Pennsylvania Department of Health
KINGSTON REHABILITATION AND NURSING CENTER
Building Inspection Results

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Severity Designations


Minimal Citation - No Harm	Minimal Harm	Actual Harm	Serious Harm

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KINGSTON REHABILITATION AND NURSING CENTER - 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 March 20, 2024, at Kingston Rehab and Nursing Center, 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# 900102
Component 01
Main Building

Based on a Medicare/Medicaid Recertification Survey completed on March 20, 2024, it was determined that Kingston Rehabilitation and Nursing Center 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, that is fully sprinklered.

Plan of Correction:

NFPA 101 STANDARD Corridor - Doors:

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.

Corridor - Doors
Doors protecting corridor openings in other than required enclosures of vertical openings, exits, or hazardous areas resist the passage of smoke and are made of 1 3/4 inch solid-bonded core wood or other material capable of resisting fire for at least 20 minutes. Doors in fully sprinklered smoke compartments are only required to resist the passage of smoke. Corridor doors and doors to rooms containing flammable or combustible materials have positive latching hardware. Roller latches are prohibited by CMS regulation. These requirements do not apply to auxiliary spaces that do not contain flammable or combustible material.
Clearance between bottom of door and floor covering is not exceeding 1 inch. Powered doors complying with 7.2.1.9 are permissible if provided with a device capable of keeping the door closed when a force of 5 lbf is applied. There is no impediment to the closing of the doors. Hold open devices that release when the door is pushed or pulled are permitted. Nonrated protective plates of unlimited height are permitted. Dutch doors meeting 19.3.6.3.6 are permitted. Door frames shall be labeled and made of steel or other materials in compliance with 8.3, unless the smoke compartment is sprinklered. Fixed fire window assemblies are allowed per 8.3. In sprinklered compartments there are no restrictions in area or fire resistance of glass or frames in window assemblies.

19.3.6.3, 42 CFR Parts 403, 418, 460, 482, 483, and 485
Show in REMARKS details of doors such as fire protection ratings, automatics closing devices, etc.

Observations:
Name: MAIN BUILDING 01 - Component: 01 - Tag: 0363

Based on observation and interview, it was determined the facility failed to maintain corridor openings in one location, affecting one of one floor.

Findings include:

1. Observation on March 20, 2024, at 10:14 a.m., revealed the Resident Pantry Room door was held open by unapproved means (trash can).

Exit interview with the Facility Administrator and the Facilities Manager on March 20, 2024, between 11:35 a.m., and 11:45 a.m., confirmed the corridor opening deficiency.

Plan of Correction - To be completed: 04/23/2024

The trash can was removed at the time of survey.

Other resident pantry doors were checked for compliance.

The Maintenance Director/designee will continue to monitor resident pantry doors on daily rounds.

Administrator/Designee will randomly audit resident pantry doors are not held open by unapproved means.

NFPA 101 STANDARD Subdivision of Building Spaces - Smoke Barrie:

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 two smoke barrier separation wall, in two locations, affecting one of one floor.

Findings include:

1. Observation on March 20, 2024, between 10:58 a.m., and 11:07 a.m., revealed the following:

a. 10:58 a.m., the portion of the smoke barrier separation wall, located within Resident Room C2, does not fully extend to the outside wall, from floor to roof deck assembly.
b. 11:07 a.m., the portion of the smoke barrier separation wall, located within Resident Room A7, does not fully extend to the outside wall, between the top of the concrete masonry unit, and roof deck above.

Exit interview with the Facility Administrator and the Facilities Manager on March 20, 2024, between 11:35 a.m., and 11:45 a.m., confirmed the smoke barrier separation wall deficiencies.

Plan of Correction - To be completed: 04/23/2024

Facility is requesting a 6-month time limited waiver from the DSI for Station A and Station B Units.

NFPA 101 STANDARD Electrical Systems - Other:

Electrical Systems - Other
List in the REMARKS section any NFPA 99 Chapter 6 Electrical Systems 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.
Chapter 6 (NFPA 99)

Observations:
Name: MAIN BUILDING 01 - Component: 01 - Tag: 0911

Based on observation and interview, it was determined the facility failed to maintain electrical systems in one location, affecting one of one floor.

Findings include:

1. Observation on March 20, 2024, at 10:32 a.m., revealed the LC No. 4 electrical panel was not locked (exit access corridor location).

Exit interview with the Facility Administrator and the Facilities Manager on March 20, 2024, between 11:35 a.m., and 11:45 a.m., confirmed the electrical systems deficiency.

Plan of Correction - To be completed: 04/23/2024

The electrical panel was locked at the time of the survey.

Other electrical panels were checked for compliance.

The Maintenance Director/designee will continue to monitor electrical panels on daily rounds.

Administrator/Designee will randomly audit electrical panels are locked.

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