HospitalInspections.org

Based on observations, the facility failed to maintain the hazardous areas.

The finding included:

Observation on 9/30/2015 at 10:02 AM, revealed two (2) penetrations inside the soiled utility room (above fire door and on the wall pink wires).

This finding was verified by the maintenance director and acknowledge by the Director of Quality Management during the exit conference on 9/30/2015.

Based on observations, the facility failed to maintain the oxygen storage room.

The finding included:

Observation on 9/30/2015 at 10:11 AM, revealed two (2) penetrations (pink wires) inside the South hallway oxygen storage room.

This finding was verified by the maintenance director and acknowledge by the Director of Quality Management during the exit conference on 9/30/2015.

Based on observations and interview, the facility failed to maintain the generator.

The finding included:

Obsrevation and interview on 9/30/2015 at 10:31 AM, revealed the facility failed to ensure an emergency generator remote annunciator was provided in a continuously occupied area. Interview with the maintenance director confirmed that the front desk is occupied from 7:00 AM until 11:00 PM. National Fire Protection Association (NFPA) 110, 3-5.6 (1996 Edition)

This finding was verified by the maintenance director and acknowledge by the Director of Quality Management during the exit conference on 9/30/2015.

Based on observations, the facility failed to maintain the electrical system.

The findings included:

Observation on 9/30/2015 at 9:25 AM through 11:03 AM, revealed back to back power strips in the following areas: IT server room and Pharmacy area (basement). CMS S&C 14-46

This finding was verified by the maintenance director and acknowledge by the Director of Quality Management during the exit conference on 9/30/2015.