HospitalInspections.org

Based on observations during the survey walk of the facility on the afternoon of 4/13/2011, while being accompanied by the Plant Operation Manager, the facility failed to provide an exit sign marking the exit path from operating room 1 and 2. Exit, other than main exterior exit doors that obviously and clearly are identifiable as exits, shall be marked by an approved sign that is readily visible from any direction of exit access.

Based on observations during the survey walk of the facility on the afternoon of 4/13/2011, while being accompanied by the Plant Operation Manager, the facility failed to indicate the egress path to an exit. An exit sign was missing which would indicate the egress path to the exterior door near the offices and the outpatient wing.

Based on observations during the survey walk of the facility on the afternoon of 4/13/2011, while being accompanied by the Plant Operation Manager, the facility failed to assure that the hazardous areas were in compliance. Penetrations existed in the one hour rated partition in the large storage room near outpatient department. It is the wall separating the kitchen storage and the general storage rooms.

Based on observations during the survey walk of the facility on the afternoon of 4/13/2011, while being accompanied by the Plant Operation Manager, the facility failed to maintain a clear and unobstructed egress path. The corridor, at both the southwest and northwest wings, contained furniture which impeded egress path.


Based on observations during the survey walk of the facility on the afternoon of 4/13/2011, while being accompanied by the Plant Operation Manager, the facility failed to maintain a clear and unobstructed egress path. Tables and chairs were located in the egress corridor, near the outpatient wing. If a two hour rated partition and door assembly seperated the outpatient wing and the wing which has delicensed med surg meds, then the exit corridor needs only five feet. If no two our separation is constructed, the egress path must remain completely unobstructed to the exit door.

Based on observations during the survey walk of the facility on the afternoon of 4/13/2011, while being accompanied by the Plant Operation Manager, the facility failed to maintain the exit signs. The red lettering on the exit signs were faded to the point many of them could not be read.

Based on observations during the survey walk of the facility on the afternoon of 4/13/2011, while being accompanied by the Plant Operation Manager, the facility failed to maintain proper clearance from the fire sprinkler head. Boxes sat less then 4 " in front of the sidewall sprinkler head in the payroll closet. Provide 18" clearance in front of sprinkler head.

Based on observations during the survey walk of the facility on the afternoon of 4/13/2011, while being accompanied by the Plant Operation Manager, the facility failed to provide a vent for the mechanical system in emergency room 2.

Based on observations during the survey walk of the facility on the afternoon of 4/13/2011, while being accompanied by the Plant Operation Manager, the facility failed to secure two oxygen and medical air canisters which were located on the emergency department egress corridor ' s floor. The canister tanks shall be stored in a room and individually secured and located to prevent failing or turning over.

Based on observations during the survey walk of the facility on the afternoon of 4/13/2011, while being accompanied by the Plant Operation Manager, the facility failed to maintain the med gas system. A med gas zone valve plate was missing.

Based on observations during the survey walk of the facility on the afternoon of 4/13/2011, while being accompanied by the Plant Operation Manager, the facility failed to provide " No Smoking " sign at the public entrances, except for a single " No Smoking " sign which was posted in the employee entrance. The facility shall post signs to inform the people of their " no smoking " policy.

Based on observations during the survey walk of the facility on the afternoon of 4/13/2011, while being accompanied by the Plant Operation Manager, the facility failed to provide a smoke detector on one side of the smoke barrier doors near material management.

Based on observations during the survey walk of the facility on the afternoon of 4/13/2011, while being accompanied by the Plant Operation Manager, the facility failed to provide an acceptable Type 1 essential electrical system. The operating rooms receptacles did not have colored (preferably red) faceplates on the receptacles powered from the critical branch of the Type 1 EES.

Based on observations during the tour of the facility on the afternoon of 04/04/2011, with the Administrator, the facility failed to comply with NFPA 70, National Electric Code. Emergency system receptacles were not labeled to indicate the panel branch and circuit number supplying them in the operating room. The labels shall be permanent.