HospitalInspections.org

Based on observation and interview, it was determined the facility failed to label and protect (2) two hour fire rated construction.
The findings include:
Observation and interview with the Maintenance Director, on January 10, 2014 at 11:20 a.m. confirmed the elevator #3 shaft wall next to the lab and blood draw areas were not labeled and through-wall penetrations were not sealed with an approved fire stop system.This finding was verified by the Maintenance Supervisor and acknowledged by the Administrator during the exit conference on January 10, 2014.

Based on observation and interview, it was determined the facility failed to ensure medical gas system components were in accordance with NFPA 99.
The findings include:
1. Observation and interview with the maintenance Director on January 10, 2014 at 11:55 a.m confirmed the Zone valves at the Post Op recovery beds were not located with an intervening wall between the zone valves and the area they serve. (NFPA99, 4-3.1.2.3)
2. Observation and interview with the maintenance Director on January 10, 2014 at. 12:15 p.m. confirmed the compressed gas storage area's electrical outlet and light switch were not located at least 5-feet above the floor.
3. Observation and interview with the maintenance Director on January 10, 2014 at. 12:15 p.m. confirmed the compressed gas storage was not separated from combustible materials.
These findings were verified by the Maintenance Supervisor and acknowledged by the Administrator during the exit conference on January 10, 2014.

Based on observation and interview, it was determined the facility failed to ensure all structural steel was protected by fire resistant construction (NFPA 101, 8.2.3.1).
The findings include:
Observation and interview with the Maintenance Director, on January 10, 2014 at 11:55 a.m. confirmed the structural steel beams in electrical room #1082 had areas where the spray-on fire proofing had been removed.This finding was verified by the Maintenance Supervisor and acknowledged by the Administrator during the exit conference on January 10, 2014.

Based on observation and interview, it was determined the facility failed to label and protect (2) two hour fire rated construction.
The findings include:
Observation and interview with the Maintenance Director, on January 10, 2014 at 11:20 a.m. confirmed the elevator #3 shaft wall next to the lab and blood draw areas were not labeled and through-wall penetrations were not sealed with an approved fire stop system.This finding was verified by the Maintenance Supervisor and acknowledged by the Administrator during the exit conference on January 10, 2014.

Based on observation and interview, it was determined the facility failed to ensure medical gas system components were in accordance with NFPA 99.
The findings include:
1. Observation and interview with the maintenance Director on January 10, 2014 at 11:55 a.m confirmed the Zone valves at the Post Op recovery beds were not located with an intervening wall between the zone valves and the area they serve. (NFPA99, 4-3.1.2.3)
2. Observation and interview with the maintenance Director on January 10, 2014 at. 12:15 p.m. confirmed the compressed gas storage area's electrical outlet and light switch were not located at least 5-feet above the floor.
3. Observation and interview with the maintenance Director on January 10, 2014 at. 12:15 p.m. confirmed the compressed gas storage was not separated from combustible materials.
These findings were verified by the Maintenance Supervisor and acknowledged by the Administrator during the exit conference on January 10, 2014.

Based on observation and interview, it was determined the facility failed to ensure all structural steel was protected by fire resistant construction (NFPA 101, 8.2.3.1).
The findings include:
Observation and interview with the Maintenance Director, on January 10, 2014 at 11:55 a.m. confirmed the structural steel beams in electrical room #1082 had areas where the spray-on fire proofing had been removed.This finding was verified by the Maintenance Supervisor and acknowledged by the Administrator during the exit conference on January 10, 2014.