Pennsylvania Department of Health
WILLIAMSPORT HOME, THE
Building Inspection Results

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WILLIAMSPORT HOME, THE
Inspection Results For:

There are  55 surveys for this facility. Please select a date to view the survey results.

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WILLIAMSPORT HOME, THE - 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 February 13, 2024, at The Williamsport Home, 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 491902
Component 01
Main Building


Based on a Medicare/Medicaid Recertification Survey completed on February 13, 2024, it was determined that The Williamsport Home 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 two story, Type II (000), unprotected, noncombustible building, that is fully sprinklered.






 Plan of Correction:


NFPA 101 STANDARD Emergency Lighting: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.
Emergency Lighting
Emergency lighting of at least 1-1/2-hour duration is provided automatically in accordance with 7.9.
18.2.9.1, 19.2.9.1
Observations:
Name: MAIN BUILDING 01 - Component: 01 - Tag: 0291

Based on documentation review and interview, it was determined the facility failed to maintain emergency lighting, affecting two of two floors.

Findings include:

1. Observation on February 13, 2024, at 12:03 p.m., revealed the facility lacked yearly, ninety minute bleed or drain testing data of the emergency lighting fixture.

Exit interview on February 13, 2024, between 12:15 p.m., and 12:30 p.m., with the Facility Administrator and the Facilities Manager, confirmed the emergency lighting deficiency.




 Plan of Correction - To be completed: 03/08/2024

This plan of correction is prepared and executed because it is required by the provisions of the state and federal regulations and not because The Williamsport Home agrees with the allegations and citations listed on the statement of deficiencies. The Williamsport Home maintains that the alleged deficiencies do not, individually, and collectively, jeopardize the health and safety of the residents, nor are they of such character as to limit our capacity to render adequate care as prescribed by regulation. This plan of correction shall operate as The Williamsport Home's written credible allegation of compliance. By submitting this plan of correction, The Williamsport Home does not admit to the accuracy of the deficiencies. This plan of correction is not meant to establish any standard of care, contract, obligation, or position, and The Williamsport Home reserves all rights to raise all possible contentions and defenses in any civil or criminal claim, action or proceeding.

1. The facility cannot retroactively correct this finding.

2. A new checklist was created, and a 90-minute emergency lighting test will be completed by February 27th.

3.The Nursing Home Administrator will conduct training/education with all maintenance personnel regarding the requirements of K0291on 2/26/2024.

4. An audit of the next 90-minute lighting tests will be completed by the Maintenance Director or designee, and the results will be taken to monthly QA by the Maintenance Director for review.

NFPA 101 STANDARD Exit Signage: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.
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 the facility failed to maintain exit signage in two locations, affecting one of two floors.

Findings include:

1. Observation on February 13, 2024, between 10:22 a.m., and 11:02 a.m., revealed the following:

a. 10:22 a.m.,the exit sign, located within the first floor portion of the 200-400 Hall stair tower enclosure, lacked a chevron, directing stair tower occupants to the exit discharge door.
b. 11:02 a.m., the Activities Room exit discharge door lacked exit signage.

Exit interview on February 13, 2024, between 12:15 p.m., and 12:30 p.m., with the Facility Administrator and the Facilities Manager, confirmed the exit sign deficiencies.



 Plan of Correction - To be completed: 03/08/2024

This plan of correction is prepared and executed because it is required by the provisions of the state and federal regulations and not because The Williamsport Home agrees with the allegations and citations listed on the statement of deficiencies. The Williamsport Home maintains that the alleged deficiencies do not, individually, and collectively, jeopardize the health and safety of the residents, nor are they of such character as to limit our capacity to render adequate care as prescribed by regulation. This plan of correction shall operate as The Williamsport Home's written credible allegation of compliance. By submitting this plan of correction, The Williamsport Home does not admit to the accuracy of the deficiencies. This plan of correction is not meant to establish any standard of care, contract, obligation, or position, and The Williamsport Home reserves all rights to raise all possible contentions and defenses in any civil or criminal claim, action or proceeding.

1. The chevron was corrected on 2/14/2024.

2. A full house audit will be conducted 2/28/2024 by maintenance personnel on all exit signs to ensure that the arrows are pointed in the correct and accurate direction.

3. The Nursing Home Administrator will conduct training/education with maintenance personnel regarding the requirement of K0293 on 2/26/2024.

4. An audit on exit signs will be conducted weekly x 2 and then monthly x 2 by the Maintenance Director or designee. The results of the audit will be taken to monthly QA by the Maintenance Director for review.

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 two floors.

Findings include:

1. Observation on February 13, 2024, at 10:33 a.m., revealed the 215 Lounge door lacked a self-closing device (storage within).

Exit interview on February 13, 2024, between 12:15 p.m., and 12:30 p.m., with the Facility Administrator and the Facilities Manager, confirmed the hazardous area enclosure deficiency.



