Nursing Investigation Results -

Pennsylvania Department of Health
ELLEN MEMORIAL HEALTH CARE CENTER-HONESDALE, INC.
Building Inspection Results

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Minimal Citation - No Harm Minimal Harm Actual Harm Serious Harm
ELLEN MEMORIAL HEALTH CARE CENTER-HONESDALE, INC.
Inspection Results For:

There are  36 surveys for this facility. Please select a date to view the survey results.

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ELLEN MEMORIAL HEALTH CARE CENTER-HONESDALE, INC. - 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 21, 2019, at Ellen Memorial Health Care Center-Honesdale, Inc., it was determined there were no deficiencies identified with the requirements of 42 CFR 483.73.




 Plan of Correction:


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


Facility ID# 318502
Component 01
Main Building

Based on a Medicare/Medicaid Recertification Survey completed on February 21, 2019, it was determined that Ellen Memorial Health Care Center-Honesdale, Inc., 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 V (000), unprotected, wood frame building, with a partial basement, that is fully sprinklered.




 Plan of Correction:


NFPA 101 STANDARD Means of Egress - General: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.
Means of Egress - General
Aisles, passageways, corridors, exit discharges, exit locations, and accesses are in accordance with Chapter 7, and the means of egress is continuously maintained free of all obstructions to full use in case of emergency, unless modified by 18/19.2.2 through 18/19.2.11.
18.2.1, 19.2.1, 7.1.10.1
Observations:
Name: MAIN BUILDING 01 - Component: 01 - Tag: 0211

Based on observation and interview, it was determined the facility failed to maintain exit doors in one instance affecting 1 of 7 smoke compartments within the facility.

Findings include:

1. Observation on February 21, 2019, at 1:05 p.m., revealed the Gold dining room, exit door, drags on the concrete and could not be fully opened.

Exit interview with the facility administrator and facility representative #1, on February 21, 2019, between 2:10 p.m. and 2:20 p.m., confirmed the exit door could not be fully opened.




 Plan of Correction - To be completed: 04/09/2019

The door sweep has been adjusted to allow for door to open fully without any drag on concrete.

Maintenance staff will be educated on the need to check that all exit doors open fully without any drag.

Maintenance Supervisor will do monthly checks on all exit doors to ensure that no drag exists and that doors open fully.
NFPA 101 STANDARD Subdivision of Building Spaces - Smoke Barrie: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.
Subdivision of Building Spaces - Smoke Barrier Construction
2012 EXISTING
Smoke barriers shall be constructed to a 1/2-hour fire resistance rating per 8.5. Smoke barriers shall be permitted to terminate at an atrium wall. Smoke dampers are not required in duct penetrations in fully ducted HVAC systems where an approved sprinkler system is installed for smoke compartments adjacent to the smoke barrier.
19.3.7.3, 8.6.7.1(1)
Describe any mechanical smoke control system in REMARKS.
Observations:
Name: MAIN BUILDING 01 - Component: 01 - Tag: 0372

Based on observation and interview, it was determined the facility failed to maintain smoke barrier walls to provide at least a one-half hour fire resistance rating in two instances affecting 4 of 7 smoke compartments, within the facility.

Findings include:

1. Observation on February 21, 2019, between 12:15 p.m. and 1:15 p.m., revealed:

a. 12:15 p.m. A spray foam was used to seal penetrations above the cross-corridor doors at resident room #216.
b. 1:15 p.m. Unsealed penetrations located above the cross-corridor doors at resident room #107.

Exit interview with the facility administrator and facility representative #1, on February 21, 2019, between 2:10 p.m. and 2:20 p.m., confirmed the unauthorized spray foam and the penetrations.




 Plan of Correction - To be completed: 04/09/2019

The spray foam will be removed above the cross-corridor doors and sheetrock/ fire caulk will be utilized to seal unsealed penetrations above cross-corridor doors.

All maintenance staff will be educated not to use spray foam across cross-corridor doors and that all unsealed penetrations must be sealed.

The Maintenance Supervisor will be responsible for monthly checks that all penetrations above all cross-corridor doors are properly sealed.
NFPA 101 STANDARD Electrical Equipment - Power Cords and Extens: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.
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 it was determined the facility failed to maintain electrical wiring and equipment in one instance affecting 1 of 7 smoke compartments within the facility.

Findings include:

1. Observation on February 21, 2019, at 1:05 p.m., revealed an extension cord was being used for the refrigerator located in the Red corridor pantry.

Exit interview with the facility administrator and facility representative #1, on February 21, 2019, between 2:10 p.m. and 2:20 p.m., confirmed the unauthorized extension cord in use.




 Plan of Correction - To be completed: 04/09/2019

The extension cord has been removed from the Red Corridor Pantry.

All refrigerators will be plugged directly into the receptacle outlets.

All maintenance staff will be educated that extension cords are not to be utilized for plugging in refrigerators.

The Maintenance Supervisor will be responsible for doing bi- monthly checks to ensure no extension cords are being utilized.

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