| Statement of Deficiencies | (X1) Provider/Supplier/CLIA Identification Number 713026 | (X3) Date Survey Completed 04/27/2026 |
| Name of Provider or Supplier Bogalusa Rehabilitation Hospital | Street Address, City, State 621 Columbia Street, Bogalusa, LA | |
| 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) |
| K0918 | Electrical Systems - Essential Electric Syste CFR(s): NFPA 101 Electrical Systems - Essential Electric System Maintenance and Testing The generator or other alternate power source and associated equipment is capable of supplying service within 10 seconds. If the 10-second criterion is not met during the monthly test, a process shall be provided to annually confirm this capability for the life safety and critical branches. Maintenance and testing of the generator and transfer switches are performed in accordance with NFPA 110. Generator sets are inspected weekly, exercised under load 30 minutes 12 times a year in 20-40 day intervals, and exercised once every 36 months for 4 continuous hours. Scheduled test under load conditions include a complete simulated cold start and automatic or manual transfer of all EES loads, and are conducted by competent personnel. Maintenance and testing of stored energy power sources (Type 3 EES) are in accordance with NFPA 111. Main and feeder circuit breakers are inspected annually, and a program for periodically exercising the components is established according to manufacturer requirements. Written records of maintenance and testing are maintained and readily available. EES electrical panels and circuits are marked, readily identifiable, and separate from normal power circuits. Minimizing the possibility of damage of the emergency power source is a design consideration for new installations. 6.4.4, 6.5.4, 6.6.4 (NFPA 99), NFPA 110, NFPA 111, 700.10 (NFPA 70) This STANDARD is not met as evidenced by: Based on visual observation the facility failed to assure that the emergency generator was maintained and tested in accordance with NFPA 110. In cases of a power outage the emergency generator powers essential life safety equipment for the facility. The deficient practice had the potential to affect ten of ten patients. Findings: During the facility tour on April 27, 2026 between the hours of 9:15 a.m. to 11:00 a.m. the following items were in need of correction: the generator annunciator indicated the generator coolant was low, the weekly generator documentation was lacking for every week dating back a year and the yearly load bank documentation was lacking. The interview with the Administrator and Maintenance personnel revealed the facility was not aware the annunciator was indicating low coolant level and the weekly generator documentation was lacking for each week in the last year. The Maintenance personnel was aware the generator load bank yearly documentation was lacking. |