Inspection Report
Complaint Investigation
Census: 70
Capacity: 70
Deficiencies: 0
Jan 17, 2025
Visit Reason
This visit was for the investigation of Complaint IN00450650.
Findings
No deficiencies related to the allegations were cited. Yorktown Manor was found to be in compliance with 42 CFR Part 483, Subpart B and 410 IAC 16.2-3.1 in regard to the complaint investigation.
Complaint Details
Complaint IN00450650 - No deficiencies related to the allegations are cited.
Report Facts
Census SNF/NF: 70
Total Capacity: 70
Census Payor Type Medicare: 4
Census Payor Type Medicaid: 56
Census Payor Type Other: 10
Inspection Report
Complaint Investigation
Census: 68
Capacity: 68
Deficiencies: 0
Nov 26, 2024
Visit Reason
This visit was conducted for the investigation of complaints IN00447205 and IN00447447.
Findings
No deficiencies related to the allegations in complaints IN00447205 and IN00447447 were cited. The facility was found to be in compliance with relevant regulations.
Complaint Details
Investigation of Complaints IN00447205 and IN00447447 found no deficiencies related to the allegations.
Report Facts
Census Bed Type: 68
Census Payor Type - Medicare: 3
Census Payor Type - Medicaid: 56
Census Payor Type - Other: 9
Inspection Report
Annual Inspection
Census: 68
Capacity: 100
Deficiencies: 5
Oct 21, 2024
Visit Reason
The inspection was conducted as a Recertification and State Licensure Life Safety and Emergency Preparedness Survey to assess compliance with Medicare and Medicaid participation requirements and state licensure regulations.
Findings
The facility was found in compliance with Emergency Preparedness requirements but was not in compliance with Life Safety Code requirements. Deficiencies included outdated battery-operated smoke alarms in resident rooms, unsecured and damaged electrical receptacles, failure to conduct quarterly fire drills at unexpected times on the first shift, incomplete monthly generator load testing records, and improper use of extension cords and power strips in patient care areas.
Severity Breakdown
SS=F: 2
SS=D: 1
SS=C: 1
SS=E: 1
Deficiencies (5)
| Description | Severity |
|---|---|
| Failed to replace battery operated smoke alarms installed in 43 of 46 resident sleeping rooms in accordance with NFPA 72. | SS=F |
| Failed to maintain electrical receptacles in wall mounted outlet boxes in 1 of 46 resident sleeping rooms; receptacles were loose and damaged. | SS=D |
| Failed to conduct quarterly fire drills at unexpected times under varying conditions on the first shift for 3 of 4 quarters. | SS=C |
| Failed to maintain a complete written record of monthly generator load testing for 5 of the last 12 months; load tests were not conducted for the required 30 minutes. | SS=F |
| Failed to ensure 3 of 3 extension cords including power strips were not used as a substitute for fixed wiring in patient care vicinity. | SS=E |
Report Facts
Deficient battery-operated smoke alarms: 43
Resident sleeping rooms inspected: 46
Fire drills not conducted as required: 3
Monthly generator load tests incomplete: 5
Resident sleeping rooms with extension cord issues: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jennifer Bailey | Administrator | Named during exit conference and report signature |
| Maintenance Director | Interviewed and involved in observations and corrective actions |
Inspection Report
Life Safety
Deficiencies: 0
Oct 21, 2024
Visit Reason
The visit was conducted as a Life Safety Code Recertification and State Licensure Survey.
Findings
Yorktown Manor was found in compliance with Medicare/Medicaid participation requirements, Life Safety from Fire, and the 2012 Edition of the NFPA 101 Life Safety Code, Chapter 19, Existing Health Care Occupancies and 410 IAC 16.2.
Inspection Report
Annual Inspection
Deficiencies: 0
Oct 8, 2024
Visit Reason
Paper compliance review for the Annual Recertification and State Licensure Survey.
Findings
Yorktown Manor was found to be in compliance with 42 CFR Part 483, Subpart B and 410 IAC 16.2-3.1 based on the paper review for the Recertification and State Licensure survey.
Inspection Report
Annual Inspection
Census: 69
Capacity: 69
Deficiencies: 3
Oct 2, 2024
Visit Reason
This visit was for a Recertification and State Licensure Survey, which included the Investigation of Complaint IN00444578.
