Observations
Based on a review of the fire drill logs , the facility failed to document the completion of monthly unannounced fire drills.
The findings include:
A review of the fire drill logs was conducted on May 21, 2012. The fire drill log was reviewed from the time period of the previous inspection (May 2011) to current inspection (May 2012). Documentation was missing for fire drills conducted for the month of November 2011.
The findings were reviewed with the project/facility director and were not disputed.
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Plan of Correction
705.10 (d) (1) LICENSURE
Fire safety.:
705.10. Fire safety. (d) Fire drills. The residential facility shall: (1) Conduct unannounced fire drills at least once a month.
The fire drill in November was neglectfully missed. The house manager will notify the staff member responsible for the drill at the beginning of the month. On the 20th of if it has not been completed a note will be placed in the log and the staff members mail box that it must be completed. The house manager will check on the last working day of the month to assure that it has been completed. The Director will also check on that day to assure the same. |