Deficient Emergency Power System Maintenance and Documentation
Penalty
Summary
The facility failed to ensure that its generators and associated emergency power systems were maintained and tested in accordance with NFPA 110, NFPA 99, NFPA 111, and NFPA 70 standards. During an observation, it was found that the automatic transfer switch number 2 for the equipment branch was not functioning, as indicated by the absence of display and indicator lights. The maintenance director confirmed that this issue had persisted since February or March, and that the generator company had not yet responded to address the malfunction. Despite the malfunction, the facility continued to have lights and power during outages, but the non-functioning transfer switch could limit available resources during a power loss. Additionally, a review of facility records revealed that there was no documentation available to verify that the back-up emergency generator had been serviced annually or that the required annual load bank test had been conducted. The maintenance director stated that the generator company had recently visited but had not yet provided any paperwork. The lack of documentation means that the facility could be unaware of potential generator issues, which may result in generator failure during a power outage. These findings were confirmed through interviews with the maintenance director at the time of observation and record review.