Pennsylvania Department of Health
PREMIER WASHINGTON REHABILITATION AND NURSING CENTER
Building Inspection Results

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Severity Designations


Minimal Citation - No Harm	Minimal Harm	Actual Harm	Serious Harm

There are 54 surveys for this facility. Please select a date to view the survey results.

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PREMIER WASHINGTON REHABILITATION AND NURSING 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 April 14-15, 2025, at Premier Washington Rehabilitation and Nursing 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# 751102
Component 01
Main Building

Based on a Medicare/Medicaid Recertification Survey completed on April 14-15, 2025, it was determined that Premier Washington Rehabilitation and Nursing 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 (111), protected noncombustible building, with a basement, that is fully sprinklered.

Plan of Correction:

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 the facility failed to maintain hazardous area enclosures in one instance, affecting 1 of 15 smoke compartments.

Findings include:

1. Observation on April 14, 2025, at 11:30 a.m., revealed the door to a storage room, in the Inventory Control room, was secured open with a rope/string, and was unable to close and latch.

Interview with the Assistant Facility Administrator and Maintenance Director on April 15, 2025, at 1:30 p.m., confirmed the listed hazardous area enclosure deficiency.

Plan of Correction - To be completed: 05/28/2025

Inventory control room door was open with a rope/string, and was unable to close and latch. The rope/string was removed from the door and closed properly.

Maintenance audited throughout the facility with no other door issues found

Education to be completed with all maintenance staff making sure all doors are closed properly throughout the facility.

Audits will be completed by maintenance to ensure all doors are not propped open and closed properly, Weekly X4 weeks and monthly X 2. All audits will be reported to QAPI.

NFPA 101 STANDARD Sprinkler System - Maintenance and Testing:

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 observation and interview, it was determined the facility failed to maintain the automatic sprinkler system in two instances, affecting two of 15 smoke compartments.

Findings include:

1. Observation on April 14, 2025, revealed the following automatic sprinkler deficiencies:

a) 9:25 a.m., there was a gap larger than 1/8 inch around two sprinkler heads with escutcheons, in a storage room inside the Inventory Control room;
b) 9:55 a.m., there was ceiling tile track hangar wire attached to a sprinkler branch line, above the smoke doors near the 2 South Supervisor's office.

Interview with the Assistant Facility Administrator and Maintenance Director on April 15, 2025, at 1:30 p.m., confirmed the automatic sprinkler system deficiencies.

Plan of Correction - To be completed: 05/28/2025

Large gap around two sprinkler pipes with escutcheons in the inventory control storage room. Ceiling hanger wire attached to sprinkler branch line above smoke door near 2 south supervisors office. Maintenance adjusted hanger in ceiling to raise the sprinkler head and escutcheon closer to the ceiling tile and replaced the ceiling tile. Maintenance removed hanger from sprinkler.

Maintenance conducted audit of facility with no other issues with sprinklers or escutcheons

The maintenance department will be educated on Sprinkler system compliance

Audits will be completed by maintenance to ensure sprinkler system is in compliance, Weekly X4 weeks and monthly X 2. All audits will be reported to QAPI.

NFPA 101 STANDARD Portable Fire Extinguishers:

Portable Fire Extinguishers
Portable fire extinguishers are selected, installed, inspected, and maintained in accordance with NFPA 10, Standard for Portable Fire Extinguishers.
18.3.5.12, 19.3.5.12, NFPA 10

Observations:
Name: MAIN BUILDING 01 - Component: 01 - Tag: 0355

Based on observation and interview, it was determined the facility failed to maintain fire extinguishers in one instance, out of over 30 checked.

Findings include:

1. Observation on April 14, 2025, at 10:20 a.m., revealed the inspection tag on the fire extinguisher in the 2 core staff break room did not have the annual inspection.

Interview with the Facility Administrator and Maintenance Director on April 15, 2025, at 1:30 p.m., confirmed the portable fire extinguisher did not have the required annual inspection.

Plan of Correction - To be completed: 05/28/2025

Inspection tag on the fire extinguisher in the 2 core breakroom did not have the annual inspection. Maintenance has ordered new fire extinguishers through Johnson Controls to be delivered.

Maintenance conducted audit of all fire extinguishers in the facility with no other issues found

Maintenance to be educated on compliance for all fire extinguishers

Audits will be completed by maintenance to ensure all fire extinguishers are within compliance, Weekly X4 weeks and monthly X 2. All audits will be reported to QAPI.

