Nursing Investigation Results -

Pennsylvania Department of Health
GROVE AT NEW WILMINGTON, THE
Building Inspection Results

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Minimal Citation - No Harm Minimal Harm Actual Harm Serious Harm
GROVE AT NEW WILMINGTON, THE
Inspection Results For:

There are  31 surveys for this facility. Please select a date to view the survey results.

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GROVE AT NEW WILMINGTON, THE - Inspection Results Scope of Citation
Number of Residents Affected
By Deficient Practice
Initial comments:Name: - Component: -- - Tag: 0000


Based on a Revisit to an Emergency Preparedness Survey completed on January 23, 2019, it was determined that The Grove at New Wilmington, was in compliance with 42 CFR 483.73.









 Plan of Correction:


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


Facility ID # 150502
Component 01
Main Building

Based on a Revisit to a Medicare/Medicaid Recertification Survey completed on January 23, 2019, it was determined that The Grove At New Wilmington, 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 one-story, Type III (200), unprotected, ordinary building, with a partial basement, that is fully sprinklered.








 Plan of Correction:


NFPA 101 STANDARD General Requirements - Other: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.
General Requirements - Other
List in the REMARKS section any LSC Section 18.1 and 19.1 General Requirements that are not addressed by the provided K-tags, but are deficient. This information, along with the applicable Life Safety Code or NFPA standard citation, should be included on Form CMS-2567.
Observations:
Name: MAIN BUILDING 01 - Component: 01 - Tag: 0100

Based on document review and interview, the facility failed to maintain the required regulations set forth by Pennsylvania Act 48, for carbon monoxide detectors on one of two building levels.

Findings include:

1. Document review on January 23, 2019, at 9:45 a.m., revealed the facility lacked the following documentation for the carbon monoxide detectors:
a. Testing/cleaning per manufactures specifications;
b. Annual battery replacement within the last year.

Interview with the maintenance director and administrator on January 23, 3019, at 9:45 a.m., confirmed the above carbon monoxide information documentation was not available at the time of the survey.

At the time of revisit on March 7, 2019, interview with the maintenance director at 8:30 a.m., confirmed the above deficiences were not corrected.



 Plan of Correction - To be completed: 03/15/2019

The Facility submits this Plan of Correction under procedures established by the Department of Health
in order to comply with the Department's directive to change conditions which the Department alleges
is deficient under State and/or Federal Long Term Care Regulations. This Plan of Correction should not
be construed as either a waiver of the facility's right to appeal or challenge the accuracy or severity of
the alleged deficiencies or an admission of past or ongoing violation of State or Federal regulatory
requirements.


The carbon monoxide detectors have been tested and cleaned per manufactures specifications.
All Carbon Monoxide detectors with battery backup have had batteries replaced.

NFPA 101 STANDARD Sprinkler System - Maintenance and Testing:This is a less serious (but not lowest level) 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 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.
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 BUILDING 01 - Component: 01 - Tag: 0353

Based on observation, document review and interview, the facility failed to maintain fire sprinkler systems for two of two sprinkler systems.

Findings include:

1. Document review on January 23, 2019, at 9:10 a.m., revealed the following fire sprinkler deficiencies:
a. November 14, 2018, quarterly fire sprinkler inspection noted, "Antifreeze loop is at +12 degrees. Recommend system must be recharged before freezing conditions. Propylene Glycol, five heads on a 1" line with no control valve for isolation, only a 1" check valve";
b. May 17, 2018, quarterly fire sprinkler inspection noted, "Outside tamper on the post indicator valve was not working";
c. February 15, 2018, quarterly fire sprinkler inspection was a blank report (no checked boxes to indicate if tested components passed or failed).

Interview with the maintenance director and administrator on January 23, 2019, at 9:10 a.m., confirmed the above fire sprinkler quarterly report deficiencies.

Deficiency A and C were corrected at the time of revisit.

At the time of revisit on March 7, 2019, interview with the maintenance director at 8:40 a.m., confirmed deficiency B was not corrected.

2. Observation on January 23, 2019, at 10:35 a.m., revealed a large park bench was placed in front of the outside fire department connection, blocking access.

Interview with the maintenance director and administrator on January 23, 2019, at 10:35 a.m., confirmed the above fire department connection was blocked by a park bench.

Above deficiency number 2 was corrected at the time of revisit.

3. Observation on January 23, 2019, at 10:42 a.m., revealed the Gathering/Porch had a fire sprinkler valve that lacked an identification tag.

