Initial Comments:
Name - Component - --
Based on an Emergency Preparedness Survey completed on November 2, 2020 at Community Services-Watsontown, it was determined there were no deficiencies identified with the requirements of 42 CFR 483.475.
Plan of Correction:
Initial Comments:
Name - MAIN BUILDING 01 Component - 01
Facility ID #20191100
Component 01
Main Building 01
Based on a Medicaid Recertification Survey completed on November 2, 2020, it was determined that Community Services-Watsontown, was not in compliance with the following requirements of the Life Safety Code for an existing ICF/IID health care occupancy. Compliance with the National Fire Protection Association's Life Safety Code is required by 42 CFR 483.470(j).
This is a one story, Type V (000), unprotected, wood frame building, that is fully sprinklered.
State plans approved as Impractical.
Plan of Correction:
NFPA 101 STANDARD
Utilities - Gas and Electric
Name - MAIN BUILDING 01 Component - 01
Utilities - Gas and Electric
Equipment using gas or related gas piping complies with NFPA 54, National Fuel Gas Code, electrical wiring and equipment complies with NPFA 70, National Electric Code.
32.2.5.1, 33.2.5.1, 9.1.1, 9.1.2
Observations:
Based on observation and interview, the facility failed to monitor the electrical wiring systems for installed devices.
Findings include:
1. Observation on November 2, 2020, at 10:45 a.m., revealed an household light gage extension cord was run from the corridor to the attic space to power air filter equipment.
Interview at the time of the exit conference with the administrator and facilities representative 1 on November 2, 2020 at 11:00 a.m., confirmed the extension cords were being used as permanent wiring.
2. Observation on November 2, 2020, at 10:47 a.m., revealed a section of non-terminated wiring above the ceiling near a disconnect switch, at the attic space access near the smoke barrier.
Interview at the time of the exit conference with the administrator and facilities representative 1 on November 2, 2020 at 11:00 a.m., confirmed the wiring did not end in a junction box or device.
Plan of Correction:1. A certified Electrician/General Contractor was contacted by the ICF. He installed an electrical box with an outlet and removed the household light gage extension cord that was run from the corridor to the attic space to power air filter equipment. These repairs were completed on Wednesday, 11/11/2020.
2. The Certified Electrician addressed the section of non-terminated wiring above the ceiling near a disconnect switch, at the attic space access near the smoke barrier by installing wires in an electrical box and they were terminated. These repairs were completed on Wednesday, 11/11/2020.
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