Initial Comments:
Name - Component - --
Based on an Emergency Preparedness Survey completed on February 26, 2025, at Communities Of Don Guanella And Divine Providence At Fairview, it was determined there were no deficiencies identified with the requirements of 42 CFR 483.475.
Plan of Correction:
Initial Comments:
Name - NEW ICF/IID-8 RESIDENTS Component - 01
Facility ID# 24101101
Component 01
Main Building
Based on a Medicaid Recertification Survey completed on February 26, 2025, it was determined that Communities Of Don Guanella And Divine Providence At Fairview 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 with an Impractical.
Plan of Correction:
NFPA 101 STANDARD
Utilities - Gas and Electric
Name - NEW ICF/IID-8 RESIDENTS 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, it was determined the facility failed to monitor the electrical system, affecting two of eight resident rooms.
Findings include:
Observation on Febraury 26, 2025, between 9:00 a.m. and 9:05 a.m., revealed the following:
a. At 9:00 a.m., Room 8, had an extension cord in use powering a charging device;
b. At 9:05 a.m., Room 6, the bed was pushed against an unprotected electrical outlet.
Interview with Facility Representatives on Febraury 26, 2025, at 9:05 a.m., confirmed both electrical deficiencies.
Plan of Correction:1) Room #8 had extension cord removed. House Manager and Residential Coordinator were retrained on ensuing that no extension cord are used in the home. Compliance is necessary for all individuals residing in the home. Weekly inspection should be completed for each of the men's bedrooms and if found in use immediately removed. Staff will work with individuals as to why this is not permitted. Training records will remain on files. Monthly audits from facility department staff will occur and these audits kept on file.
2) Room # 6 had an outlet cover protector installed behind individual's bed. All bedrooms were also checked to ensure all outlets are protected with outlet covers if outlet is not being used. House Manager and Residential Coordinator were retrained to ensure outlets are covered. Training records will be kept on file. Monthly audits from facility department staff will occur to ensure outlet covers are in place. and these audits kept on file.
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