Interview with the maintenance director and administrator on January 23, 2019, at 10:42 a.m., confirmed the above sprinkler valve lacked an identification tag.

At the time of revisit on March 7, 2019, interview with the maintenance director at 8:45 a.m., confirmed the deficiency number 3 was not corrected.









 Plan of Correction - To be completed: 03/15/2019

The outside tamper on the post indicator valve Has been locked out on Friday March, 15, 2019 which meets code per Ivan Piotek, from Firefighters.
The Identification tags for the fire sprinkler valve has been provided on Friday March 15, 2019.
NFPA 101 STANDARD Smoking Regulations: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.
Smoking Regulations
Smoking regulations shall be adopted and shall include not less than the following provisions:
(1) Smoking shall be prohibited in any room, ward, or compartment where flammable liquids, combustible gases, or oxygen is used or stored and in any other hazardous location, and such area shall be posted with signs that read NO SMOKING or shall be posted with the international symbol for no smoking.
(2) In health care occupancies where smoking is prohibited and signs are prominently placed at all major entrances, secondary signs with language that prohibits smoking shall not be required.
(3) Smoking by patients classified as not responsible shall be prohibited.
(4) The requirement of 18.7.4(3) shall not apply where the patient is under direct supervision.
(5) Ashtrays of noncombustible material and safe design shall be provided in all areas where smoking is permitted.
(6) Metal containers with self-closing cover devices into which ashtrays can be emptied shall be readily available to all areas where smoking is permitted.
18.7.4, 19.7.4

Observations:
Name: MAIN BUILDING 01 - Component: 01 - Tag: 0741

Based on observation and interview, the facility failed to maintain smoking regulations for one of four smoking receptacles.

Findings include:

1. Observation on January 23, 2019, at 10:40 a.m., revealed the second floor, Porch/Gathering smoking area, had a cigarette butt container with the following deficiencies:
a. Combustible trash was inside.
b. Lid did not self-close.

Interview with the maintenance director on January 23, 2019, at 10:40 a.m., confirmed the above smoking receptacle deficiencies.

At the time of Revisit on March 7, 2019, interview with the maintenance director at 8:50 a.m., confirmed the above deficiency A was not corrected.

Deficiency B had been corrected at the time of Revisit.









 Plan of Correction - To be completed: 03/15/2019

The combustible trash that was inside the cigarette butt container has been removed . A Daily audit of the designated smoking area has been implemented by the Director of Environmental Services.
Any concerns found as result of the auditing will be reviewed at the monthly QAPI Meeting.
NFPA 101 STANDARD Electrical Equipment - Power Cords and Extens: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 Equipment - Power Cords and Extension Cords
Power strips in a patient care vicinity are only used for components of movable patient-care-related electrical equipment (PCREE) assembles that have been assembled by qualified personnel and meet the conditions of 10.2.3.6. Power strips in the patient care vicinity may not be used for non-PCREE (e.g., personal electronics), except in long-term care resident rooms that do not use PCREE. Power strips for PCREE meet UL 1363A or UL 60601-1. Power strips for non-PCREE in the patient care rooms (outside of vicinity) meet UL 1363. In non-patient care rooms, power strips meet other UL standards. All power strips are used with general precautions. Extension cords are not used as a substitute for fixed wiring of a structure. Extension cords used temporarily are removed immediately upon completion of the purpose for which it was installed and meets the conditions of 10.2.4.
10.2.3.6 (NFPA 99), 10.2.4 (NFPA 99), 400-8 (NFPA 70), 590.3(D) (NFPA 70), TIA 12-5
Observations:
Name: MAIN BUILDING 01 - Component: 01 - Tag: 0920

Based on observation and interview, the facility failed to maintain electrical power and extension cords in one of over fifty rooms.

Findings include:

1. Observation on January 23, 2019, between 11:27 a.m. and 11:30 a.m., revealed first floor, resident room 103, had the following electrical deficiencies:
a. (11:27 a.m.), 3 X 1 electrical adapter was utilized inside the room.
b. (11:30 a.m.), medical equipment (Bi-pap and Nebulizer) was plugged into a surge protector.

Interview with the maintenance director on January 23, 2019, at 11:30 a.m., confirmed the above electrical deficiencies.

Deficiency 1 (A) was corrected at the time of revisit.

At the time of the Revisit on March 7, 2019, interview with the maintenance director at 9:00 a.m., confirmed the above deficiency 1 (B) was not corrected.







 Plan of Correction - To be completed: 03/15/2019

On March 7, 2019, the day of revisit the medical equipment was plugged into a wall outlet and the surge protector was removed.

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