NFPA 101 STANDARD Electrical Systems - Other:

Electrical Systems - Other
List in the REMARKS section any NFPA 99 Chapter 6 Electrical Systems 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 6 (NFPA 99)

Observations:
Name: MAIN BUILDING 01 - Component: 01 - Tag: 0911

Based on observation and interview, it was determined the facility failed to maintain electrical wiring in one instance, in one of 15 smoke compartments. Installation shall be in accordance with NFPA 70, National Electric Code. 19.5.1.1, NFPA 101 (2012).

Findings include:

1. Observation on April 14, 2025, at 10:17 a.m., revealed an open electrical junction box on the ceiling of the transfer switch room.

Interview with the Facility Administrator and Maintenance Director on April 15, 2025, at 1:30 p.m., confirmed the open electrical junction box.

Plan of Correction - To be completed: 05/28/2025

An open electrical junction box on the ceiling of the transfer switch room was identified. The cover for the box was immediately put back on

Maintenance completed an audit throughout the facility with no other junction box issues

The maintenance department will be educated to make sure all junction boxes are covered

Audits will be completed by maintenance to ensure all junction boxes are covered, Weekly X4 weeks and monthly X 2. All audits will be reported to QAPI

NFPA 101 STANDARD Electrical Equipment - Power Cords and Extens:

Electrical Equipment - Power Cords and Extension Cords
Power strips in a patient care vicinity are only used for components of movable patient-care-related electrical equipment (PCREE) assembles that have been assembled by qualified personnel and meet the conditions of 10.2.3.6. Power strips in the patient care vicinity may not be used for non-PCREE (e.g., personal electronics), except in long-term care resident rooms that do not use PCREE. Power strips for PCREE meet UL 1363A or UL 60601-1. Power strips for non-PCREE in the patient care rooms (outside of vicinity) meet UL 1363. In non-patient care rooms, power strips meet other UL standards. All power strips are used with general precautions. Extension cords are not used as a substitute for fixed wiring of a structure. Extension cords used temporarily are removed immediately upon completion of the purpose for which it was installed and meets the conditions of 10.2.4.
10.2.3.6 (NFPA 99), 10.2.4 (NFPA 99), 400-8 (NFPA 70), 590.3(D) (NFPA 70), TIA 12-5

Observations:
Name: MAIN BUILDING 01 - Component: 01 - Tag: 0920

Based on observation and interview, it was determined the facility failed to maintain electrical power cords and extension cords, affecting two of 15 smoke compartments.

Findings include:

1. Observation on April 15, 2025, revealed the following electrical equipment defciencies:

a) 9:18 a.m., there was a microwave plugged into an extension cord in the second floor Supervisor's office;
b) 9:35 a.m., there was a coffee pot and microwave plugged into a power strip in the Pharmacy break room..

Interview with the Assistant Facility Administrator and Maintenance Supervisor on April 15, 2025, at 1:30 p.m., confirmed the electrical power strip deficiencies.

Plan of Correction - To be completed: 05/28/2025

Appliances cited were removed from power strip to an appropriate outlet

Maintenance completed audit with no other issues with power strips were identified in the facility

Maintenance staff in serviced on what can and can't be plugged into a power strip.

Audits will be completed by maintenance to ensure all power strips are used properly, Weekly X4 weeks and monthly X 2. All audits will be reported to QAPI

Initial comments:Name: BUILDING 02 - Component: 02 - Tag: 0000

Facility ID# 751102
Component 02
West Wing - Alzheimer Unit

Based on a Medicare/Medicaid Recertification Survey completed on April 14-15, 2025, at Premier Washington Rehabilitation and Nursing Center, it was determined there were no deficiencies identified under 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 II (000) unprotected noncombustible building, without a basement, that is fully sprinklered.

Plan of Correction:

Initial comments:Name: A0303 - Component: 03 - Tag: 0000

Facility ID# 751102
Component 03
Activities Room

Based on a Medicare/Medicaid Recertification Survey completed on April 14-15, 2025, at Premier Washington Rehabilitation and Nursing Center, it was determined there were no deficiencies identified under 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 II (111) protected noncombustible building, without a basement, that is fully sprinklered.

Plan of Correction:

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