Findings
The facility was found deficient in several areas including failure to complete shift-to-shift narcotic reconciliation for medication carts, failure to serve proper meal portions according to menus, and failure to ensure hand hygiene during medication administration. No deficiencies related to the complaint investigation were cited.
Complaint Details
Complaint IN00444578 was investigated and no deficiencies related to the allegations were cited.
Severity Breakdown
SS=D: 2
SS=E: 1
Deficiencies (3)
| Description | Severity |
|---|---|
| Failed to ensure shift to shift narcotic reconciliation was completed for 2 of 3 medication carts reviewed (300 hall cart and 100 hall cart). | SS=D |
| Failed to ensure menus were followed to serve proper portions for 1 of 1 meal observed (10/7/24 Lunch). | SS=E |
| Failed to ensure hand hygiene was completed during medication administration for 3 of 5 residents observed (Residents 12, 36, and 50). | SS=D |
Report Facts
Census: 69
Total Capacity: 69
Medicare Residents: 5
Medicaid Residents: 54
Other Residents: 10
Meal Portion Size Served: 4
Meal Portion Size Required: 6
Medication carts reviewed: 3
Medication carts with deficient reconciliation: 2
Residents observed for hand hygiene: 5
Residents with hand hygiene deficiencies: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jennifer Bailey | Administrator | Signed report and provided facility policy documents |
| RN 5 | Observed during medication cart narcotic reconciliation and medication administration with hand hygiene deficiencies | |
| Director of Nursing | DON | Provided interviews regarding narcotic reconciliation expectations and hand hygiene policies |
| Cook 4 | Observed serving incorrect meal portion size | |
| Certified Dietary Manager | CDM | Interviewed regarding meal portion size error and dietary policies |
Inspection Report
Complaint Investigation
Census: 65
Capacity: 65
Deficiencies: 0
Aug 29, 2024
Visit Reason
This visit was conducted for the investigation of Complaint IN00440771.
Findings
No deficiencies related to the complaint allegations were cited. The facility was found to be in compliance with 42 CFR Part 483, Subpart B and 410 IAC 16.2-3.1.
Complaint Details
Investigation of Complaint IN00440771 found no deficiencies related to the allegations.
Report Facts
Census Bed Type: 65
Census Payor Type - Medicare: 5
Census Payor Type - Medicaid: 54
Census Payor Type - Other: 6
Inspection Report
Complaint Investigation
Deficiencies: 0
Jul 5, 2024
Visit Reason
The inspection was conducted as a paper compliance review related to the investigation of Complaint IN00431698 completed on June 11, 2024.
Findings
Yorktown Manor was found to be in compliance with 42 CFR Part 483, Subpart B and 410 IAC 16.2-3.1 regarding the paper compliance review of the complaint investigation.
Complaint Details
The visit was related to Complaint IN00431698 and the facility was found to be in compliance based on the paper review.
Inspection Report
Complaint Investigation
Census: 68
Capacity: 68
Deficiencies: 1
Jun 11, 2024
Visit Reason
This visit was for the investigation of Complaint IN00431698 related to allegations of deficient treatment and services to prevent and heal pressure ulcers.
Findings
The facility failed to promptly initiate wound treatment to promote healing of pressure injuries for 2 of 3 residents reviewed (Resident B and Resident C), resulting in delays of six and seven days respectively without treatment orders. The facility policy and procedures for skin assessments and wound care were reviewed and corrective actions planned.
Complaint Details
Complaint IN00431698 was substantiated with a federal/state deficiency cited at F686 related to treatment/services to prevent/heal pressure ulcers.
Severity Breakdown
SS=D: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failed to promptly initiate wound treatment to promote healing of pressure injuries for 2 of 3 residents reviewed. | SS=D |
Report Facts
Census: 68
Total Capacity: 68
Days without treatment order for Resident B: 6
Days without treatment order for Resident C: 7
Residents reviewed for pressure injuries: 3
Residents affected: 2
Inspection Report
Complaint Investigation
Deficiencies: 0
Mar 28, 2024
Visit Reason
The inspection was conducted as a paper compliance review related to the investigation of Complaint IN00427080 completed on February 21, 2024.
Findings
Yorktown Manor was found to be in compliance with 42 CFR Part 483, Subpart B and 410 IAC 16.2-3.1 regarding the paper compliance review of the complaint investigation.
Complaint Details
The visit was complaint-related for Complaint IN00427080, and the facility was found to be in compliance.
