Inspection Report
Life Safety
Deficiencies: 4
Mar 16, 2023
Visit Reason
The inspection was conducted as a fire life safety and sanitation licensure survey at Grace Assisted Living at State Street.
Findings
The survey identified multiple non-core issues including prohibited use of extension cords and multiple plug adapters, use of relocatable power taps with medical devices, lack of policy on medical gases related to oxygen therapy, and deficiencies in emergency action and fire drill procedures.
Deficiencies (4)
| Description |
|---|
| Use of extension cords and multiple plug adapters prohibited: Room 173 using two 3-1 MPAs and room 105 using one MPA to supply power to devices/appliances. |
| Use of relocatable power taps prohibited with medical devices: Room 136 using a RPT to supply power to the oxygen concentrator. |
| No policy or procedure in accordance with NFPA 99 on elimination of ignition sources and misuse of flammable substances for residents using medical respiratory therapy such as oxygen. |
| Emergency egress and relocation drills not conducted as required; drills lacked documentation of evacuation point and emergency plan failed to specify designated assembly point. |
Report Facts
Number of extension cords and MPAs: 3
Number of emergency drills required per year: 6
Number of emergency drills required on evening shift: 2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Shantel Cardenas | Administrator | Named as facility administrator |
| Sam Burbank | Survey Team Leader | Named as survey team leader for fire life safety and sanitation licensure |
Inspection Report
Complaint Investigation
Deficiencies: 1
Oct 13, 2022
Visit Reason
The inspection was conducted as a health care licensure and follow-up combined with a complaint investigation.
Findings
The facility's Registered Nurse did not complete all required nursing assessments for residents, with quarterly assessments for Residents #2, #4, and #9 being overdue.
Complaint Details
The visit was complaint-related as indicated by the survey type including complaint investigation; substantiation status is not stated.
Deficiencies (1)
| Description |
|---|
| The facility RN did not complete all required nursing assessments for all residents; quarterly assessments for Residents #2, #4, and #9 were overdue. |
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Shantel Cardenas | Administrator | Named as the facility administrator. |
| Mina Ramirez | Survey Team Leader | Led the health care licensure and follow-up plus complaint investigation survey. |
Inspection Report
Life Safety
Deficiencies: 4
Sep 13, 2021
Visit Reason
The inspection was conducted as a fire life safety and sanitation licensure survey for Grace Assisted Living at State Street.
Findings
The facility was found to have deficiencies related to fire and life safety standards, including lack of designated evacuation points in the emergency disaster plan, no documented resident training on disaster roles, failure of door latching for 2-hour separation, and no documented annual staff inservice on oxygen risks.
Deficiencies (4)
| Description |
|---|
| Facility emergency disaster plan does not designate the point for drill in accordance with NFPA 101, Chapter 33, Section 33.7.3.3; drills do not demonstrate this evacuation point. |
| No documented resident training (as able) on the roles and responsibilities for the disaster plan in accordance with NFPA 101, Chapter 33, Section 33.7.2. |
| Testing of the 2-hour separation of occupancy at the Independent Living side revealed the leaf on the west-side of the pair of doors would not fully close and latch in accordance with NFPA 80. |
| No documented annual inservice for staff on the risks associated with oxygen in accordance with NFPA 99, Chapter 11, Section 11.5.2.1. |
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