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E0035
C

Deficiency in Emergency Preparedness Communication Plan

Philadelphia, Pennsylvania Survey Completed on 12-23-2024

Penalty

No penalty information released
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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 maintain and update an emergency preparedness communication plan that includes a method for sharing information from the emergency plan with residents and their families or representatives. During a document review and interview conducted on December 23, 2024, at 8:30 a.m., it was revealed that the emergency communications plan lacked a method for disseminating information to residents and their families or representatives. This deficiency affected the entire facility. An exit interview with the Assistant Administrator and the Maintenance Director confirmed the absence of the necessary documentation.

Plan Of Correction

Emergency preparedness plan has been reviewed and updated to include communication/notification to residents/representatives in an emergency situation. Maintenance Dir/designee will re-educate maintenance staff on timely updates for policies and procedures relating to communication/notification to residents/representatives in an emergency situation. NHA/designee will complete weekly audits x1 and monthly x2 to ensure EPP manual is updated. Maintenance Director will report the findings of the audits to the QAPI Committee X 3 months.

See complete original report
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