility failed to post a precautionary sign at a location where oxygen was being administered or ready for use.

The findings include:


In accordance with Section 19.7.4 Smoking. Smoking regulations shall be adopted and shall include not less than the following provisions:
(1) Smoking shall be prohibited in any room, ward, or compartment where flammable liquids, combustible gases, or oxygen is used or stored and in any other hazardous location, and such areas shall be posted with signs that read NO SMOKING or shall be posted with the international symbol for no smoking. Exception: In health care occupancies where smoking is prohibited and signs are prominently placed at all major entrances, secondary signs with language that prohibits smoking shall not be required.
(2) Smoking by patients classified as not responsible shall be prohibited.
Exception: The requirement of 19.7.4(2) shall not apply where the patient is under direct supervision.
(3) Ashtrays of noncombustible material and safe design shall be provided in all areas where smoking is permitted.
(4) Metal containers with self-closing cover devices into which ashtrays can be emptied shall be readily available to all areas where smoking is permitted.

An "E" size cylinder of oxygen was available for use in Nursing Home room 36 as observed at 2:45 p.m. on August 24, 2010. There was no "No Smoking, Oxygen In Use" or similar language sign posted at this location. It was noted that the main entry door to the Nursing Home did not have a "No Smoking" sign, thus a sign was necessary to be posted at each location where oxygen was being administered or ready for use.

Based on observations made on August 24, 2010, the facility failed to maintain the electrical system and/or its components in accordance with the standards of NFPA 70, 1999 edition and/or interpretations from the Centers for Medicare and Medicaid Services (CMS).

The findings include:

Flexible cords shall not be run through doorways, windows or similar openings per Article 400-8 of NFPA 70.

1. The flexible cord for a pedestal fan in use in the kitchen area was run through the doorway of the dietary office as observed at 10:51 a.m. on August 24, 2010.

The width of the working space in front of the electric equipment shall be the width of the equipment or 30 inches, whichever is greater per Article 110-26 of NFPA 70 . In all cases, the work space shall permit at least a 90 degree opening of equipment doors or hinged panels. The work space shall be clear and extend from the grade, floor, or platform to the height required by 110-26. Working space required by this Article shall not be used for storage.

2. The clean linen room located across from room 15 in the Critical Access Hospital houses an electrical panel board (panel B). An air mattress secured within its carrying case was being stored directly in front of the access to this panel board as observed at 11:22 a.m. on August 24, 2010.

3. The MDS office on the Riverside Lane wing of the Nursing Home houses an electrical panel board (panel NH-NW). Several boxes and other items were placed directly in front of the access to this panel board as observed at 1:47 p.m. on August 24, 2010.

The limited use of circuit breaker protected power strips is acceptable by CMS provided that no major appliances such as air conditioners, refrigerators, microwaves, heating units and oxygen concentrators are connected to the power strip.

4. A window air conditioner was plugged into a power strip in room 11 of the Nursing Home as observed at 2:02 p.m. on August 24, 2010.

5. A window air conditioner was plugged into a power strip in the Director of Nurse's office in the Nursing Home as observed at 2:15 p.m. on August 24, 2010.

No overcurrent device shall be connected in series with any conductor that is intentionally grounded per Article 240-22 of NFPA 70. Note: UL listing guidelines for relocatable power taps/power strips, being XBYS, notes that these strips are not intended to be in series connected or daisy chained to other power strips or extension cords.

6. The staff coordinator's office located within the Nursing Home was examined at 2:13 p.m. on August 24, 2010. A long multiple outlet power strip was in use for charging portable radios. Another power strip was plugged into the long power strip with an additional power strip being plugged into the power strip coming off of the long power strip, resulting in power strips being in series.

Equipment intended to interrupt current at fault levels (Ground-Fault Circuit-Interrupter (GFCI) receptacles) shall have an interrupting rating sufficient for the nominal circuit voltage and the current available at the line terminals of the equipment per Articles 110-3 and 110-9 of NFPA 70. Such equipment (GFCI receptacles) shall be listed or labeled and shall break and restore current when the test and reset buttons are exercised.

7. A GFCI receptacle in the Nursing Home library room was tested at 2:10 p.m. on August 24, 2010. The device "test" button was exercised and a buzzing sound was exhibited when the test button was pushed. An independent testing device made specifically for GFCI receptacles was then used and the receptacle did not break current when this device interrupted the circuit.