Pennsylvania Department of Health
SUNBURY SKILLED NURSING AND REHABILITATION CENTER
Building Inspection Results

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Severity Designations


Minimal Citation - No Harm	Minimal Harm	Actual Harm	Serious Harm

There are 41 surveys for this facility. Please select a date to view the survey results.

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SUNBURY SKILLED NURSING AND REHABILITATION 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 July 22, 2024, at Sunbury Skilled 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# 123302
Component 01
Main Building

Based on a Medicare/Medicaid Recertification Survey completed on July 22, 2024, it was determined that Sunbury Skilled 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 483.90(a).

This is a three story, Type II (000), unprotected, noncombustible building that is fully sprinklered.

Plan of Correction:

NFPA 101 STANDARD Building Construction Type and Height:

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.

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 the facility failed to meet building construction requirements, affecting three of three floors.

Findings include:

1. Observation on July 22, 2024, at 12:00 p.m., revealed the facility exceeded the maximum allowable story height for the type of building construction.

Exit interview with the facility administrator and the facility maintenance director on July 22, 2024, at 1:25 p.m., confirmed the building construction deficiency.

Plan of Correction - To be completed: 08/29/2024

The statements made on this plan of correction are not an admission to and do not constitute an agreement with the alleged deficiencies herein.

To remain in compliance with all federal and state regulations the center has taken or will take the actions set forth in the following plan of correction. The following plan of correction constitutes the center's allegation of compliance. All alleged deficiencies have been or will be corrected by the date or dates indicated.

0161

Facility requests DSI to conduct a Fire Safety Evaluation System (FSES).

NFPA 101 STANDARD Hazardous Areas - Enclosure:

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.

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 the facility failed to maintain one hazardous area enclosure, affecting one of three floors.

Findings include:

1. Observation on July 22, 2024, at 12:22 p.m., revealed holes were located within the first floor, Storage Room door.

Exit interview with the facility administrator and the facility maintenance director on July 22, 2024, at 1:25 p.m., confirmed the hazardous area enclosure deficiency.

Plan of Correction - To be completed: 08/29/2024

0321

1. The holes present on the first floor storage room door have been appropriately sealed.

2. The maintenance director/designee will complete random audits monthly for two months to validate that room doors are sealed properly. Date of compliance August 29, 2024.

NFPA 101 STANDARD Cooking Facilities:

Cooking Facilities
Cooking equipment is protected in accordance with NFPA 96, Standard for Ventilation Control and Fire Protection of Commercial Cooking Operations, unless:
* residential cooking equipment (i.e., small appliances such as microwaves, hot plates, toasters) are used for food warming or limited cooking in accordance with 18.3.2.5.2, 19.3.2.5.2
* cooking facilities open to the corridor in smoke compartments with 30 or fewer patients comply with the conditions under 18.3.2.5.3, 19.3.2.5.3, or
* cooking facilities in smoke compartments with 30 or fewer patients comply with conditions under 18.3.2.5.4, 19.3.2.5.4.
Cooking facilities protected according to NFPA 96 per 9.2.3 are not required to be enclosed as hazardous areas, but shall not be open to the corridor.
18.3.2.5.1 through 18.3.2.5.4, 19.3.2.5.1 through 19.3.2.5.5, 9.2.3, TIA 12-2

Observations:
Name: MAIN BUILDING 01 - Component: 01 - Tag: 0324

Based on observation and interview, it was determined the facility failed to maintain cooking facilities in one location, affecting one of three floors.

Findings include:

1. Observation on July 22, 2024, at 12:12 p.m., revealed the K-Type fire extinguisher, located within the Dietary department, lacked signage that states that the ansul system should be engaged before using the fire extinguisher.

Exit interview with the facility administrator and the facility maintenance director on July 22, 2024, at 1:25 p.m., confirmed the cooking facilities deficiency.

Plan of Correction - To be completed: 08/29/2024

0324

1. Appropriate signage was placed near the K-Type fire extinguisher located in the Kitchen.

2. The maintenance director/designee will complete random audits monthly for two months to validate that fire extinguishers have appropriate signage present. Date of compliance August 29, 2024.

NFPA 101 STANDARD Subdivision of Building Spaces - Smoke Barrie:

Subdivision of Building Spaces - Smoke Barrier Doors
2012 EXISTING
Doors in smoke barriers are 1-3/4-inch thick solid bonded wood-core doors or of construction that resists fire for 20 minutes. Nonrated protective plates of unlimited height are permitted. Doors are permitted to have fixed fire window assemblies per 8.5. Doors are self-closing or automatic-closing, do not require latching, and are not required to swing in the direction of egress travel. Door opening provides a minimum clear width of 32 inches for swinging or horizontal doors.
19.3.7.6, 19.3.7.8, 19.3.7.9

Observations:
Name: MAIN BUILDING 01 - Component: 01 - Tag: 0374

Based on observation and interview, it was determined the facility failed to maintain one smoke barrier separation door, affecting one of three floors.

Findings include:

1. Observation on July 22, 2024, at 11:41 a.m., revealed the third floor, smoke barrier separation door did not fully close, nor latch.

Exit interview with the facility administrator and the facility maintenance director on July 22, 2024, at 1:25 p.m., confirmed the smoke barrier separation door deficiency.

Plan of Correction - To be completed: 08/29/2024

0374

1. The third floor smoke barrier separation door will be updated to ensure it fully closes and latches.

2. The maintenance director/designee will complete random audits monthly for two months to validate that smoke barrier doors are closing and latching appropriately. Date of compliance August 29, 2024.

NFPA 101 STANDARD HVAC:

HVAC
Heating, ventilation, and air conditioning shall comply with 9.2 and shall be installed in accordance with the manufacturer's specifications.
18.5.2.1, 19.5.2.1, 9.2

Observations:
Name: MAIN BUILDING 01 - Component: 01 - Tag: 0521

Based on documentation review and interview, it was determined the facility failed to maintain heating, ventilation and air conditioning in multiple instances, affecting three of three floors.

Findings include:

1. Observation on July 22, 2024, at 12:42 p.m., revealed fire damper fusible links were not removed, nor were fire dampers exercised during the inspection of October 9, 2022. In addition, neither the location of fire dampers, nor the number of fire dampers included in the inspection were mentioned.

Exit interview with the facility administrator and the facility maintenance director on July 22, 2024, at 1:25 p.m., confirmed the HVAC deficiency.

Plan of Correction - To be completed: 08/29/2024

0521

1. Facility will schedule an additional inspection for the fire dampers.

2. The maintenance director/designee will ensure an accurate inspection is completed annually.

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