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F0908
F

Failure to Maintain Safe Operating Conditions for Essential Equipment

Wyndmoor, Pennsylvania Survey Completed on 01-10-2025

Penalty

Fine: $11,550
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to ensure that essential mechanical equipment was in safe operating condition, specifically one of the two elevators and the heating system in the main kitchen. Resident R220, who has Type II Diabetes, high blood pressure, neuropathy, and a nonhealing diabetic foot ulcer, experienced a distressing incident on January 3, 2025, when the elevator malfunctioned. The elevator made loud thumping sounds and stopped misaligned with the floor, causing the doors not to open. This incident triggered the resident's PTSD, and it was revealed that the facility was aware of the elevator's issues since December 13, 2024, but did not address them until after the incident. Additionally, the main kitchen's heating system was non-functional, with temperatures ranging from 46 to 56 degrees Fahrenheit, making it difficult for dietary staff to perform their duties. The kitchen had been without heat since November 2024, and staff were observed wearing extra clothing to stay warm. The unfavorable working conditions were reported to have caused illnesses among the staff, with four members calling in sick. The Nursing Home Administrator confirmed that the heating system had been out of service since November 2024, requiring significant repairs to restore proper function.

Plan Of Correction

1. The elevator parts arrived and the elevator was fixed on 1/8/25. The kitchen heat has been restored and the doors were immediately fixed. 2. All kitchen doors will be audited to make sure they are working functionally. 3. Staff will be educated on the components of this regulation with an emphasis on maintaining essential equipment in a safe operating condition. 4. Elevators and the kitchen heat will be audited to sure they are working correctly 1x week for 1 month, 2x a month for one month and then 1x a month for 1 month. 5. The findings of these quality monitoring's to be reported to the Quality Assurance/Performance Improvement Committee monthly x6 months.

See complete original report
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