| Statement of Deficiencies | (X1) Provider/Supplier/CLIA Identification Number 65C0001001 | (X3) Date Survey Completed 02/08/2019 |
| Name of Provider or Supplier Hafa Adai Specialist Group, Llp | Street Address, City, State Sunflower Villa, 280 Pale San Vitores, Tamuning, GU | |
| For information on the provider's plan to correct this deficiency, please contact the provider or the state survey agency. | ||
| (X4) ID Prefix Tag | Summary Statement of Deficiencies
(Each deficiency should be preceded by full regulatory or LSC identifying information) |
| K0223 | Doors with Self-Closing Devices CFR(s): NFPA 101 Doors with Self-Closing Devices Doors required to be self-closing are permitted to be held open by a release device complying with 7.2.1.8.2 that automatically closes all such doors throughout the smoke compartment, entire facility, and all stair enclosure doors upon activation of: * Required manual fire alarm system, and * Local smoke detectors designed to detect smoke passing through the opening or a required smoke detection system; and * Automatic sprinkler system, if installed; and * Loss of power 20.2.2.4, 20.2.2.5, 21.2.2.4, 21.2.2.5 This STANDARD is not met as evidenced by: Based on observation and interview the facility did not ensure that a door to a hazardous area, required to be self-closing, was being held open only by an automatic release device. Without an automatic release device there is no assurance that a door being otherwise held open, will close upon activation of a manual fire, smoke detectors, sprinkler system or loss of power. This could allow smoke or fire to spread rapidly and would affect all patients and staff. The facility also failed to ensure that hazardous areas were equipped with self closing doors, as required. This could allow smoke and fire to spread rapidly and would affect all patients and staff. Findings include: 1. On January 31, 2019 during a walk-through of the facility with the facility's maintenance employee the door between the nurse's station and the record room was observed to be equipped with a self-closure but was held open by friction on the latch surface while pressed against a bookshelf. The room was observed to contain combustible patient records on at least 20 shelves approximately five feet long. The room's dimensions are approximately 10ft by 10ft. The maintenance employee affirmed that the door was being held open by being pressed against a bookshelf and was equipped with a self-closing device. 2. On January 31, 2019 during a walk-through, with the maintenance employee, of the laundry and medical supply storage area adjacent to the operating room it was observed that within the following rooms (approximately 13ft x 7ft) were stored combustible medical supplies. None of these hazardous areas had doors equipped with self-closing devices. * The room containing a clothes washer and dryer. In this room was observed to be two automatic sprinkler heads. * The room directly opposite the room containing a clothes washer and dryer. This room did not have automatic sprinkler heads. * The room diagonal to the room containing a clothes washer and dryer. This room did not have automatic sprinkler heads. The maintenance employee acknowledged that these rooms did not have doors that were equipped with closures. |