Compassion of Faith

The facility failed to ensure all resident rooms open on an exit, corridor, living area, or public area and are arranged for convenient access to dining and recreation areas.

The facility failed to provide a fire sprinkler system that met the referenced codes and standards.

The facility failed to ensure means of escape met the referenced codes and standards.

The facility failed to train staff in the use of fire extinguishers, failed to inspect and maintain fire extinguishers, and failed to keep records of inspection and maintenance of fire extinguishers.

The facility failed to keep documentation about the fire alarm system onsite at the facility.

The facility failed to provide hot water with a temperature between 100 and 120 degrees F for lavatories and bathing units.

The facility failed to include a section addressing resource management in the emergency preparedness and response plan.

The facility failed to include a section addressing transportation in the emergency preparedness and response plan.

The facility failed to ensure the building electrical system met the references codes and standards.

The facility failed to provide safe waste containers in kitchens and hazardous areas.

The facility failed to notify each resident, next of kin, or legally authorized representative how to register for evacuation assistance with 2-1-1 Texas.

The facility failed to inspect, test, and maintain fire sprinkler system components.

The facility failed to have a program to inspect, test, and maintain the fire sprinkler system and keep records of inspection, testing, and maintenance of the fire sprinkler system.

The facility failed to notify the EMC of the facility's plan, take actions to ensure coordination with the EMC, and document communications with the EMC.

The facility failed to ensure equipment could be accessed to the facility could inspect, test, and service the equipment.

The facility failed to ensure portable fire extinguishers were mounted on hangers or brackets supplied with the fire extinguisher or mounted in a fire extinguisher cabinet, were protected from impact or dislodgement, and were mounted at the appropriate height based on the weight of the extinguisher.

The facility failed to maintain electrical, heating, and cooling systems so they worked safely.

The facility failed to include a section addressing communication in the emergency preparedness and response plan.

The facility failed to include a section addressing warning in the emergency preparedness andand response plan.

The facility's emergency preparedness and response plan failed to address the eight core functions of emergency management.

The facility failed to provide the required emergency preparedness and response plan training and conduct drills.

The facility's plan failed to include the location of a current list of the facility's resident population.

The facility failed to conduct and document a risk assessment for potential emergencies or disasters.

The facility failed to provide a resident or legally authorized agent with the name, address, and contact information for each receiving facility or pre-arranged evacuation destination identified by the facility.

The facility failed to include a section addressing evacuation in the emergency preparedness and response plan.

The facility failed to ensure resident room doors would latch in their frames.

The facility failed to include a section addressing health and medical needs in the emergency preparedness and response plan.

The facility failed to keep walls and ceilings in good condition.

The facility failed to register with 2-1-1 Texas to assist the state in identifying persons who may need assistance in a disaster.

The facility failed to include a section addressing sheltering arrangements in the emergency preparedness and response plan.

The facility failed to review the plan at least annually to reflect changes in information, within 30 days following a disaster, within 30 days after a drill, and within 30 days after a change in rule or policy.

The receiving facility's plan failed to include procedures for accommodating a temporary emergency placement of one or more residents during a disaster or emergency.

The facility failed to develop and maintain a written emergency preparedness and response plan based on its risk assessment under subsection (b) of this section and that is adequate to protect facility residents and staff in a disaster or emergency.

The facility failed to document any reviews and updates made to the plan.

The facility failed to provide the minimum levels of illumination required in the facility.

The facility failed to ensure doors to resident rooms and living units could be closed by the occupants.

The failed to provide safe waste containers in smoking areas.

The facility failed to have a complete fire safety plan for the protection of everyone in the facility in the event of a fire.

The facility's plan failed to document the contact information for the EMC for the area.

The facility failed to include a section addressing direction and control in the emergency preparedness and response plan.

The facility failed to provide residents and residents' legally authorized representative with a copy of the plan upon admission, on request, and when a significant change to the plan is made.

The facility's plan failed to include a process that ensures communication with the EMC.

The facility failed to keep floors in good condition and regularly cleaned.

The facility failed to inspect, test, and maintain fire alarm system components.

The facility failed to ensure the sensitivity of smoke detectors was checked according to NFPA 72.

The facility failed to ensure an attic was not used for storage.