Survey Date | Inspection Type | Track ID | Deficiency | Severity and Scope | Class | Requirement Description | Correction Date |
08/07/2024 | Complaint | 8FIM | None | None | None | NoneNone | None |
06/13/2024 | Standard | DPD8 | F0644 | D | | COORDINATION OF PASARR AND ASSESSMENTS | 07/12/2024 |
06/13/2024 | Standard | DPD8 | F0645 | D | | PASARR SCREENING FOR MD & ID | 07/12/2024 |
06/11/2024 | Fire/Life/Safety | DPD8 | K0222 | E | 3 | EGRESS DOORSEgress Doors
Doors in a required means of egress shall not be equipped with a latch or a lock that requires the use of a tool or key from the egress side unless using one of the following special locking arrangements:
CLINICAL NEEDS OR SECURITY THREAT LOCKING
Where special locking arrangements for the clinical security needs of the patient are used, only one locking device shall be permitted on each door and provisions shall be made for the rapid removal of occupants by: remote control of locks; keying of all locks or keys carried by staff at all times; or other such reliable means available to the staff at all times.
18.2.2.2.5.1, 18.2.2.2.6, 19.2.2.2.5.1, 19.2.2.2.6
SPECIAL NEEDS LOCKING ARRANGEMENTS
Where special locking arrangements for the safety needs of the patient are used, all of the Clinical or Security Locking requirements are being met. In addition, the locks must be electrical locks that fail safely so as to release upon loss of power to the device; the building is protected by a supervised automatic sprinkler system and the locked space is protected by a complete smoke detection system (or is constantly monitored at an attended location within the locked space); and both the sprinkler and detection systems are arranged to unlock the doors upon activation.
18.2.2.2.5.2, 19.2.2.2.5.2, TIA 12-4
DELAYED-EGRESS LOCKING ARRANGEMENTS
Approved, listed delayed-egress locking systems installed in accordance with 7.2.1.6.1 shall be permitted on door assemblies serving low and ordinary hazard contents in buildings protected throughout by an approved, supervised automatic fire detection system or an approved, supervised automatic sprinkler system.
18.2.2.2.4, 19.2.2.2.4
ACCESS-CONTROLLED EGRESS LOCKING ARRANGEMENTS
Access-Controlled Egress Door assemblies installed in accordance with 7.2.1.6.2 shall be permitted.
18.2.2.2.4, 19.2.2.2.4
ELEVATOR LOBBY EXIT ACCESS LOCKING ARRANGEMENTS
Elevator lobby exit access door locking in accordance with 7.2.1.6.3 shall be permitted on door assemblies in buildings protected throughout by an approved, supervised automatic fire detection system and an approved, supervised automatic sprinkler system.
18.2.2.2.4, 19.2.2.2.4 | 07/12/2024 |
06/11/2024 | Fire/Life/Safety | DPD8 | K0353 | E | 3 | SPRINKLER SYSTEM - MAINTENANCE AND TESTINGSprinkler 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
| 07/12/2024 |
05/06/2024 | Complaint | YG62 | None | None | None | NoneNone | None |
05/02/2024 | Complaint | IRLX | None | None | None | NoneNone | None |
04/05/2024 | Complaint | 7I8P | F0567 | D | | PROTECTION/MANAGEMENT OF PERSONAL FUNDS | 05/05/2024 |
04/05/2024 | Complaint | 7I8P | F0622 | G | | TRANSFER AND DISCHARGE REQUIREMENTS | 05/05/2024 |
04/05/2024 | Complaint | 7I8P | F0623 | E | | NOTICE REQUIREMENTS BEFORE TRANSFER/DISCHARGE | 05/05/2024 |
|
|