Nursing Investigation Results -

Pennsylvania Department of Health
JAMESON CARE CENTER, INC
Building Inspection Results

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Minimal Citation - No Harm Minimal Harm Actual Harm Serious Harm
JAMESON CARE CENTER, INC
Inspection Results For:

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JAMESON CARE CENTER, 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 May 10, 2022, at Jameson Care 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 # 069402
Component 01
Main Building

Based on a Medicare/Medicaid Recertification Survey completed on May 10, 2022, it was determined that Jameson Care Center was not in compliance with the 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 (111), protected, wood frame building, with a partial basement, that is fully sprinklered.



 Plan of Correction:


NFPA 101 STANDARD Building Construction Type and Height: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.
Building Construction Type and Height
2012 EXISTING
Building construction type and stories meets Table 19.1.6.1, unless otherwise permitted by 19.1.6.2 through 19.1.6.7
19.1.6.4, 19.1.6.5

Construction Type
1 I (442), I (332), II (222) Any number of stories
non-sprinklered and sprinklered

2 II (111) One story non-sprinklered
Maximum 3 stories sprinklered

3 II (000) Not allowed non-sprinklered
4 III (211) Maximum 2 stories sprinklered
5 IV (2HH)
6 V (111)

7 III (200) Not allowed non-sprinklered
8 V (000) Maximum 1 story sprinklered
Sprinklered stories must be sprinklered throughout by an approved, supervised automatic system in accordance with section 9.7. (See 19.3.5)
Give a brief description, in REMARKS, of the construction, the number of stories, including basements, floors on which patients are located, location of smoke or fire barriers and dates of approval. Complete sketch or attach small floor plan of the building as appropriate.
Observations:
Name: MAIN BUILDING 01 - Component: 01 - Tag: 0161

Based on observation and interview, it was determined that the facility failed to maintain the building construction type on one of two levels.

Findings include:

Observation on May 10, 2022, at 9:36 a.m., revealed the basement main storage area had an unsealed penetration around a four-inch sprinkler pipe in the rated ceiling assembly.

Interview with the maintenance supervisor on May 10, 2022, at 9:36 a.m., confirmed the basement main storage room had an unsealed penetration in the ceiling.





 Plan of Correction - To be completed: 06/30/2022

Failure to maintain fire separation in basement main storage area rated ceiling assembly will be repaired. Environmental services staff will use an approved fire stop compound to seal sprinkler pipe penetration to ensure rated ceiling assembly.
Environmental Director or designee will review during Safety rounds and report at the monthly QAPI meeting.



NFPA 101 STANDARD Exit Signage:Least serious deficiency but affects more than a limited number of residents, staff, or occurrences. This deficiency has the potential for causing no more than a minor negative impact on the resident but is 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 observation and interview, it was determined that the facility failed to meet requirements for exit sign lighting for one of over twenty exit lights.

Findings include:

Observation on May 10, 2022, at 9:41 a.m., revealed the exit sign at the back basement door to the stairway was not illuminated at the time of the survey.

Interview with the maintenance supervisor on May 10, 2022, at 9:41 a.m., confirmed the exit sign to the basement stairway was not illuminated at the time of the survey.





 Plan of Correction - To be completed: 07/05/2022

Failure to meet exit sign lighting requirement shall be met. The exit sign at rear basement exit door will be replaced to ensure illumination.
Environmental Director or designee will review during Safety rounds and will report at the monthly QAPI meeting.

NFPA 101 STANDARD Hazardous Areas - Enclosure:This is a less serious (but not lowest level) deficiency and is isolated to the fewest 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.
Hazardous Areas - Enclosure
Hazardous areas are protected by a fire barrier having 1-hour fire resistance rating (with 3/4 hour fire rated doors) or an automatic fire extinguishing system in accordance with 8.7.1 or 19.3.5.9. When the approved automatic fire extinguishing system option is used, the areas shall be separated from other spaces by smoke resisting partitions and doors in accordance with 8.4. Doors shall be self-closing or automatic-closing and permitted to have nonrated or field-applied protective plates that do not exceed 48 inches from the bottom of the door.
Describe the floor and zone locations of hazardous areas that are deficient in REMARKS.
19.3.2.1, 19.3.5.9

Area Automatic Sprinkler Separation N/A
a. Boiler and Fuel-Fired Heater Rooms
b. Laundries (larger than 100 square feet)
c. Repair, Maintenance, and Paint Shops
d. Soiled Linen Rooms (exceeding 64 gallons)
e. Trash Collection Rooms
(exceeding 64 gallons)
f. Combustible Storage Rooms/Spaces
(over 50 square feet)
g. Laboratories (if classified as Severe
Hazard - see K322)
Observations:
Name: MAIN BUILDING 01 - Component: 01 - Tag: 0321

Based on observation and interview, it was determined that the facility failed to maintain hazardous areas for one of five smoke compartments.

Findings include:

Observation on May 10, 2022, at 9:23 a.m., revealed the C-Wing, above the laundry room entrance, had unsealed penetrations around two sections of pipe that were protruding through the rated wall assembly.

Interview with the maintenance supervisor on May 10, 2022, at 9:23 a.m., confirmed the above penetrations existed.








 Plan of Correction - To be completed: 06/30/2022

Failure to maintain hazardous area in one smoke compartment will be repaired. C- wing Hallway ceiling outside laundry entry will have an approved fire stop compound applied by environmental staff to seal penetrations around two sections of pipe in the rated wall assembly.
Environmental Director or designee will review during Safety rounds and will report at the monthly QAPI meeting.

NFPA 101 STANDARD Sprinkler System - Maintenance and Testing:This is a less serious (but not lowest level) deficiency and is isolated to the fewest 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.
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 that the facility failed to meet requirements for one of two sprinkler systems.

Findings include:

1. Document review on May 10, 2022, at 8:25 a.m., revealed the last four quarterly sprinkler inspection deficiency lists noted that the three-year air leakage test had not been completed.

Interview with the maintenance supervisor on May 10, 2022, at 8:25 a.m., confirmed the three-year air leakage test had not been completed at the time of the survey.

2.Observation on May 10, 2022, at 9:03 a.m., revealed the A-Wing, resident room 22, had a missing escutcheon plate, which created a gap in the ceiling, potentially causing a delay in sprinkler activation.

Interview with the maintenance supervisor on May 10, 2022, at 9:03 a.m., confirmed the above sprinkler escutcheon plate was missing.





 Plan of Correction - To be completed: 06/30/2022

Failure to meet requirements for Fire Sprinkler will be corrected.
1. Our outside Fire Sprinkler contractor will complete the three-year air leakage test and provide documentation for our records.
2. A- Wing, resident room 22, will have the escutcheon plate repaired by our outside Fire Sprinkler contractor to ensure safe operation of the Fire Sprinkler system.

Environmental Director or designee will review during Safety rounds and will report at the monthly QAPI meeting.


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