Nursing Investigation Results -

Pennsylvania Department of Health
FOREST CITY NURSING AND REHAB CENTER
Building Inspection Results

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Minimal Citation - No Harm Minimal Harm Actual Harm Serious Harm
FOREST CITY NURSING AND REHAB CENTER
Inspection Results For:

There are  37 surveys for this facility. Please select a date to view the survey results.

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FOREST CITY NURSING AND REHAB 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 May 18, 2022, at Forest City Nursing and Rehabilitation 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# 061202
Component 01
Building 01

Based on a Medicare/Medicaid Recertification Survey completed on May 18, 2022, it was determined that Forest City Nursing and Rehabilitation 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 483.70(a).

This is a two story, Type II (000), unprotected, non-combustible building that 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 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.
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 01 - Component: 01 - Tag: 0281

Based on observation and interview, it was determined the facility failed to maintain the illumination of a means of egress, affecting three of nine smoke compartments.

Findings include:

1. Observation on May 18, 2022, at 10:55 a.m., revealed the exit discharge located near the classroom lacked lighting along the exiting path leading to the public way.

Exit interview with the facility administrator and facility representative #1 on May 18, 2022, at 11:55 a.m., confirmed the lack of illumination.




 Plan of Correction - To be completed: 06/21/2022

The exit discharge located near the classroom will have lighting stalled along the exiting path leading to the public way.
An audit of the exit discharge locations will be completed for lighting along the exiting paths leading to the public ways.
Any discrepancies will have lighting installed.
This audit will be reviewed at monthly Safety meeting.

NFPA 101 STANDARD Exit Signage: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.
Exit Signage
2012 EXISTING
Exit and directional signs are displayed in accordance with 7.10 with continuous illumination also served by the emergency lighting system.
19.2.10.1
(Indicate N/A in one-story existing occupancies with less than 30 occupants where the line of exit travel is obvious.)
Observations:
Name: MAIN BUILDING 01 - Component: 01 - Tag: 0293

Based on documentation review and interview, it was determined the facility failed to maintain illuminated exit signage, affecting two of nine smoke compartments.

Findings include:

1. Review of documentation on May 18, 2022, between 10:10 a.m. and 10:30 a.m., revealed the exit signs lacked illumination at the following locations:

a. 10:10 a.m. - The 2nd floor exit stair adjacent to resident room #218.
b. 10:30 a.m. - The 1st floor exit stair near the Mechanical room.

Exit interview with the facility administrator and facility representative #1 on May 18, 2022, at 11:55 a.m., confirmed the lack of illuminated exit signs.




 Plan of Correction - To be completed: 06/21/2022

Identified Exit sign lighting, 2nd floor exit adjacent to Rm 218, and 1st floor exit stair near the Mechanical room, has been repaired so they have illumination.
An audit of exit lights throughout the facility will be completed. Any exit signs lacking illumination will be repaired.
An audit of exit sign lights for illumination will be completed monthly x 3 months by the maintenance Supervisor/designee
The exit sign illumination audits will be reviewed at monthly safety committee meeting x 3 months.

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 doors, affecting one of nine smoke compartments.

Findings include:

1. Observation on May 18, 2022, at 9:30 a.m., revealed the 2nd floor Dietary door to the corridor had a deadbolt installed.

Exit interview with the facility administrator and facility representative #1 on May 18, 2022, at 11:55 a.m., confirmed the deadbolt.




 Plan of Correction - To be completed: 06/21/2022

The 2nd floor Dietary door will have the deadbolt removed and replaced with an approved opening device.
An audit of doors to the corridor will be completed by the Maintenance Supervisor/designee to make sure there are no other deadbolts in the facility.
Any discrepancies will be corrected.
The audit will be reviewed at monthly Safety meeting x 1 month.

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, affecting two of nine smoke compartments.

Findings include:

1. Observation on May 18, 2022, at 9:50 a.m., revealed an unsealed penetration around an electrical wire located in the 2nd floor Beauty Shop.

Exit interview with the facility administrator and facility representative #1 on May 18, 2022, at 11:55 a.m., confirmed the penetration.




 Plan of Correction - To be completed: 06/21/2022

The penetration in the (smoke barriers) beauty shop around electrical wires have been repaired.
A random audit will be completed by the Maintenance Supervisor/designee in smoke barriers to repair any other penetrations around electrical wires that may be found.
A random audit will be completed monthly x 3 months by the Maintenance Supervisor/designee in smoke barriers to repair any other penetrations around electrical wires that may be found.
The audit will be reviewed at monthly safety committee meeting x 3 months.

NFPA 101 STANDARD Electrical Systems - 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.
Electrical Systems - Maintenance and Testing
Hospital-grade receptacles at patient bed locations and where deep sedation or general anesthesia is administered, are tested after initial installation, replacement or servicing. Additional testing is performed at intervals defined by documented performance data. Receptacles not listed as hospital-grade at these locations are tested at intervals not exceeding 12 months. Line isolation monitors (LIM), if installed, are tested at intervals of less than or equal to 1 month by actuating the LIM test switch per 6.3.2.6.3.6, which activates both visual and audible alarm. For LIM circuits with automated self-testing, this manual test is performed at intervals less than or equal to 12 months. LIM circuits are tested per 6.3.3.3.2 after any repair or renovation to the electric distribution system. Records are maintained of required tests and associated repairs or modifications, containing date, room or area tested, and results.
6.3.4 (NFPA 99)
Observations:
Name: MAIN BUILDING 01 - Component: 01 - Tag: 0914

Based on document review and interview, the facility failed to maintain electrical receptacles, affecting the entire facility.

Findings include:

1. Review of documentation on May 18, 2022, at 8:50 a.m., revealed the facility lacked records for a required annual electrical receptacle inspection.

Exit interview with the facility administrator and facility representative #1 on May 18, 2022, at 11:55 a.m., confirmed the lack of documentation.




 Plan of Correction - To be completed: 06/21/2022

The facility cannot retroactively correct the annual receptacle inspection documentation.
The Maintenance supervisor will complete a current receptacle inspection.
A listing of required inspection documentation will be completed including but not limited to annual receptacle inspection to ensure the inspection was completed.
The list will be reviewed by the maintenance supervisor at Safety committee meeting to ensure the annual receptacle inspection was completed.


NFPA 101 STANDARD Electrical Equipment - Other: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 - Other
List in the REMARKS section any NFPA 99 Chapter 10, Electrical Equipment, 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 10 (NFPA 99)
Observations:
Name: MAIN BUILDING 01 - Component: 01 - Tag: 0919

Based on observation and interview, it was determined the facility failed to maintain electrical wiring and equipment, affecting one of nine smoke compartments.

Findings include:

1. Observation on May 18, 2022, at 10:15 a.m., revealed two open electrical junction boxes located at the 2nd floor Nurses Station.

Exit interview with the facility administrator and facility representative #1 on May 18, 2022, at 11:55 a.m., confirmed the exposed electrical wires.




 Plan of Correction - To be completed: 06/21/2022

The 2 electrical junction boxes at the 2nd floor nurses station had covers installed.
An audit of other nursing station junction boxes will be completed by the Maintenance Supervisor/designee and any discrepancies will be repaired.
An audit of nursing station junction boxes will be completed by the Maintenance supervisor/designee monthly x 3 months.
The audit of junction boxes will be reviewed at safety committee meeting x 3 months.



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