Inspection Reports for St. Joseph Villa
451 East Bishop Federal Lane, UT, 84115
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Inspection Report
Annual Inspection
Census: 173
Capacity: 221
Deficiencies: 3
Aug 22, 2024
Visit Reason
A Comparative Federal Monitoring Survey was conducted following a State Agency Annual Survey to assess compliance with federal regulations for long term care facilities.
Findings
The facility was found noncompliant with fire safety and emergency preparedness regulations, including failure to maintain sprinkler systems and smoke barriers, and deficiencies in the emergency preparedness plan affecting residents and staff.
Deficiencies (3)
| Description |
|---|
| Sprinkler system maintenance and testing failed to maintain sprinkler heads free from corrosion, affecting one of seven smoke compartments. |
| Smoke barriers failed to resist passage of smoke due to two unsealed penetrations, affecting two of seven smoke compartments and 24 residents. |
| Emergency preparedness plan failed to include a documented, facility-based and community-based risk assessment including missing residents, affecting all seven smoke compartments, staff, and residents. |
Report Facts
Deficient smoke compartments: 1
Deficient smoke compartments: 2
Residents affected: 24
Facility capacity: 221
Census: 173
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Erik Wilhelm | Reviewer | Reviewed the inspection report. |
| Administrator | Verified census and acknowledged findings during exit interview. | |
| Maintenance Director | Verified findings and provided information about sprinkler system and smoke barrier conditions. |
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