Pennsylvania Department of Health
MAPLE FARM
Building Inspection Results

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Severity Designations


Minimal Citation - No Harm	Minimal Harm	Actual Harm	Serious Harm

There are 32 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.


MAPLE FARM - 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 April 24, 2024, at Maple Farm, it was determined there were no deficiencies identified with the requirements of 42 CFR 483.73.

Plan of Correction:

Initial comments:Name: MAIN BLDG - Component: 01 - Tag: 0000

Facility ID #22720201
Component 01
Main Building

Based on a Medicare/Medicaid Recertification Survey completed on April 23, 2024, it was determined that Maple Farm 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 structure, with a basement, which is fully sprinklered.

Plan of Correction:

NFPA 101 STANDARD Doors with Self-Closing Devices:

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.

Doors with Self-Closing Devices
Doors in an exit passageway, stairway enclosure, or horizontal exit, smoke barrier, or hazardous area enclosure are self-closing and kept in the closed position, unless held open by a release device complying with 7.2.1.8.2 that automatically closes all such doors throughout the smoke compartment or entire facility upon activation of:
* Required manual fire alarm system; and
* Local smoke detectors designed to detect smoke passing through the opening or a required smoke detection system; and
* Automatic sprinkler system, if installed; and
* Loss of power.
18.2.2.2.7, 18.2.2.2.8, 19.2.2.2.7, 19.2.2.2.8

Observations:
Name: MAIN BLDG - Component: 01 - Tag: 0223

Based on observation and interview, it was determined the facility failed to maintain the rated horizontal fire doors, to close and latch within the frame, in two of seven smoke compartments within the component.
Findings include:
1. Observation on April 23, 2024, at 12:00 PM, revealed the Oxygen Storage Room's horizontal fire-rated access door failed to self-close and latch in the frame, due to inoperable springs and broken left latch assembly.

Interview at the time of the exit conference with the Administrator and Director of Environmental Services on April 23, 2024, at 1:00 PM, confirmed the horizontal fire-rated access door would not self-close and latch.

Plan of Correction - To be completed: 06/21/2024

Oxygen Room Storage horizontal access door will be replaced by contracted door service.

The Director of Facility Services will educate Maintenance staff on maintaining rated horizontal fire doors.

Maintenance staff will complete random audits of facility rated horizontal fire doors to ensure they properly latch weekly for 4 weeks, monthly for 2 months and quarterly thereafter. Results of the audits will be reported to the QAPI Committee.

NFPA 101 STANDARD Number of Exits - Patient Sleeping and Non-Sl:

Number of Exits - Patient Sleeping and Non-Sleeping Rooms
Patient sleeping rooms of more than 1,000 square feet or nonsleeping rooms of more than 2,500 square feet have at least two exit access doors remotely located from each other.
18.2.5.5.1, 18.2.5.5.2, 19.2.5.5.1, 19.2.5.5.2

Observations:
Name: MAIN BLDG - Component: 01 - Tag: 0253

Based on observation and interview, it was determined the facility failed to maintain the automatic sprinkler piping system, to be free of extraneous weight, affecting two of three smoke zones within the component.

Findings include:

1. Observation on April 23, 2024, between 12:05 AM and 12:35 PM, revealed items were being supported by the sprinkler piping system, at the following locations:

a. 12:05 AM, Main Street Hall, attic, throughout, multiple types of wires, flex conduit and flex ducting;
b. 12:35 AM, Brossman Hall, attic, throughout, multiple types of wires, flex conduit and flex ducting.

Interview at the time of the exit conference with the Administrator and Director of Environmental Services on April 23, 2024, at 1:00 PM, confirmed various items laying across automatic sprinkler pipes.

Plan of Correction - To be completed: 06/21/2024

The Maintenance Staff will remove wires, flex conduit and flex ducting from sprinkler piping system.

The Director of Facility Services will educate Maintenance staff on maintaining sprinkler piping system to ensure that it is free of extraneous weight.

Maintenance staff will complete random audits of the facility automatic sprinkler piping system to ensure that they are free of extraneous weight weekly for 4 weeks, monthly for 2 months and quarterly thereafter. Results of the audits will be reported to the QAPI Committee.

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