Inspection Report
Complaint Investigation
Census: 63
Capacity: 63
Deficiencies: 1
Feb 20, 2024
Visit Reason
This visit was conducted for the investigation of three complaints (IN00428298, IN00427080, and IN00423945). Deficiencies related to complaint IN00427080 were cited, while no deficiencies were found related to the other two complaints.
Findings
The facility failed to provide adequate supervision and follow care plan interventions for a dependent resident (Resident C), resulting in a fall from an elevated bed without side rails in use. The resident had multiple falls in January 2024 and was at high risk for falls. The facility implemented corrective actions including review and update of care plans, staff in-service training, and quality assurance monitoring.
Complaint Details
Complaint IN00427080 was substantiated with a federal/state deficiency cited at F689 related to failure to prevent accidents and provide adequate supervision. Complaints IN00428298 and IN00423945 had no deficiencies related to the allegations.
Severity Breakdown
SS=D: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to provide adequate supervision and follow care plan interventions for a dependent resident, resulting in a fall from an elevated bed without side rails in use. | SS=D |
Report Facts
Falls sustained by Resident C: 4
Census: 63
Total licensed capacity: 63
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| CNA 1 | Staff member who left Resident C unsupervised in an elevated bed, resulting in a fall. | |
| LPN 2 | Entered room after fall and found resident on floor; received report from CNA 1. | |
| LPN 3 | Indicated side rails should have been in use and bed should not have been elevated. | |
| CNA 5 | Reported resident specific interventions and walking rounds. | |
| CNA 6 | Reported resident specific interventions and walking rounds. |
Inspection Report
Complaint Investigation
Census: 56
Capacity: 56
Deficiencies: 0
Nov 14, 2023
Visit Reason
This visit was conducted for the investigation of Complaint IN00420939.
Findings
No deficiencies related to the complaint allegations were cited. The facility was found to be in compliance with 42 CFR Part 483, Subpart B and 410 IAC 16.2-3.1.
Complaint Details
Complaint IN00420939 was investigated and found to have no deficiencies related to the allegations.
Report Facts
Census Payor Type - Medicare: 3
Census Payor Type - Medicaid: 47
Census Payor Type - Other: 6
Inspection Report
Complaint Investigation
Deficiencies: 0
Nov 1, 2023
Visit Reason
The inspection was conducted as a paper compliance review related to the Investigation of Complaint IN00419033 completed on October 12, 2023.
Findings
Yorktown Manor was found to be in compliance with 42 CFR Part 483, Subpart B and 410 IAC 16.2-3.1 regarding the paper compliance review of the complaint investigation.
Complaint Details
Investigation of Complaint IN00419033 completed on October 12, 2023; facility found in compliance.
Inspection Report
Complaint Investigation
Census: 62
Capacity: 62
Deficiencies: 1
Oct 12, 2023
Visit Reason
This visit was conducted for the investigation of Complaint IN00419033 regarding a federal/state deficiency related to quality of care.
Findings
The facility failed to ensure wound care was provided per physician order for 1 of 3 residents reviewed for wound care (Resident E). Specifically, the resident's surgical site dressing was missing under the elastic bandage contrary to physician orders.
Complaint Details
Complaint IN00419033 was substantiated with a federal/state deficiency cited at F684 related to quality of care.
Severity Breakdown
SS=D: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to provide wound care per physician order for Resident E, including missing gauze dressing on left below the knee amputation site incision. | SS=D |
Report Facts
Census: 62
Total Capacity: 62
Medicare Census: 4
Medicaid Census: 46
Other Payor Census: 12
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jennifer Bailey | Administrator | Signed the report |
| Director of Nursing | Observed wound care deficiency and provided information during inspection |
Inspection Report
Re-Inspection
Census: 61
Capacity: 100
Deficiencies: 0
Oct 4, 2023
Visit Reason
A Post Survey Revisit (PSR) to the Life Safety Code Recertification and State Licensure Survey was conducted to verify compliance with fire safety and licensure requirements.
Findings
Yorktown Manor was found in compliance with Medicare/Medicaid participation requirements, Life Safety from Fire, and the 2012 edition of the NFPA 101 Life Safety Code. The facility was fully sprinkled except for the main dining hall entrance foyer and had appropriate fire alarm and smoke detection systems.
