Nursing Investigation Results -

Pennsylvania Department of Health
PREMIER AT PERRY VILLAGE FOR NURSING AND REHABILITATION, LLC
Building Inspection Results

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Minimal Citation - No Harm Minimal Harm Actual Harm Serious Harm
PREMIER AT PERRY VILLAGE FOR NURSING AND REHABILITATION, LLC
Inspection Results For:

There are  26 surveys for this facility. Please select a date to view the survey results.

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PREMIER AT PERRY VILLAGE FOR NURSING AND REHABILITATION, LLC - 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 May 22, 2019, at Premier at Perry Village for Nursing and Rehabilitation, LLC, it was determined there were no deficiencies identified with the requirements of 42 CFR 483.73.



 Plan of Correction:


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


Facility ID #161002
Component 01
Main Building

Based on a Medicare/Medicaid Recertification Survey completed on May 22, 2019, it was determined that Premier at Perry Village for Nursing and Rehabilitation, LLC 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 II (000), unprotected noncombustible structure, without a basement, which is fully sprinklered.



 Plan of Correction:


NFPA 101 STANDARD Illumination of Means of Egress: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.
Illumination of Means of Egress
Illumination of means of egress, including exit discharge, is arranged in accordance with 7.8 and shall be either continuously in operation or capable of automatic operation without manual intervention.
18.2.8, 19.2.8
Observations:
Name: MAIN BUILDING - Component: 01 - Tag: 0281

Based on observation and interview, it was determined the facility failed to illuminate the means of egress, including exit discharge, at one of ten exits within the component.

Findings include:

1. Observation on May 22, 2019, at 10:45 AM revealed the West Exit discharge light, outside the building, lacked a two-bulb light fixture.

Interview with the Maintenance Director on May 22, 2019, at 10:45 AM confirmed the West Exit discharge lacked a two-bulb light fixture.




 Plan of Correction - To be completed: 07/08/2019

West Wing exit will have 2 single bulb light fixtures on a single circuit.
All exit lights will have 2 single bulb light fixtures on a single circuit.
Maintenance staff will be re-educated on having 2 single bulb light fixtures on a single circuit at all exit signs.
The maintenance staff/designee will audit 2 exit signs weekly for 4 weeks to ensure that 2 bulbs on the same circuit are at the exit signs. Audits will be reviewed monthly at QAPI.
NFPA 101 STANDARD Sprinkler System - Maintenance and Testing: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.
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 - Component: 01 - Tag: 0353

Based on observation and interview, it was determined the facility failed to inspect the automatic sprinkler system, on one of one system within the component.

Findings include:

1. Observation on May 22, 2019, between 10:50 AM and 11:10 AM revealed sprinkler valves lacked metal UL-approved signs attached with wire or chains to the valve assemblies, in the following locations:

a. 10:50 AM, West Wing 200 Hall, Biohazard Room;
b. 10:55 AM, Main Patio;
c. 11:10 AM, East Wing, Biohazard Room.

Interview with the Maintenance Director on May 22, 2019, at 11:10 AM confirmed the automatic sprinkler valves lacked UL-approved signs.



 Plan of Correction - To be completed: 07/08/2019

West wing 200 hall biohazard room, main patio and east wing biohazard room will have UL-approved signs attached with wire or chains to the fixture.
All sprinkler valves will have UL-approved signs attached with wire or chains to the fixture.
Maintenance staff will be re-educated on using UL-approved signs attached with wire or chains to the fixture.
The maintenance staff/designee will audit 2 areas weekly for 4 weeks to ensure that UL-approved signs are attached with wire or chains to the fixture. Audits will be reviewed monthly at QAPI.

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