Pennsylvania Department of Health
MONTICELLO HOUSE
Building Inspection Results

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Severity Designations


Minimal Citation - No Harm	Minimal Harm	Actual Harm	Serious Harm

There are 46 surveys for this facility. Please select a date to view the survey results.

Surveys don't appear on this website until at least 41 days have elapsed since the exit date of the survey.


MONTICELLO HOUSE - 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 28, 2024, at Monticello House, 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# 017302
Building 01
Main Building

Based on a Medicare/Medicaid Recertification Survey completed on May 28, 2024, it was determined that Monticello House was not in compliance with the following requirements of the Life Safety Code for an existing Nursing 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 five-story, Type II (222), fire-resistive building, with an underground parking garage, that is fully sprinklered.

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 01 - Component: 01 - Tag: 0133

Based on observation and interview, it was determined the facility failed to maintain the fire resistive rating of common walls, affecting three of six levels.

Findings include:

Observation on May 28, 2024, revealed fire rated common wall deficiencies, in the following locations:

a. 11:05 a.m., basement garage, the roll down fire door separating Monticello /Independent buildings, was held in the propped position with 2- vice-grip type pliers attached to the gears.
b. 11:20 a.m., on the fifth floor, above fire doors separating Monticello/Core buildings, unsealed penetration around data wires.
c. 11:40 a.m., on the fourth floor, above fire doors separating Monticello/Core buildings, unsealed penetration around data wires.

Exit Interview with the Administrator and Maintenance Director on May 28, 2024, at 12:45 p.m., confirmed the common wall deficiencies.

Plan of Correction - To be completed: 07/09/2024

The garage roll down fire door will have the vice-grip pliers removed so door functions properly.

The unsealed penetration above the 4th and 5th floor fire doors, located above the suspended ceiling between Monticello/Core building, will be properly sealed with a UL approved through-penetration fire stop system.

As a part of the Maintenance Supervisor's quarterly inspection protocol, the Facility Operations Department randomly inspect areas for existing penetrations/deteriorating seals and will seal those found to be noncompliant with a UL approved through-penetration fire stop system. They will also inspect the roll down fire door to ensure properly functioning.

Director of Facility Operations and/or delegate will report areas of concerns, findings, and corrections to the Quality Assurance Performance Improvement (QAPI) Committee for the next two quarters.

Disclaimer:
Preparation and/or execution of this entire Plan of Correction does not constitute admission or agreement by the Provider of the truth of the facts alleged or conclusion set forth in this Statement of Deficiencies. The entire Plan of Correction is prepared and/or executed solely because it is required by the provisions of Federal and State laws.

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 document review and interview, it was determined the facility failed to maintain sprinkler system components, affecting the entire facility.

Findings include:

Document review on May 28, 2024, at 9:30 a.m., revealed the June 2, 2023, Annual fire pump inspection report listed the following deficiencies. Evidence of corrective action was not available at time of survey:

a. 5-year service per Manufacturer specs in need to be done.
b. Both jockey and fire pump lines are married and need to be separated.

Exit Interview with the Administrator and Maintenance Director on May 28, 2024, at 12:45 p.m., confirmed the sprinkler system deficiency.

Plan of Correction - To be completed: 07/09/2024

The 5-year service per manufacturer specs documentation was located and completed in June 2021.

Jockey and fire pump lines will be separated

As a part of the Maintenance Supervisor's quarterly inspection protocol, the Facility Operations Department will review inspection reports completed in the past quarter to ensure recommendations have been followed.

Director of Facility Operations and/or delegate will report areas of concerns, findings, and corrections to the Quality Assurance Performance Improvement (QAPI) Committee for the next two quarters.

Disclaimer:
Preparation and/or execution of this entire Plan of Correction does not constitute admission or agreement by the Provider of the truth of the facts alleged or conclusion set forth in this Statement of Deficiencies. The entire Plan of Correction is prepared and/or executed solely because it is required by the provisions of Federal and State laws.

