Pennsylvania Department of Health
HAIDA NURSING AND REHAB
Building Inspection Results

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Severity Designations


Minimal Citation - No Harm	Minimal Harm	Actual Harm	Serious Harm

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HAIDA NURSING AND REHAB - 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 December 1, 2025, it was determined that Haida Nursing and Rehab had deficiencies that have the potential for minimal harm as related to the requirements of 42 CFR 483.73.

Plan of Correction:

Initial comments:Name: MAIN BUILDING 01 - Component: 01 - Tag: 0000

Facility ID# 340102
Component 01
Main Building

Based on a Medicare/Medicaid Recertification Survey completed on December 1, 2025, it was determined that Haida Nursing and Rehab was not in compliance with the following requirements of the Life Safety Code for an existing healthcare 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 V (000), unprotected wood frame structure, that is fully sprinklered.

Plan of Correction:

NFPA 101 STANDARD Sprinkler System - Maintenance and Testing:

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.

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 seven smoke compartments.

Findings include

1. Observation on December 1, 2025, revealed the following automatic sprinkler system deficiencies:

a) 10:50 a.m., there was a sprinkler head covered in lint and dust above the dryers in the laundry room;
b) 11:10 a.m., there was a PVC conduit being supported by a sprinkler pipe above the ceiling outside of A Wing.

Interview with the Facility Administrator and Maintenance Director on December 1, 2025, at 11:40 a.m., confirmed the automatic sprinkler system deficiencies.

Plan of Correction - To be completed: 12/17/2025

1.) The sprinkler head covered in lint and dust above the dryers in the laundry room was cleaned. The PVC conduit that was being supported by a sprinkler pipe above the ceiling outside of A Wing will be raised with wood so it is no longer supported by the sprinkler pipe.
2.) A full house audit of sprinkler heads will be completed by Maintenance to ensure cleanliness. Any concerns identified will be corrected at the time of audit. An audit of the sprinkler pipes will be completed to ensure nothing is resting or being supported by a sprinkler pipe.
3.) Education to Maintenance department on maintenance and testing the automatic sprinkler system and standpipe systems.
4.) An audit of the sprinkler heads will be completed by Maintenance Director or designee monthly times 3 months to ensure cleanliness. An audit of the sprinkler line will be completed by Maintenance Director or designee monthly times 3 months to ensure nothing is resting on the pipes. Results of the audit will be reported at the Quality Assurance Performance Improvement meeting.

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