Report Facts
Facility capacity: 100
Census: 61
Inspection Report
Life Safety
Census: 64
Capacity: 100
Deficiencies: 6
Sep 5, 2023
Visit Reason
The survey was conducted as a Life Safety Code Recertification and State Licensure Survey, including an Emergency Preparedness Survey, to assess compliance with applicable federal and state regulations.
Findings
The facility was found in compliance with Emergency Preparedness Requirements but was not in compliance with Life Safety Code requirements. Deficiencies included obstructions in corridor egress, improperly equipped PPE carts, unsecured exit door codes, hazardous area doors not self-closing, missing drip tray on kitchen hood, inaccurate fire alarm system date/time, and sprinkler pipes obstructed by wiring.
Severity Breakdown
SS=E: 5
SS=F: 1
Deficiencies (6)
| Description | Severity |
|---|---|
| Failed to ensure 1 of 6 corridor means of egresses was continuously maintained free of obstructions due to a PPE cart without wheels blocking the corridor. | SS=E |
| Failed to ensure means of egress through 4 facility exits was readily accessible; exit door codes were not posted or required special knowledge to access. | SS=E |
| Failed to ensure 1 of over 10 hazardous area doors (kitchen mop storage closet) was provided with a properly working self-closing device. | SS=E |
| Failed to install the kitchen range hood system with required drip trays; left side drip tray missing. | SS=E |
| Failed to maintain the fire alarm system with accurate date and time; panel showed incorrect time and date. | SS=F |
| Failed to maintain sprinkler system; wires were resting on sprinkler pipes and zip-tied to sprinkler piping in attic. | SS=E |
Report Facts
Certified beds: 100
Census: 64
Residents potentially affected: 15
Residents potentially affected: 25
Staff potentially affected: 6
Residents potentially affected: 20
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jennifer Bailey | Administrator | Present during exit conference and involved in review of findings |
| Maintenance Director | Interviewed regarding deficiencies and corrective actions |
Inspection Report
Annual Inspection
Census: 64
Capacity: 64
Deficiencies: 5
Aug 21, 2023
Visit Reason
This visit was for a Recertification and State Licensure Survey conducted from August 21 to August 25, 2023.
Findings
The facility was found deficient in several areas including failure to communicate timely with the medical director regarding a resident's hematuria, delayed action on pharmacy recommendations, improper labeling and storage of insulin pens, failure to test and record dishwasher sanitization rinse cycles, and inaccurate reporting of Registered Nurse staffing hours in the Payroll-Based Journal system.
Severity Breakdown
SS=D: 4
SS=E: 1
Deficiencies (5)
| Description | Severity |
|---|---|
| Failure to communicate with the medical director for a resident with hematuria, resulting in delayed doctor's appointment and specialist visit. | SS=D |
| Failure to ensure pharmacy recommendations were acted upon timely for unnecessary medications. | SS=D |
| Failure to discard expired insulin pen and to indicate date opened on another insulin pen. | SS=D |
| Failure to test and record dishwasher sanitization rinse cycle and failure to prepare pureed food according to facility recipe. | SS=E |
| Failure to accurately report Registered Nurse coverage hours into the Payroll-Based Journal system for January 1 through March 31, 2023. | SS=D |
Report Facts
Census Bed Type: 64
Medicare Census: 3
Medicaid Census: 47
Other Payor Census: 14
Deficiency Count: 5
Sanitizer Rinse Test Result: 50
Insulin Pen Opened Date: 7
Insulin Pen Expiration Days: 28
RN Coverage Missing Dates Count: 29
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jennifer Bailey | Administrator | Signed report and involved in plan of correction |
| LPN 15 | Interviewed regarding resident with hematuria and communication issues | |
| Director of Nursing | DON | Interviewed regarding resident care, pharmacy recommendations, and RN staffing |
| Dietary Aide 12 | Observed dishwasher sanitization testing | |
| Dietary Aide 10 | Observed preparing pureed food not following recipe |
Inspection Report
Complaint Investigation
Deficiencies: 0
Aug 15, 2023
Visit Reason
The inspection was conducted as a paper compliance review related to the Investigation of Complaint IN00410821 completed on July 7, 2023.
Findings
Yorktown Manor was found to be in compliance with 42 CFR Part 483, Subpart B and 410 IAC 16.2-3.1 based on the paper review of the complaint investigation.
Complaint Details
Investigation of Complaint IN00410821 completed on July 7, 2023; facility found in compliance.
