Pennsylvania Department of Health
FAIRVIEW MANOR
Building Inspection Results

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Severity Designations


Minimal Citation - No Harm	Minimal Harm	Actual Harm	Serious Harm

There are 39 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.


FAIRVIEW MANOR - 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 15, 2025, at Fairview Manor, 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 #320802
Component 01
Main Building

Based on a Medicare/Medicaid Recertification Survey completed on April 15, 2025, it was determined that Fairview Manor 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 V (111), protected, wood frame building, with a partial basement, that is fully sprinklered.

Plan of Correction:

NFPA 101 STANDARD Sprinkler System - 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.

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, the facility failed to maintain sprinkler system regulations for one of one building component.

Findings include:

Document review on April 15, 2025, at 11:45 a.m., revealed the sprinkler inspection report, dated April 1, 2025, listed a deficiency (#2 OSY valve packing leaking) that was not corrected at the time of the survey.

Interview with the maintenance manager on April 15, 2025, at 11:45 a.m., confirmed the sprinkler deficiency was not corrected at the time of the survey.

Plan of Correction - To be completed: 05/26/2025

0291 NFPA 101 STANDARD
Sprinkler System: Maintenance and Testing
Name - MAIN BUILDING 01 Component - 01
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.

NHA/Designee to provide documentation of repair/ replacement of #2 OSY Valve packing leak.

NHA/Designee will ensure automatic sprinkler and standpipe systems are inspected, tested, and maintained in accordance with NFPA 25.

NHA/ Designee has scheduled the replacement of OSY Valve to be completed by contracted vendor. NHA/ Designee will provide documentation of repair.

All audits and inspections will be reviewed by the QAPI committee for review and recommendations as needed. Substantial compliance will be achieved on or before 5/26/25.

NFPA 101 STANDARD Electrical Systems - Receptacles:

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.

Electrical Systems - Receptacles
Power receptacles have at least one, separate, highly dependable grounding pole capable of maintaining low-contact resistance with its mating plug. In pediatric locations, receptacles in patient rooms, bathrooms, play rooms, and activity rooms, other than nurseries, are listed tamper-resistant or employ a listed cover.
If used in patient care room, ground-fault circuit interrupters (GFCI) are listed.
6.3.2.2.6.2 (F), 6.3.2.2.4.2 (NFPA 99)

Observations:
Name: MAIN BUILDING 01 - Component: 01 - Tag: 0912

Based on observation and interview, the facility failed to maintain electrical receptacles for ten of more than fifty receptacles.

Findings include:

Observation on April 15, 2025, between 10:23 a.m. and 11:44 a.m., revealed the facility failed to ensure ground fault circuit interrupter (GFCI) protection in the following areas:
1. (10:23 a.m.) Cafnear the D wing entrance, coffee and juice machine receptacles;
2. (10:32 a.m.) D wing soiled utility room, receptacle within six feet of a sink;
3. (10:44 a.m.) C-D wings, ice machine receptacles;
4. (10:51 a.m.) C wing soiled utility room, receptacle within six feet of a sink;
5. (11:05 a.m.) B wing soiled utility room, receptacle within six feet of a sink;
6. (11:11 a.m.) B wing dining room, coffee pot and ice machine receptacles;
7. (11:13 a.m.) A wing dining room, coffee pot receptacle;
8. (11:15 a.m.) A wing soiled utility room, receptacle within six feet of a sink;
9. (11:25 a.m.) A wing resident laundry room, washing machine receptacle;
10. (11:44 a.m.) Physical therapy room, clothes washing machine receptacle.

Interview with the maintenance supervisor on April 15, 2025, at 11:44 a.m., confirmed the electrical outlet deficiencies.

Plan of Correction - To be completed: 05/26/2025

0912 NFPA 101 STANDARD
Electrical Systems - Receptacles
Name - MAIN BUILDING 01
Electrical Systems – Receptacles. Power receptacles have at least one, separate, highly dependable grounding pole capable of maintaining low-contact resistance with its mating plug. In pediatric locations, receptacles in patient rooms, bathrooms, playrooms, and activity rooms, other than nurseries, are listed tamper-resistant or employ a listed cover. If used in patient care room, ground-fault circuit interrupters (GFCI) are listed.
All non-compliant receptacles identified during the inspection will be replaced with GFCI grounded and labeled receptacles.
Nursing Home Administrator or designee will schedule replacement work is completed by an approved electrician.
Nursing Home Administrator/ Environmental services Supervisor will review work order upon completion to ensure that deficiencies have been addressed according NFPA 101 standards
All audits will be reviewed by the QAPI committee for review and recommendations as needed. Substantial compliance will be achieved on or before 5/26/25.

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