 Plan of Correction - To be completed: 03/08/2024

This plan of correction is prepared and executed because it is required by the provisions of the state and federal regulations and not because The Williamsport Home agrees with the allegations and citations listed on the statement of deficiencies. The Williamsport Home maintains that the alleged deficiencies do not, individually, and collectively, jeopardize the health and safety of the residents, nor are they of such character as to limit our capacity to render adequate care as prescribed by regulation. This plan of correction shall operate as The Williamsport Home's written credible allegation of compliance. By submitting this plan of correction, The Williamsport Home does not admit to the accuracy of the deficiencies. This plan of correction is not meant to establish any standard of care, contract, obligation, or position, and The Williamsport Home reserves all rights to raise all possible contentions and defenses in any civil or criminal claim, action or proceeding.

1. A self-closing door closure was ordered on 2/14/2024 and will be installed by 2/23/2024.

2. A full house audit was conducted on 2/22/2024 by the maintenance personnel to determine if there are any other self-closures that need to be installed.

3. The Nursing Home Administrator will conduct training/education with all maintenance personnel regarding the requirements of K0321 on 2/26/2024.

4. An audit will be conducted on any identified door needing self-closures weekly x 2 and then monthly x 2 by the Maintenance Director of designee. The results of the audit will be taken to monthly QA by the Maintenance Director for review.

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 documentation review and interview, it was determined the facility failed to maintain the automatic sprinkler system, affecting two of two floors.

Findings include:

1. Observation on February 13, 2024, at 11:55 a.m., revealed the facility lacked the following:

a. automatic sprinkler gauges, change or recalibration in the last five year period.
b. five year, internal valve inspection.
c. five year, internal pipe inspection.

Exit interview on February 13, 2024, between 12:15 p.m., and 12:30 p.m., with the Facility Administrator and the Facilities Manager, confirmed the automatic sprinkler system deficiency.



 Plan of Correction - To be completed: 03/08/2024

This plan of correction is prepared and executed because it is required by the provisions of the state and federal regulations and not because The Williamsport Home agrees with the allegations and citations listed on the statement of deficiencies. The Williamsport Home maintains that the alleged deficiencies do not, individually, and collectively, jeopardize the health and safety of the residents, nor are they of such character as to limit our capacity to render adequate care as prescribed by regulation. This plan of correction shall operate as The Williamsport Home's written credible allegation of compliance. By submitting this plan of correction, The Williamsport Home does not admit to the accuracy of the deficiencies. This plan of correction is not meant to establish any standard of care, contract, obligation, or position, and The Williamsport Home reserves all rights to raise all possible contentions and defenses in any civil or criminal claim, action or proceeding.

1. The documentation for the inspections was found and sent via email to the life safety representative on 2/20/2024. The facility is in compliance with K0353. The inspection was completed within the 5-year time frame, the next inspection is due by November of 2024.

2. No auditing will need to be completed. Information for inspections will be placed in a binder.

3. The Nursing Home Administrator will work with the Maintenance Director to ensure that the inspection coming due is completed in the required time.

4. No auditing will need to be completed.

NFPA 101 STANDARD HVAC: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.
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 observation and interview, it was determined the facility failed to maintain HVAC in one location, affecting one of two floors.

Findings include:

1. Observation on February 13, 2024, at 11:50 a.m., revealed the fire damper, located within the first floor portion of the HVAC shaft, located closest to the 100 Hallway stair tower, lacked a fusible link, and was propped in the "open" position with two pieces of wood.

Exit interview on February 13, 2024, between 12:15 p.m., and 12:30 p.m., with the Facility Administrator and the Facilities Manager, confirmed the HVAC deficiency.




 Plan of Correction - To be completed: 03/08/2024

This plan of correction is prepared and executed because it is required by the provisions of the state and federal regulations and not because The Williamsport Home agrees with the allegations and citations listed on the statement of deficiencies. The Williamsport Home maintains that the alleged deficiencies do not, individually, and collectively, jeopardize the health and safety of the residents, nor are they of such character as to limit our capacity to render adequate care as prescribed by regulation. This plan of correction shall operate as The Williamsport Home's written credible allegation of compliance. By submitting this plan of correction, The Williamsport Home does not admit to the accuracy of the deficiencies. This plan of correction is not meant to establish any standard of care, contract, obligation, or position, and The Williamsport Home reserves all rights to raise all possible contentions and defenses in any civil or criminal claim, action or proceeding.

1. The wood was removed to ensure that the fire damper was not stuck in the open position.

2. A full house audit will be conducted on 3/5/2024 by maintenance personnel to identify any other propped open areas. Any issues identified will be promptly fixed.

3. The Nursing Home Administrator will conduct training/education with all maintenance personnel regarding the requirements of K0521 on 2/26/2024.

