K0920 K920: Ensure proper usage of power strips and extension cords.
D

Non-compliance with NFPA 70 Standards for Power Strips

New Gouverneur Hospital S N FNew York, New York Survey Completed on 12-31-2024

Summary

During the Life Safety Recertification survey conducted on two consecutive days, the facility was found to be non-compliant with NFPA 70 standards regarding the use of extension cords and power strips. Specifically, surveyors observed multiple instances of unmounted power strips in various rooms and offices throughout the facility. These included four unmounted power strips in room 132, one in room 125, one in the Dietary office, two in the Staff Work Room on the 12th Floor, one in the Office of the Assistant Director of Nursing, and a power strip on the floor powering a microwave in the Office of Community Outreach & Marketing. The Director of Maintenance acknowledged the findings and indicated that the extension cords would be mounted, and the microwave was immediately plugged directly into an outlet. However, the report focuses on the deficiency observed during the survey, which highlights the facility's failure to ensure that power strips and extension cords were used in accordance with the National Electrical Code, potentially compromising electrical safety standards.

Plan Of Correction

Plan of Correction: Approved January 31, 2025 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** K920 Power Strips 1. What Corrective Action(s) will be accomplished for those residents found to have been affected by the deficient practice The following was addressed for the identified areas: Four unmounted power strips in room [ROOM NUMBER].132 were mounted, one unmounted power strip in room [ROOM NUMBER].125 was mounted, one unmounted power strip in the Dietary office was mounted, two unmounted power strips in the Staff Work Room on the 12th Floor were mounted, one unmounted power strip in the Office of the Assistant Director of Nursing was mounted and the power strip on the floor, powering a microwave in the Office of Community Outreach & Marketing, was mounted, and the microwave was plugged directly into an outlet. 2. How will you identify other residents having the potential to be affected by the same deficient practice and what corrective action will be taken The following corrective actions will be implemented to identify other residents who may be affected by the same practice: all skilled nursing facility rooms were checked to ensure that any power strips in use were mounted or that electrical items were plugged directly into an outlet. The Director of Maintenance/Designee will provide education to all staff regarding the policies and procedures related to electrical safety highlighting the proper use and installation of power strips. An educational summary will be provided to all staff highlighting the proper use and installation of power strips. Information on the proper use and installation of power strips will be shared at a Resident Council Meeting. 3. What measures will be put in place or what systemic changes you will make to ensure that the deficient practice does not recur The facility’s compliance will be monitored utilizing the following quality assurance system: The Director of Maintenance/Designee will conduct regular maintenance checks to ensure that all power strips are properly mounted and used in accordance with NFPA 101. Findings will be collected on a monthly basis and additional corrective action will be implemented as needed. 4. How the Corrective Action(s) will be monitored to ensure the deficient practice will not recur, i.e., what quality assurance program will be put into practice The Director of Maintenance will gather information from the maintenance checks performed and report the findings to the QAPI committee for a period of 3 months or until compliance is achieved. 5. Responsible Individual: Director of Maintenance

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.
See other K0920 citations
Improper Use of Power Strips and Extension Cords in Multiple Facility Areas
E
K0920 K920: Ensure proper usage of power strips and extension cords.
Short Summary

Surveyors found multiple instances of improper use of relocatable power taps (RPTs) and extension cords during a facility tour with the Maintenance Director. In the social services office, an RPT was plugged into another RPT connected to a wall outlet, with the cord running across a walkway and taped to the floor. In the multipurpose room, a television was plugged into an extension cord, and in the MDS office, an RPT was plugged into another RPT with an outlet adapter in use. These conditions did not comply with NFPA 101, NFPA 99, and NFPA 70 standards governing electrical equipment, power strips, and extension cords.

No penalty information released
tooltip icon
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.
Improper Use of Power Strip as Permanent Power Source in Electrical Room
C
K0920 K920: Ensure proper usage of power strips and extension cords.
Short Summary

Surveyors found that the facility failed to comply with NFPA 99, NFPA 70, and NFPA 1 requirements for electrical equipment when, during a tour with the Maintenance Director, a power strip in the electrical room was observed being used as a permanent power source instead of a dedicated receptacle. The report states that this improper use of a relocatable power tap could lead to electrical hazards for residents and staff, and notes that extension cords and power strips are not to be used as substitutes for fixed wiring under the cited codes.

No penalty information released
tooltip icon
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.
Improper Use of Adapters and Power Strips for Refrigerators
F
K0920 K920: Ensure proper usage of power strips and extension cords.
Short Summary

Surveyors observed that an adapter was used to power a refrigerator in the kitchen and a refrigerator in the dining room manager's office was plugged into a power strip. The Director of Facilities confirmed both uses, which did not comply with NFPA 99 and NFPA 70 requirements prohibiting adapters and power strips from being used as substitutes for permanent wiring.

No penalty information released
tooltip icon
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.
Improper Use of Outlet Multiplier in Salon
D
K0920 K920: Ensure proper usage of power strips and extension cords.
Short Summary

A three-to-one outlet multiplier was found in use in the first floor salon, with a hair dryer, hair straightener, and hair curler plugged into it, in violation of electrical equipment requirements. The maintenance director confirmed this setup during an interview.

No penalty information released
tooltip icon
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.
Unapproved Power Strip Causes Electrical Fire at Bedside
F
K0920 K920: Ensure proper usage of power strips and extension cords.
Short Summary

A power strip not meeting required UL standards was found in use at a bedside, resulting in an electrical fire. The device had been brought in by a family member for charging a phone, and the facility could not verify its compliance with safety standards. This deficiency affected multiple residents and a smoke compartment.

No penalty information released
tooltip icon
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.
Improper Use of Extension Cords and Power Strips for Window AC Units
F
K0920 K920: Ensure proper usage of power strips and extension cords.
Short Summary

Surveyors found that multiple window AC units throughout the facility were retrofitted by removing factory GFCI power cords and attaching extension cords, eliminating original electrical protections. One AC unit in the Dietary Director's office was also plugged into a power strip, contrary to regulations. Facility leadership confirmed these modifications, which violated electrical safety standards.

No penalty information released
tooltip icon
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.
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