Improper Storage of Oxygen Cylinders
Penalty
Summary
The facility failed to properly maintain the storage of medical gas cylinders, specifically oxygen tanks, as required by NFPA 101 and NFPA 99 standards. During a tour of the facility, surveyors observed that empty and full oxygen cylinders were intermingled within the designated storage area. Specifically, three empty oxygen tanks were found stored in the section intended for full tanks, alongside four full tanks. This observation was made in one of three smoke compartments and affected 11 of 33 residents. Upon interview, the Administrator confirmed the finding and indicated uncertainty regarding why the tanks were misplaced. The report notes that the storage closet did not comply with the requirement to segregate empty cylinders from full ones, as outlined in the relevant fire and safety codes. No additional information about the medical history or condition of the affected residents was provided in the report.
Plan Of Correction
Potential Patients affected The organization was unable to find in a retrospective review that any patients had been adversely affected and were not placed in an immediate jeopardy situation. Immediate Organizational Action During the building tour it was discovered that 3 empty oxygen tanks were being stored in the full section. The facility had Engineering remove the tanks. Organizational System Improvements: Persons responsible: Environment of Care/Safety & Security Manager The Environment of Care/ Safety & Security Manager had an additional 6 tank holder ordered so that there is available storage capacity for empty tanks, this will reduce the risk of comingling tanks. (see attachment C) PI Monitoring: The Facility will utilize its Environment of Care (EOC) rounds to ensure that proper tank storage is being adhered to.