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F0689
E

Failure to Prevent Fire Hazard Due to Improper Use of Surge Protector

Berwyn, Illinois Survey Completed on 09-30-2025

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

The facility failed to follow its fire prevention policy by not ensuring that a resident's room was free from hazardous fire conditions. Specifically, a resident had a mini refrigerator plugged into an unapproved, non-medical grade surge protector, which was not approved by the maintenance director. The surge protector, which had six outlets, showed evidence of melting and irregular shapes on three of the plug inserts, as well as a melted area near the power button and a hole on the bottom. The refrigerator and surge protector were resident-owned and not provided or approved by the facility. The fire department confirmed that refrigerators should not be plugged into surge protectors, and the facility's own policy prohibits the use of ganged or multiple outlet plugs. The incident occurred when the resident heard popping noises, smelled burning, and observed black smoke and small sparks coming from the surge protector, followed by a small flame near the refrigerator cord. Both the resident and her roommate, who were alert and oriented at the time, evacuated the room and staff responded immediately. Observations after the incident revealed black soot on the floor and a burning smell in the room. The fire department report documented that maintenance quickly unplugged the unit upon arrival. This failure to adhere to fire safety policies had the potential to affect all residents on the unit.

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