4. An audit will be conducted to monitor for any propped areas weekly x 2 and then monthly x 2 by the Maintenance Director or designee. The results of the audit will be taken to monthly QA by the Maintenance Director for review.

NFPA 101 STANDARD Fire Drills: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.
Fire Drills
Fire drills include the transmission of a fire alarm signal and simulation of emergency fire conditions. Fire drills are held at expected and unexpected times under varying conditions, at least quarterly on each shift. The staff is familiar with procedures and is aware that drills are part of established routine. Where drills are conducted between 9:00 PM and 6:00 AM, a coded announcement may be used instead of audible alarms.
19.7.1.4 through 19.7.1.7
Observations:
Name: MAIN BUILDING 01 - Component: 01 - Tag: 0712


Based on documentation review and interview, it was determined the facility failed to conduct fire drills in two instances, affecting two of two floors.

Findings include:

1. Observation on February 13, 2024, at 12:01 p.m., revealed the facility lacked a first shift fire drill, for the second quarter of 2023, as well as a second shift fire drill for the third quarter of 2023.

Exit interview on February 13, 2024, between 12:15 p.m., and 12:30 p.m., with the Facility Administrator and the Facilities Manager, confirmed the fire drill deficiencies.




 Plan of Correction - To be completed: 03/08/2024

This plan of correction is prepared and executed because it is required by the provisions of the state and federal regulations and not because The Williamsport Home agrees with the allegations and citations listed on the statement of deficiencies. The Williamsport Home maintains that the alleged deficiencies do not, individually, and collectively, jeopardize the health and safety of the residents, nor are they of such character as to limit our capacity to render adequate care as prescribed by regulation. This plan of correction shall operate as The Williamsport Home's written credible allegation of compliance. By submitting this plan of correction, The Williamsport Home does not admit to the accuracy of the deficiencies. This plan of correction is not meant to establish any standard of care, contract, obligation, or position, and The Williamsport Home reserves all rights to raise all possible contentions and defenses in any civil or criminal claim, action or proceeding.

1. The facility is not able to retroactively correct the missed fire drills.

2. An audit of the fire drills was completed on 2/21/2024 by the Nursing Home Administrator for the past one year to determine the cause of the missing fire drills. A new process will be initiated to ensure fire drills meet regulation K0712.

3. The Nursing Home Administrator will conduct training/education with all maintenance personnel regarding the requirements of K0712 on 2/26/2024.

4. The fire drills will be brought to monthly QA by the Maintenance Director or designee.

NFPA 101 STANDARD Electrical Systems - Other: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.
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 systems in one location, affecting one of two floors.

Findings include:

1. Observation on February 13, 2024, at 11:23 a.m., revealed errant wiring lacked a junction box, located beyond the suspended ceiling assembly, located closest to the stair tower door, within the second floor, 400 Hallway.

Exit interview on February 13, 2024, between 12:15 p.m., and 12:30 p.m., with the Facility Administrator and the Facilities Manager, confirmed the electrical systems deficiency.



 Plan of Correction - To be completed: 03/08/2024

This plan of correction is prepared and executed because it is required by the provisions of the state and federal regulations and not because The Williamsport Home agrees with the allegations and citations listed on the statement of deficiencies. The Williamsport Home maintains that the alleged deficiencies do not, individually, and collectively, jeopardize the health and safety of the residents, nor are they of such character as to limit our capacity to render adequate care as prescribed by regulation. This plan of correction shall operate as The Williamsport Home's written credible allegation of compliance. By submitting this plan of correction, The Williamsport Home does not admit to the accuracy of the deficiencies. This plan of correction is not meant to establish any standard of care, contract, obligation, or position, and The Williamsport Home reserves all rights to raise all possible contentions and defenses in any civil or criminal claim, action or proceeding.

1. The wires were eliminated on 2/14/2024.

2. Each hallway was audited on 2/14/2024 by the maintenance personnel to determine if there are any other exposed wires. Anything that is found will be corrected accordingly.

3. The Nursing Home Administrator will conduct training/education with all maintenance personnel regarding the requirements of 0911 on 2/26/2024.

4. An audit of wiring in each hallway will be conducted by the maintenance director or designee weekly x 2 and then monthly x 2. Results of the audit will be taken to monthly QA and reviewed.

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


Facility ID# 491902
Component 02
Sunshine Room

Based on a Medicare/Medicaid Recertification Survey completed on February 13, 2024, at The Williamsport Home, 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 483.70(a).

This is a one story, Type V (111), protected, wood frame building, that is fully sprinklered.







 Plan of Correction:


Initial comments:Name: NEW STR UNIT - Component: 03 - Tag: 0000


Facility ID# 491902
Component 03
Ravine Ridge

Based on a Medicare/Medicaid Recertification Survey completed on February 13, 2024, at The Williamsport Home, 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 483.70(a).

This is a two story, Type II (111), protected, noncombustible building, that is fully sprinklered.





 Plan of Correction:



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