Pennsylvania Department of Health
MANATAWNY CENTER FOR REHABILITATION AND NURSING
Building Inspection Results

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Severity Designations


Minimal Citation - No Harm	Minimal Harm	Actual Harm	Serious Harm

There are 44 surveys for this facility. Please select a date to view the survey results.

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MANATAWNY CENTER FOR REHABILITATION AND NURSING - Inspection Results	Scope of Citation Number of Residents Affected By Deficient Practice

Initial comments:Name: - Component: -- - Tag: 0000

Based on an Emergency Preparedness Survey completed on February 27, 2024, at Manatawny Center for Rehabilitation and Nursing, it was determined there were no deficiencies identified with the requirements of 42 CFR 483.73.

Plan of Correction:

Initial comments:Name: MAIN - Component: 01 - Tag: 0000

Facility ID #130802
Component 01
Main Building

Based on a Medicare/Medicaid Recertification Survey completed on February 27, 2024, it was determined that Manatawny Center for Rehabilitation and Nursing was not in compliance with the following requirements of the Life Safety Code for an existing health care occupancy. Compliance with the National Fire Protection Association's Life Safety Code is required by 42 CFR 483.90(a).

This is a two-story, Type III (200), unprotected ordinary structure, with a partial basement, which is fully sprinklered.

Plan of Correction:

NFPA 101 STANDARD Building Construction Type and Height:

Least serious deficiency but was found to be widespread throughout the facility and/or has the potential to affect a large portion or all the residents. This deficiency has the potential for causing no more than a minor negative impact on the resident.

Building Construction Type and Height
2012 EXISTING
Building construction type and stories meets Table 19.1.6.1, unless otherwise permitted by 19.1.6.2 through 19.1.6.7
19.1.6.4, 19.1.6.5

Construction Type
1 I (442), I (332), II (222) Any number of stories
non-sprinklered and sprinklered

2 II (111) One story non-sprinklered
Maximum 3 stories sprinklered

3 II (000) Not allowed non-sprinklered
4 III (211) Maximum 2 stories sprinklered
5 IV (2HH)
6 V (111)

7 III (200) Not allowed non-sprinklered
8 V (000) Maximum 1 story sprinklered
Sprinklered stories must be sprinklered throughout by an approved, supervised automatic system in accordance with section 9.7. (See 19.3.5)
Give a brief description, in REMARKS, of the construction, the number of stories, including basements, floors on which patients are located, location of smoke or fire barriers and dates of approval. Complete sketch or attach small floor plan of the building as appropriate.

Observations:
Name: MAIN - Component: 01 - Tag: 0161

Based on observation and interview, it was determined the facility failed to maintain building construction requirements, affecting two of two floors within the component.

Findings include:

1. Observation on February 27, 2024, between 9:00 AM and 1:15 PM, revealed the building to be a two-story, Type III (200), unprotected ordinary structure, which is fully sprinklered. This type of construction is limited to one story in height.

Interview at the time of the exit conference with the Administrator and Facilities Manager on February 27, 2024, at 1:15 PM, confirmed the construction type is not allowed in health care.

Plan of Correction - To be completed: 03/22/2024

1.The facility is requesting DSI to complete an FSES inspection

NFPA 101 STANDARD Sprinkler System - Maintenance and Testing:

This is a less serious (but not lowest level) deficiency and affects more than a limited number of residents, staff, or occurrences. This deficiency is one that results in minimal discomfort to the resident or has the potential (not yet realized) to negatively affect the resident's ability to achieve his/her highest functional status. This deficiency was not found to be throughout this facility.

Sprinkler System - Maintenance and Testing
Automatic sprinkler and standpipe systems are inspected, tested, and maintained in accordance with NFPA 25, Standard for the Inspection, Testing, and Maintaining of Water-based Fire Protection Systems. Records of system design, maintenance, inspection and testing are maintained in a secure location and readily available.
a) Date sprinkler system last checked _____________________
b) Who provided system test ____________________________
c) Water system supply source __________________________
Provide in REMARKS information on coverage for any non-required or partial automatic sprinkler system.
9.7.5, 9.7.7, 9.7.8, and NFPA 25

Observations:
Name: MAIN - Component: 01 - Tag: 0353

Based on observation and interview, it was determined the facility failed to maintain the automatic sprinkler system to be free of obstructions, and sprinkler piping system to be free of extraneous weight, affecting two of eleven smoke compartments within the component.

Findings include:

1. Observation on February 27, 2024, between 11:00 AM and 11:06 AM, revealed sprinkler heads covered with debris, at the following locations:

a. 11:00 AM, Laundry Room Dryer Chase Room;
b. 11: 03 AM, Laundry Room, dryer area;
c. 11:06 AM, Laundry Room, washer area, 5 sprinkler heads.

Interview at the time of the exit conference with the Administrator and Facilities Manager on February 27, 2024, at 1:15 PM, confirmed the debris on the sprinkler heads.

2. Observation on February 27, 2024, at 12:00 PM, revealed multiple wires laying across the sprinkler pipes in B Wing, 1st floor, above the ceiling, by the Housekeeping Closet.

Interview at the time of the exit conference with the Administrator and Facilities Manager on February 27, 2024, at 1:15 PM, confirmed multiple wires laying across sprinkler pipes.

Plan of Correction - To be completed: 03/22/2024

1.The Maintenance Director removed debris from the laundry room sprinkler heads located in the dryer chase room area, dryer area and washer area. The Maintenance Director removed the wires laying across the sprinkler pipes located above the ceiling by the housekeeping closet on B Wing.