Inspection Report
Complaint Investigation
Census: 64
Capacity: 64
Deficiencies: 1
Jul 6, 2023
Visit Reason
This visit was conducted for the investigation of complaints IN00411600, IN00411033, and IN00410821. Complaints IN00411600 and IN00411033 had no deficiencies related to the allegations, while complaint IN00410821 resulted in cited deficiencies.
Findings
The facility failed to provide adequate toenail care for one resident (Resident B), who had severely thickened, deformed, and painful toenails that were not properly cared for. The resident required podiatry services which were not timely provided due to lack of family consent and communication issues. The facility implemented corrective actions including assessments for all residents needing foot care, staff in-service training, and a quality assurance audit tool to prevent recurrence.
Complaint Details
Complaint IN00410821 was substantiated with federal/state deficiencies cited related to inadequate toenail care. Complaints IN00411600 and IN00411033 had no deficiencies related to the allegations.
Severity Breakdown
SS=D: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to provide adequate toenail care for one resident, resulting in severely thickened, deformed, and painful toenails not properly cared for. | SS=D |
Report Facts
Census: 64
Total Capacity: 64
Medicare residents: 6
Medicaid residents: 51
Other payor residents: 7
Podiatry visits: 3
Audit sample size: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jennifer Bailey | Administrator | Signed the report and provided the foot care policy |
| CNA 12 | Interviewed regarding toenail care practices for Resident B | |
| CNA 5 | Interviewed about Resident B's toenail care and showering | |
| LPN 10 | Interviewed about Resident B's toenail condition and care needs | |
| Social Service Director (SSD) | Provided information on podiatry visits and family consent for Resident B |
Inspection Report
Complaint Investigation
Census: 66
Capacity: 66
Deficiencies: 0
May 19, 2023
Visit Reason
This visit was conducted for the investigation of complaints IN00407446, IN00408434, and IN00408479.
Findings
No deficiencies related to the allegations in complaints IN00407446, IN00408434, and IN00408479 were cited. The facility was found to be in compliance with 42 CFR Part 483, Subpart B and 410 IAC 16.2-3.1.
Complaint Details
Investigation of Complaints IN00407446, IN00408434, and IN00408479 found no deficiencies related to the allegations.
Report Facts
Census: 66
Total Capacity: 66
Census Payor Type - Medicare: 2
Census Payor Type - Medicaid: 51
Census Payor Type - Other: 13
Inspection Report
Complaint Investigation
Census: 58
Capacity: 58
Deficiencies: 0
Apr 19, 2023
Visit Reason
The visit was conducted for the investigation of Complaint IN00405327.
Findings
No deficiencies related to the complaint allegations were cited. The facility was found to be in compliance with 42 CFR Part 483, Subpart B and 410 IAC 16.2-3.1.
Complaint Details
Complaint IN00405327 was investigated and found to have no deficiencies related to the allegations.
Report Facts
Medicare residents: 10
Medicaid residents: 43
Other residents: 5
Inspection Report
Complaint Investigation
Deficiencies: 0
Mar 29, 2023
Visit Reason
Paper compliance review to the Investigation of Complaint IN00402792 completed on March 2, 2023.
Findings
Yorktown Manor was found to be in compliance with 42 CFR Part 483, Subpart B and 410 IAC 16.2-3.1 in regard to the paper compliance review to the Complaint Investigation.
Complaint Details
Investigation of Complaint IN00402792 completed on March 2, 2023; facility found in compliance.
Inspection Report
Complaint Investigation
Census: 56
Capacity: 56
Deficiencies: 1
Mar 1, 2023
Visit Reason
This visit was for the investigation of complaints IN00402934, IN00402792, and IN00401735 at Yorktown Manor.
Findings
The facility failed to protect residents from physical abuse by other residents, affecting 3 of 4 residents reviewed. Multiple incidents of resident-to-resident abuse were documented, including hitting, pushing, and verbal aggression. The facility implemented corrective actions including behavior monitoring, staff training, and increased supervision.
Complaint Details
Complaint IN00402792 was substantiated with federal/state deficiencies cited at F600 related to abuse and neglect. Complaints IN00402934 and IN00401735 had no deficiencies related to the allegations.
Severity Breakdown
SS=E: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to protect residents from physical abuse by other residents. | SS=E |
Report Facts
Residents reviewed for abuse: 4
Census: 56
Total capacity: 56
Medicare residents: 10
Medicaid residents: 40
Other payor residents: 6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jennifer Bailey | Administrator | Named as facility representative and involved in notification of police and corrective actions. |
Inspection Report
Complaint Investigation
Census: 58
Capacity: 58
Deficiencies: 0
Aug 19, 2022
Visit Reason
The visit was conducted for the investigation of Complaint IN00385082.
