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NY State Tag
D

Ventilation Unit Malfunction in Soiled Utility Room

New Berlin, New York Survey Completed on 02-14-2025

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

During a Life Safety Code recertification survey, it was observed that a ventilation unit in a soiled utility room on one resident floor was not functioning properly. This issue was identified near a specific resident room, where a strong foul odor was present, and the vent showed no draw. The Director of Environmental Services indicated that the vent should have been operational since a vendor had reportedly fixed the rooftop unit the previous day. However, they suggested that there might be an obstruction in the ductwork, which was causing the malfunction.

Plan Of Correction

Plan of Correction: Approved May 5, 2025 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Maintenance employees cleaned the dampers and the duct work in the soiled utility room near resident room [ROOM NUMBER], which increased the suction of the exhaust fan. All maintenance and environmental services employees received education on ensuring vents are free of dust or debris to prevent obstruction in the duct work. The Director of Environmental Services or designee will inspect the ventilation units/exhaust fans with monthly environmental rounds for proper functioning. The audit will be reviewed quarterly with the Quality Assurance and Performance Improvement Committee for 1 year to ensure compliance. Person Responsible for Completion: The Director of Environmental Services

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