Inspection visit
Fire Safety inspection
Citations
13 citations recorded*CMS
This is a Fire Safety survey. CMS cites these findings under the Life Safety Code and Emergency Preparedness rules, a separate set from the health (F-tag) deficiencies. The codes and grading differ, so these do not link to the health violation pages.
What do CMS severity letters mean?
Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.
General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.
Each letter combines severity with scope: how many residents the deficiency affected.
- 0001GeneralS&S Fpotential for harm
Establish an Emergency Preparedness Program (EP).
- 0711GeneralS&S Fpotential for harm
Provide a written emergency evacuation plan.
- 0006GeneralS&S Fpotential for harm
Conduct risk assessment and an All-Hazards approach.
- 0007GeneralS&S Fpotential for harm
Address patient/client population and determine types of services needed.
- 0020GeneralS&S Fpotential for harm
Establish policies and procedures including evacuation.
- 0023GeneralS&S Fpotential for harm
Establish policies and procedures for medical documentation.
- 0024GeneralS&S Fpotential for harm
Establish policies and procedures for volunteers.
- 0033GeneralS&S Fpotential for harm
Establish methods for sharing information.
- 0039GeneralS&S Fpotential for harm
Conduct testing and exercise requirements.
- 0531GeneralS&S Cno actual harm
Have elevators that firefighters can control in the event of a fire.
- 0712GeneralS&S Cno actual harm
Have simulated fire drills held at unexpected times.
- 0911GeneralS&S Fpotential for harm
Meet requirements for the installation and maintenance of electrical systems.
- 0918GeneralS&S Fpotential for harm
Have generator or other power source capable of supplying service within 10 seconds.
FAQ · About this visit
Common questions about this visit
What happened during the September 13, 2023 survey of Peabody Manor?
This was a inspection survey of Peabody Manor on September 13, 2023. The surveyor cited 13 deficiencies, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at Peabody Manor on September 13, 2023?
Yes, 13 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Establish an Emergency Preparedness Program (EP)."
What type of survey was this?
This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.
SourceView on CMS Care Compare
Next steps
Concerned about a resident’s care?Find your local ombudsman through the Eldercare Locatoror file a complaint with your state survey agency.
Researching this visit professionally?Book a 15-minute calland we will walk through what we have on file.
Data from CMS Care Compare public records. Dataset last refreshed . If you believe any information is inaccurate, report it here.