Findings
The complaint was substantiated, but no deficiencies related to the allegations were cited. The facility was found to be in compliance with relevant regulations.
Complaint Details
Complaint IN00385082 was substantiated, but no deficiencies related to the allegations were cited.
Report Facts
Medicare residents: 6
Medicaid residents: 47
Other residents: 5
Inspection Report
Life Safety
Census: 58
Capacity: 100
Deficiencies: 13
Aug 18, 2022
Visit Reason
The visit was a Life Safety Code Recertification and State Licensure Survey conducted by the Indiana Department of Health in accordance with 42 CFR 483.90(a) and 42 CFR 483.73 for Emergency Preparedness.
Findings
The facility was found not in compliance with several Life Safety Code requirements including egress door locking arrangements, exit door accessibility, exit signage, hazardous area enclosures, cooking facility fire protection, fire alarm system maintenance, electrical safety including GFCI protection, fire drills, and proper use of power strips and extension cords.
Severity Breakdown
SS=F: 4
SS=E: 9
Deficiencies (13)
| Description | Severity |
|---|---|
| Doors within a required means of egress were magnetically locked with a 4-digit code not posted at the exits, affecting main facility front door, employee entrance/exit, 300 Hall Exit, and 400 Hall Exit. | SS=F |
| Main Hall Double Door exit doors near the staff lounge would not open easily on the first try. | SS=F |
| Courtyard door in the activities area was not posted with a 'NO EXIT' sign, potentially misleading residents. | SS=E |
| Hazardous storage room corridor doors in the kitchen were propped open or lacked self-closing devices, including dry storage and consultant storage areas. | SS=E |
| Double door set leading out of the kitchen into the corridor was manually overridden and left with a 3 inch gap, not smoke tight. | SS=E |
| Kitchen range hood extinguishing system nozzles were not properly positioned over cooking equipment. | SS=E |
| Fire alarm system batteries failed testing and had not been replaced as of the survey date. | SS=F |
| One wet location receptacle powering a water machine was not provided with ground fault circuit interrupter (GFCI) protection. | SS=E |
| Fire drills were not conducted at unexpected times or days, with 9 of 12 drills conducted near the end of the month. | SS=F |
| Power strips in resident rooms 409 and 304 lacked required UL rating for patient care vicinity. | SS=E |
| Power strip in resident room 409 was used to power a dorm style refrigerator, which is not permitted as a substitute for fixed wiring. | SS=E |
| Two power strips were daisy chained together in resident room 107, which is prohibited. | SS=E |
| Power strip used to power equipment in resident room 409 was dangling and not secured, risking damage to the power cord. | SS=E |
Report Facts
Facility certified beds: 100
Census: 58
Number of exit doors with magnetic locks: 4
Number of hazardous area doors without proper self-closing: 2
Number of power strips lacking UL rating: 2
Number of power strips daisy chained: 2
Number of fire drills reviewed: 12
Number of fire drills conducted near end of month: 9
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Maintenance Director | Interviewed and acknowledged multiple findings including door locking, fire alarm battery failure, hazardous area doors, and electrical issues | |
| Administrator | Present at exit conference acknowledging findings |
Inspection Report
Life Safety
Deficiencies: 0
Aug 18, 2022
Visit Reason
Paper compliance to the Life Safety Code Recertification and State Licensure Survey conducted on 08/18/22 was completed on 09/13/22.
Findings
Yorktown Manor was found in compliance with Requirements for Participation in Medicare/Medicaid, 42 CFR Subpart 483.90(a), Life Safety from Fire and the 2012 Edition of the National Fire Protection Association (NFPA) 101, Life Safety Code (LSC), Chapter 19, Existing Health Care Occupancies and 410 IAC 16.2.
Inspection Report
Annual Inspection
Deficiencies: 0
Aug 12, 2022
Visit Reason
The visit was conducted as a paper compliance review for the Annual Recertification and State Licensure survey.
Findings
Yorktown Manor was found to be in compliance with 42 CFR Part 483, Subpart B and 410 IAC 16.2-3.1 based on the paper review for the Recertification and State Licensure survey.
Report
File
0tzv12_2567.pdf
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