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Based on observation and interview, the facility failed to ensure proper air temperature controls in patient care areas were maintained and monitored in 2 of 3 units checked (Emergency department Medical Surgical unit).

This deficient practice had the likelihood of affecting all patients on these units.

Findings include:

During observations on 11/12/2025 after 11:23 a.m. the following was found:

Emergency department (ED)

Trauma room #2
Thermostat setting was between 80-85 degrees Fahrenheit.
The temperature taken at the thermostat was 65.1 degrees Fahrenheit.
Bed level temperature was 67.2 degrees Fahrenheit.
Eye level temperature was 66.3 degrees Fahrenheit.

Exam room #1
Thermostat - no thermostat was in the room.
Bed level temperature was 59.0 degrees Fahrenheit.
Eye level temperature was 59.1 degrees Fahrenheit.

Medication room
Thermostat set at 70.0 degrees Fahrenheit.
Temperature at the thermostat area was 59.1 degrees Fahrenheit.
Eye level temperature was 59.1 degrees Fahrenheit.

Staff #4 said the thermostat in the medication room also controlled the temperature in Room #1.
Staff #'s 3 and 4 confirmed the temperatures.

Interview with ED staff on 11/12/2025 after 11:23 a.m. revealed the following:

"Sometimes the air temperature gets cool or too warm. When it gets that way they call plants operations. The HVAC system work correctly most of the time and there have been no recent problems or complaints from families. The exam room #1 near the ambulance doors gets cold and people complain if they are in that room. Hard to regulate the temperature in that room because the doors are constantly opening." They "try not to place patients in that room."

"It's cooler on the south end of the hall and warmer on the north end of the hall." If they "place patients in Room #1, they complain about it being too cold and we have to give them a warm blanket."

"It gets very cold at the south end of the hall "and when they "put people in Room #1, they complain, and they have to give them a warm blanket."

Interview with Staff #4 on 11/12/2025 at 11:42 a.m., revealed that the south end of the ED was built in 1995 and was on a different air condition unit than the north side. Staff # 4 stated they don't check room temperatures unless there is a complaint. There were problems regulating the temperature when changing to the winter settings. During the summer the chiller water temperature is set at 44 degrees Fahrenheit and the winter at 48.6 degrees Fahrenheit. The heating water temperature for the summer is at 120 degrees Fahrenheit and in the winter, it is set between 140-150 degrees Fahrenheit. Staff # 4 stated that the room temperatures were supposed to be set between 68 -72 degrees Fahrenheit.


On 11/12/2025 after 11:45 a.m., the following was found:

Medical Surgical unit


Confidential interview with a staff member revealed that it was cold on the unit and that they couldn't adjust the thermostats. The staff member stated the units were not blowing and they had received complaints from patients. The staff member stated they had turned in a work order last week.


Room 276
Thermostat setting was at 73.3 degrees Fahrenheit.
Temperature reading at the thermostat area was 60.4 degrees Fahrenheit.
Bed level temperature was 59.7 degrees Fahrenheit.
Eye level temperature was 60.8 degrees Fahrenheit.

Staff #4 checked the fan blower, and it was off. When it was adjusted the unit started blowing heat.


Room 269
Thermostat was set at 58.0 degrees Fahrenheit.
Temperature reading at the thermostat 73.9 degrees Fahrenheit.
Bed level temperature was 74.4 degrees Fahrenheit.
Eye level temperature was 74.1 degrees Fahrenheit.

Air was barely blowing out the vent in the room. The blower was adjusted, but it was still not blowing.


Room 270
Thermostat setting was over 85.0 degrees Fahrenheit.
Temperature reading at the thermostat was 67.4 degrees Fahrenheit.
Bed level temperature was 67.1 degrees Fahrenheit.
Eye level temperature was 67.4 degrees Fahrenheit.

The air blowing out of the vent in the room was 57.3 degrees Fahrenheit. The thermostat was calibrated.
and the unit started blowing warm air.

Room 271
Thermostat setting was over 80 degrees Fahrenheit.
Temperature reading at Thermostat was 73.2 degrees Fahrenheit.
Bed level temperature was 76.6 degrees Fahrenheit.
Eye level temperature was 75.9 degrees Fahrenheit.

The air blowing out of the vent in the room was 62.6 degrees Fahrenheit. The valves were adjusted, but cool air was still blowing from the unit.


Room 272
Thermostat setting was over 84.0 degrees Fahrenheit.
Temperature reading at thermostat area was 65.1degrees Fahrenheit.
Bed level temperature was 66.2 degrees Fahrenheit.
Eye level temperature was 66.0 degrees Fahrenheit.

The air was barely blowing out of the vent in the room and when the temperature was taken it registered at 54.5 degrees Fahrenheit. When the blower valves were adjusted to an on position the unit immediately started blowing heat.

Room 266
Thermostat setting was over 80.0 degrees Fahrenheit.
Temperature reading at the thermostat was 68.0 degrees Fahrenheit.
Bed level temperature was 66.7 degrees Fahrenheit.
Eye level temperature was 67.8-68.0 degrees Fahrenheit.

The air at the vent was taken as being 81.1 degrees Fahrenheit, but air was barely blowing out of the vent. The blower valve had to be adjusted by plant operations to get the unit to function.

Staff #'s 3 and 4 confirmed the temperatures.

Interview with Staff # 4 revealed that 2 weeks ago the motor to the pump which heat water to serve 2 Central North side went out and had to be repaired. The director stated that Room # 's 269 and 271 were going to be taken out of service because they needed HVAC actuators (controls airflow and temperature).

Review of a facility's policy revised 08/2025 and named "Maintaining a Safe, Functional Environment" revealed the following:

".1. Wilson N. Jones Regional Medical Center maintains ventilation temperature, and humidity levels for the care, treatment and services provided. All buildings and spaces within the hospital shall be constructed, maintained and monitored in accordance with AIA Guidelines for the Design and Construction of Health Care Plant Operations.."

According to the American Institute of Architects (AIA) and associated standards adopted with ANSI/ASHRAE/ASHE Standard 170 gives the following on air temperatures:

For patient rooms/general inpatient rooms: 70-75 degrees Fahrenheit and pharmacy 68-75 degrees Fahrenheit. The HVAC systems must be capable of maintaining any temperature set point within the specified range (and maintain it within a tolerance, often plus or minus 2 degrees Fahrenheit.