Administrator in Training Manual

NURSING HOME ADMINISTRATOR PRACTICE MANUAL

MAINTENANCE

Chapter 7

Stan Mucinic, LNHA

1. The critical mission of the maintenance department is to prevent equipment failures through preventative maintenance.

2. The maintenance staff needs to make sure all equipment is working properly, and that there are no mechanical failures of the air conditioning and heating system, refrigerator and freezer, fire alarm system, fire sprinkler system, door alarms, automatic doors and access or emergency power backup.

3. The maintenance director of a skilled nursing facility needs to be familiar with the life safety code, ADA, and every mechanical and plumbing system in the facility.

4. As the administrator, you cannot assume that the individual who is directing your maintenance program knows everything they need to know. You need to know which maintenance and environmental features are out of compliance, and you must make sure that whatever needs to be done to bring the facility into compliance is done.

5. You are the compliance officer for your facility and the safety of every person in that building is your responsibility.

6. Life safety code violations must be identified and fixed quickly. These violations place everyone’s life in danger.

7. You must be familiar with the life safety code. One of the most frequent violations is failure to conduct and document at least 12 fire drills per year.

8. There is not excuse for any facility not to conduct and document fire drills. You must have them and you must require your maintenance director to provide you a copy of all drills and you should participate in any many as you can.

9. These drills if conducted properly can identify important issues that would arise in a real fire. An example is that the fire doors do not close properly and there is no positive latch, staff are not sure of their responsibilities in the fire and fail to go their stations, staff cannot identify the location of a fire, the alarm system is not functioning properly, or a pull station is not functioning,.

10. Any problems found during a fire drill should be documented and the steps taken to fix those issues should be documented as well.

11. The maintenance director must perform inspections and tests of key duct systems, dampers, fire alarm tests, emergency generators, and the paperwork for these inspections must be available if requested by surveyors. The lack of this documentation is a another source of tags.

12. Another common reason for life safety tags is that the fire exit doors and fire extinguishers are blocked by carts or furniture. You must do daily rounds and point out to staff whenever you see any objects blocking fire exits.

13. You should not move the object, but instead call staff over and explain to them that it is unacceptable and have someone move it.

15. There should not be anything blocking fire exit doors on the outside. Remove any debris or chairs that may have been placed outside.

16. Check the mechanisms on these doors to make sure they open and close properly. The hardware on doors break or become loose and must be adjusted.

17. You should go through the maintenance service requests on each wing and see how quickly the service requests are being handled and fixed.

18. It is the responsibility of the maintenance staff to walk the perimeter of the facility each morning and make sure everything is in order.

19. Maintenance should check all doors early in the morning and test all door alarms to make sure they are functioning properly. Many operate on battery and those batteries can die.

20. Maintenance staff should also check water temperatures from faucets in resident rooms and the shower room and other areas in the building to make the water is not too hot or too cold.

21. Federal law says resident faucets must not provide water at a temperature of more than 110 degrees F.

22. The maintenance staff should also check the atmospheric temperature of the facility which should be between 71 and 81 degrees F.

23. Air temperature is measured 3 feet off the floor.

24. Also check all railings and grab bars to make sure none are loose. They must support at least 250 lbs.

25. Maintenance staff should check the soiled linen and trash rooms each morning to make sure the rooms are clean, the containers are covered and the room is kept locked at all times.

26. Confirm the room is maintained at proper room pressure and the wash sinks in the rooms are functioning properly, the sink has cold and hot water.

27. Once per month, the maintenance staff should go through the building and visually inspect all fire extinguishers and sign off the inspection card.

28. The fire extinguishers need to be serviced quarterly and recharged annually by a licensed servicing company.

29. At least weekly, the staff should walk through the building and press the test button on the emergency lighting battery packs. The facility must have emergency battery power for 1 ½ hours.

30. The red outlets are hooked up directly to the emergency power generator which must be inspected weekly and tested monthly under full load for 30 minutes.