2.The Maintenance Director will be educated on NFPA 101 Standard Sprinkler System Maintenance and Testing on the requirement to maintain the automatic sprinkler system to be free of obstructions, and sprinkler piping system to be free of extraneous weight.

3.The Maintenance Director/designee will conduct audits of all components to verify all sprinkler heads are free of debris and sprinkler pipes are free of extraneous weight. Monthly audits of each component will be conducted to verify sprinkler heads are free of debris and sprinkler pipes are free of extraneous weight.

4.Findings will be reviewed at the Quality Assurance Performance Improvement meeting.

NFPA 101 STANDARD Electrical Systems - Receptacles:

This is a less serious (but not lowest level) deficiency and is isolated to the fewest number of residents, staff, or occurrences. This deficiency is one that results in minimal discomfort to the resident or has the potential (not yet realized) to negatively affect the resident's ability to achieve his/her highest functional status.

Electrical Systems - Receptacles
Power receptacles have at least one, separate, highly dependable grounding pole capable of maintaining low-contact resistance with its mating plug. In pediatric locations, receptacles in patient rooms, bathrooms, play rooms, and activity rooms, other than nurseries, are listed tamper-resistant or employ a listed cover.
If used in patient care room, ground-fault circuit interrupters (GFCI) are listed.
6.3.2.2.6.2 (F), 6.3.2.2.4.2 (NFPA 99)

Observations:
Name: MAIN - Component: 01 - Tag: 0912

Based on observation and interview, it was determined the facility failed to maintain power receptacles to be Ground Fault Interruption (GFI) protected, within six feet of a water source, in one of one kitchen within the component.

Findings include:

1. Observation on February 27, 2024, at 11:30 AM, revealed the basement Kitchen Water Station area outlet was not GFI protected, and was within six feet of a water source.

Interview at the time of the exit conference with the Administrator and Facilities Manager on February 27, 2024, at 1:15 PM, confirmed the outlet was not GFI protected.

Plan of Correction - To be completed: 03/22/2024

1.The Maintenance Director will have the Kitchen Water Stations area outlet replaced with a GFI protected outlet.

2.The Maintenance Director will be educated on NFPA 101 Electrical Systems - Receptacles, to maintain power receptacles, which are Ground Fault Interruption (GFI) protected, within six feet of a water source.

3.The Maintenance Director/designee will inspect all other components to verify Ground Fault Interruption (GFI) protected outlets are installed within six feet of a water source.

4.Findings will be reviewed at the Quality Assurance Performance Improvement meeting.

Initial comments:Name: A-B - Component: 02 - Tag: 0000

Facility ID #130802
Component 02
A-B Addition

Based on a Medicare/Medicaid Recertification Survey completed on February 27, 2024, at Manatawny Center for Rehabilitation and Nursing, it was determined there were no deficiencies identified under the requirements of the Life Safety Code for an existing health care occupancy. Compliance with the National Fire Protection Association's Life Safety Code is required by 42 CFR 483.90(a).

This is a one-story, Type II (111), protected noncombustible structure, without a basement, which is fully sprinklered.

Plan of Correction:

Initial comments:Name: B-C - Component: 03 - Tag: 0000

Facility ID #130802
Component 03
B-C Addition

Based on a Medicare/Medicaid Recertification Survey completed on February 27, 2024, it was determined that Manatawny Center for Rehabilitation and Nursing was not in compliance with the following requirements of the Life Safety Code for an existing health care occupancy. Compliance with the National Fire Protection Association's Life Safety Code is required by 42 CFR 483.90(a).

This is a two-story, Type II (111), protected noncombustible structure, without a basement, which is fully sprinklered.

Plan of Correction:

NFPA 101 STANDARD Sprinkler System - Maintenance and Testing:

Observations:
Name: B-C - Component: 03 - Tag: 0353

Based on observation and interview, it was determined the facility failed maintain the automatic sprinkler system to be free of extraneous weight, affecting one of two smoke compartments within the component.

Findings include:

1. Observation on February 27, 2024, at 12:50 PM, revealed rigid ventilation ducting supported by the sprinkler pipes in B Wing, 1st floor, above the ceiling, by the Beauty Shop.

Interview at the time of the exit conference with the Administrator and Facilities Manager on February 27, 2024, at 1:15 PM, confirmed rigid ventilation ducting sprinkler pipes.

Plan of Correction - To be completed: 03/22/2024

1.The Maintenance Director removed the rigid ventilation ducting supported by the sprinkler pipes on B Wing, 1st Floor, above the ceiling by the Beauty Shop.

2.The Maintenance Director will be educated on NFPA 101 Standard Sprinkler System Maintenance and Testing on the requirement to maintain the automatic sprinkler system to be free of obstructions, and sprinkler piping system to be free of extraneous weight.

3.The Maintenance Director/designee will conduct audits of all components to verify all sprinkler heads are free of debris and sprinkler pipes are free of extraneous weight. Monthly audits of each component will be conducted to verify sprinkler heads are free of debris and sprinkler pipes are free of extraneous weight.

4.Findings will be reviewed at the Quality Assurance Performance Improvement meeting.

Initial comments:Name: BUILDING 04 - Component: 04 - Tag: 0000

Facility ID #130802
Component 04
Adult Day Care Building

Based on a Medicare/Medicaid Recertification Survey completed on February 27, 2024, at Manatawny Manor, it was determined there were no deficiencies identified under the requirements of the Life Safety Code for an existing health care occupancy. Compliance with the National Fire Protection Association's Life Safety Code is required by 42 CFR 483.90(a).

This is a one-story, Type III (211), protected ordinary structure, without a basement, which is fully sprinklered.

Plan of Correction:

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