Nursing Investigation Results -

Pennsylvania Department of Health
LAKESIDE AT WILLOW VALLEY
Building Inspection Results

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Minimal Citation - No Harm Minimal Harm Actual Harm Serious Harm
LAKESIDE AT WILLOW VALLEY
Inspection Results For:

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

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LAKESIDE AT WILLOW VALLEY - 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 19, 2019, at Lakeside at Willow Valley, 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 #233602
Component 01
Main Building

Based on a Medicare/Medicaid Recertification Survey completed on February 19, 2019, it was determined that Lakeside at Willow Valley 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 four-story, Type II (222), fire resistive structure, without a basement, which is partially sprinklered, with smoke detection in resident rooms and common areas. The healthcare portion of the facility is fully sprinklered on the 1st and ground floor.



 Plan of Correction:


NFPA 101 STANDARD Multiple Occupancies - Construction Type: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.
Multiple Occupancies - Construction Type
Where separated occupancies are in accordance with 18/19.1.3.2 or 18/19.1.3.4, the most stringent construction type is provided throughout the building, unless a 2-hour separation is provided in accordance with 8.2.1.3, in which case the construction type is determined as follows:
* The construction type and supporting construction of the health care occupancy is based on the story in which it is located in the building in accordance with 18/19.1.6 and Tables 18/19.1.6.1
* The construction type of the areas of the building enclosing the other occupancies shall be based on the applicable occupancy chapters.
18.1.3.5, 19.1.3.5, 8.2.1.3
Observations:
Name: MAIN BUILDING - Component: 01 - Tag: 0133

Based on observation and interview, it was determined the facility failed to maintain the rating of common walls, on one of four floors within the component.

Findings include:

1. Observation on February 19, 2019, at 12:17 PM revealed a penetration of a gray wire, above the common wall doors to Lakes Manor.

Interview at the time of the exit conference with the Administrator and the Maintenance Director on February 19, 2019, at 2:00 PM confirmed there was a penetration.



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

1. The area stated above was re-sealed with an approved through penetration fire stop system on February 19, 2019 at 3:00pm
2. The above ceiling work permit and penetrations will be reviewed daily with our team member, and contractors to ensure all penetrations are being sealed while work is completed in Lakeside
3. PE 5074 Fire Penetrations inspections for Lakeside was updated to include monthly inspection of existing caulking as well as penetrations to make sure it is still maintaining its fire rating of all smoke barrier walls in Lakeside. Any caulk that is not in compliance will be replaced with approved through penetration fire top system.
4. The inspections will be documented and monitored by our Facility Management work order system. The inspections will be reviewed at all quarterly Quality Assurance Meetings
5. Date of Compliance: March 15th, 2019


NFPA 101 STANDARD Stairways and Smokeproof Enclosures: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.
Stairways and Smokeproof Enclosures
Stairways and Smokeproof enclosures used as exits are in accordance with 7.2.
18.2.2.3, 18.2.2.4, 19.2.2.3, 19.2.2.4, 7.2




Observations:
Name: MAIN BUILDING - Component: 01 - Tag: 0225

Based on observation and interview, it was determined the facility failed to maintain the rating of stairtowers, in one of three stairtowers within the component.

Findings include:

1. Observation on February 19, 2019, at 12:13 PM revealed the joint, between the deck and the stairtower, was partially sealed.

Interview at the time of the exit conference with the Administrator and the Maintenance Director on February 19, 2019, at 2:00 PM confirmed the joint was not sealed.



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

1. The area stated above was re-sealed with an approved through penetration fire stop system on February 19, 2019 at 3:30pm
2. The above ceiling work permit and penetrations will be reviewed daily with our team member, and contractors to ensure all penetrations are being sealed while work is completed in Lakeside
3. PE 5074 Fire Penetrations inspections for Lakeside was updated to include monthly inspection of existing caulking as well as penetrations to make sure it is still maintaining its fire rating of all smoke barrier walls in Lakeside. Any caulk that is not in compliance will be replaced with approved through penetration fire top system.
4. The inspections will be documented and monitored by our Facility Management work order system. The inspections will be reviewed at all quarterly Quality Assurance Meetings
5. Date of Compliance: March 15th, 2019


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