NFPA 101 STANDARD Rubbish Chutes, Incinerators, and Laundry Chu:

Rubbish Chutes, Incinerators, and Laundry Chutes
2012 EXISTING
(1) Any existing linen and trash chute, including pneumatic rubbish and linen systems, that opens directly onto any corridor shall be sealed by fire resistive construction to prevent further use or shall be provided with a fire door assembly having a fire protection rating of 1-hour. All new chutes shall comply with 9.5.
(2) Any rubbish chute or linen chute, including pneumatic rubbish and linen systems, shall be provided with automatic extinguishing protection in accordance with 9.7.
(3) Any trash chute shall discharge into a trash collection room used for no other purpose and protected in accordance with 8.4. (Existing laundry chutes permitted to discharge into same room are protected by automatic sprinklers in accordance with 19.3.5.9 or 19.3.5.7.)
(4) Existing fuel-fed incinerators shall be sealed by fire resistive construction to prevent further use.
19.5.4, 9.5, 8.4, NFPA 82

Observations:
Name: MAIN BUILDING 01 - Component: 01 - Tag: 0541

Based on observation and interview, it was determined the facility failed to maintain the fire protection rating for chutes and discharge rooms, affecting three of six levels.

Findings include:

Observations on May 28, 2024, revealed the following deficiencies:

a. 11:10 a.m., on the ground floor, linen chute discharge room door propped open.
b. 11:15 a.m., on the ground floor, linen chute door had a faulty latching mechanism.
c. 11:30 a.m., on the fifth floor short hall trash chute door failed to self-close and latch.
d. 11:50 a.m., on the fourth floor short hall trash chute door failed to self-close and latch.

Exit Interview with the Administrator and Maintenance Director on May 28, 2024, at 12:45 p.m., confirmed the chute deficiencies.

Plan of Correction - To be completed: 07/09/2024

The ground floor, linen chut discharge room door will be shut and not be propped open.

The ground floor, linen chute door will be adjusted to ensure it automatically closes and positively latches.

The 4th and 5th floor Short hall trash chute doors will be adjusted to ensure it automatically closes and positively latches.

As a part of the Maintenance Supervisor's quarterly inspection protocol, the Facility Operations Department will inspect linen and chute doors to ensure they automatically close and latch and inspect the linen chute discharge room door to ensure it is not propped open.

Director of Facility Operations and/or delegate will report areas of concerns, findings, and corrections to the Quality Assurance Performance Improvement (QAPI) Committee for the next two quarters.

Disclaimer:
Preparation and/or execution of this entire Plan of Correction does not constitute admission or agreement by the Provider of the truth of the facts alleged or conclusion set forth in this Statement of Deficiencies. The entire Plan of Correction is prepared and/or executed solely because it is required by the provisions of Federal and State laws.

NFPA 101 STANDARD Electrical Equipment - Power Cords and Extens:

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 prohibit the unauthorized use of electrical devices affecting one of six levels.

Findings include:

Observation on May 28, 2024, at 12:00 p.m., revealed a fridge plugged into a surge protector, on the fifth floor, Nurse Manager Office.

Exit Interview with the Administrator and Maintenance Director on May 28, 2024, at 12:45 p.m., confirmed the unauthorized electrical device.

Plan of Correction - To be completed: 07/09/2024

Fridge in 5th floor Nurse Manager Office will be plugged directly into wall outlet and removed from the surge protector.

As a part of the Maintenance Supervisor's quarterly inspection protocol, the Facility Operations Department randomly inspect Fridges on the unit to ensure they are not plugged into a surge protector.

Director of Facility Operations and/or delegate will report areas of concerns, findings, and corrections to the Quality Assurance Performance Improvement (QAPI) Committee for the next two quarters.

Disclaimer:
Preparation and/or execution of this entire Plan of Correction does not constitute admission or agreement by the Provider of the truth of the facts alleged or conclusion set forth in this Statement of Deficiencies. The entire Plan of Correction is prepared and/or executed solely because it is required by the provisions of Federal and State laws.

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