Chapter 6 - Maintenance Stan Mucinic Copyright 2013 All Rights reserved Page 3 of 6 31. The maintenance staff should also walk through all areas in the building, including offices and closets and locate any holes in the walls which must be fire stopped, to prevent smoke from traveling through the walls in the event of a fire. This is a life safety violation.

32. Check the facility survey results to if the facility was cited fro any K tags.

33. If there were any K tags, review the approved plan of correction and verify the facility is in compliance with the plan.

34. The maintenance office and laundry are fire hazard areas, and both need either a 1 hour fire rated enclosure or a fire sprinkler system.

35. Any paint cans or other flammable item should be stored in a fire proof cabinet.

36. The beauty salon also has flammable items such nail polish remover, dyes and chemicals. You must ensure they are properly stored and do present a fire hazard.

37. The smoke compartment has a 2 hour fire wall

38. All doors in the facility must be at least 44 inches wide, except the bathroom door which must be a minimum of 32 inches wide.

39. Must provide each resident 80 square feet of space in a semi-private room

40. Must provide each resident 100 square feet of space in private rooms

41. Ask the maintenance director to see the schedule for all routine maintenance.

42. Most of the purchases from the maintenance department can be capitalized.

43. Tools, equipment and capital repairs worth $500 or more, with a life span of 1 year or more, can be capitalized. Purchase these items on a purchase order and pay them through the capital budget instead of your operating account.

44. You should do an audit of each room in the facility to identify any furniture that is scratched, stained, has fraying or ripped fabric, is dirty or has missing knobs or cannot be easily opened by resident. These are common tags so do the audit and get these things fixed before survey.

45. The maintenance staff should ay down a fresh coat of paint on all interior rooms, hallways, kitchen, etc. Evaluate whether the exterior of the facility also needs a new coat of paint.

46. The interior of the facility should have a fresh coat of paint about 2 months before survey.

47. Any damaged or scuffed or chipped base boards should be replaced.

48. Linoleum floors should have a fresh coat of wax and the floors should be stripped and waxed at least every 2 weeks or sooner if scoffed or dirty.

49. The dining room should have a fresh coat of paint as wel,l and make sure the microwave oven is clean and in good repair.

51. Maintenance should walk the halls every morning and identify any water stained ceiling tiles. These are indications of a leak in the roof and possible water damage and mold. Always have a good supply of ceiling tiles available if you need it. Those tiles must be replaced immediately.

52. You and your staff should be able to identify the emergency shut off valves for the water and gas. If there is a gas leak or a break in the water main, then staff needs to know where the cutoff valves are in an emergency.

53. Also, key staff should know where the fuse panels are and which panels control which parts of the building and which equipment.

54. You will not be there and maintenance will not be there either at 2 a.m. in the morning. That is when these things happen.

55. Tour the outside of the facility and look for broken pavement in the parking lot or on sidewalks, clean up any debris or garbage around the outside of the facility. Look for anything that may cause someone to trip and fall and bang their head on something.

56. Have quick clean up stations in the hallways to quickly clean up a spill and prevent a fall or injury. Make sure you have “wet floor” signs and that staff acts quickly to detour people around a spill. This is the most common cause of injuries to staff and visitors.

57. You must have a contract with a professional pest control company and you must keep copies of any service orders as evidence that the facility is being treated on an on going basis.

58. Assess the landscape around the building, and spruce up the building in springtime with flowers and trimmed bushes.

59. You also want to know where your sewage clean outs are inside the building. If the toilets backup, sewage will back up into the building and it can is very bad situation.

60. You should have a diagram of these various shutoff valves, clean outs, fuse panels and emergency equipment so staff can deal with these problems timely.

61. Assess the exterior lighting and floodlights to ensure that there are no dark areas inside and outside around the facility where staff and visitors can be harmed.

62. Clean wheelchairs monthly and inspect for repairs like squeaky wheels, wobbly wheels, cracked plastic panels, and broken foot rests.

63. Maintain an inventory of all maintenance equipment and supplies in the maintenance department. Equipment can disappear.

64. Physical environment issues are one of the biggest sources of tags.