Health inspection·January 19, 2024

F 0908 Keep all essential equipment working safely. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure portable space heating devices that heated above 212 degrees were prohibited for 29 of 229 resident rooms inspected for fire safety according to NFPA 101, 19.7.8. in that: Residents Affected - Some There were 29 occupied resident rooms which had portable space heaters in use in 100 and 200 Hall. This failure could affect the health of safety of resident's dependent on electrical appliance safety, in the event of electrical fire, exposing resident to smoke inhalation and other fire related injuries. Findings included: Observation on 1/17/24 at 9:52 a.m. to 10:35 a.m., revealed occupied resident rooms #126, #120, #117, and #213 had working portable space heaters plugged into the wall and in use. The portable space heater in #213 and #125 were labelled with the facility's name. During an interview on 1/17/24 at 10:00 a.m., the Maintenance Director stated the facility provided portal heaters to residents who had cold rooms. The Maintenance Director stated the facility purchased the portable heaters at a local department store. Observation on 1/17/24 at 10:37 a.m., revealed occupied resident room [ROOM NUMBER] had a portal heater plugged into the wall and in use. The resident was observed to be free from injury and in no acute distress. During an interview on 1/17/24 at 11:00 a.m., the Maintenance Director stated 2 of the facility's HVAC units stopped functioning on 1/15/24 after the recent rain and cold weather, which caused the coils in the HVAC units to freeze. The Maintenance Director stated the resident rooms had a separate unit, which was still functional but was not able to keep up with the current cold weather. The Maintenance Director stated, we don't use space heaters normally . but during the last rain and freezing weather, we had to because the rain froze the units. The Maintenance Director stated the Administrator authorized the use of the portal space heaters. The Maintenance Director stated the facility had approximately 17 [portable space heater] units currently in use. When asked why would the facility not use space heaters, the Maintenance Director stated, because people get careless. When asked what can happen if a space heater was used improperly, the Maintenance Director stated, it could cause a fire, someone might pull the cord. It could cause [an electrical] short. The Maintenance Director stated the ADON spoke to the staff about conducting rounds and checking on the residents. The Maintenance Director stated the facility monitored if the residents were safe, if the residents were not Page 1 of 2 675690 675690 01/19/2024 Golden Estates Rehabilitation Center 130 Spencer LN San Antonio, TX 78201

F 0908 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some going to place items on the heater, and if the resident was not confused. The Maintenance Director stated the facility's admissions policies addressed the use of portable space heaters, but he was unsure specifically what the admission policy stated. Observation on 1/17/24 at 11:52 a.m., revealed occupied resident room [ROOM NUMBER] had a working portable space heater plugged into the wall and in use. The resident was observed to be free from injury and in no acute distress. During an interview on 1/17/24 at 1:20 p.m., the Administrator stated the facility provided heaters to the resident rooms, checked the residents frequently, provided extra blankets to the residents, checked the temperatures in the room, changed shower schedules, provided hot liquids, and provided hot meals. The Administrator stated the facility generally did not allow portable space heaters and the admission packet also stated portable space heaters were not allowed. The Administrator stated due to the age of the facility's HVAC system, the portable space heaters were provided for resident warmth. The Administrator stated the department managers monitored the portable space heaters every 30 minutes to ensure the heater was not close to the resident, the room was not too hot, and the heater was free from flammable items. The Administrator stated the residents were assessed for safety with the portable space heaters on a case-by-case basis and if the portable space heater was not deemed safe for the resident, then the portable space heater would not be provided. Observation during the building inspection tour on 1/17/24 between 2:14 p.m. to 2:56 p.m. revealed portable space heaters plugged into the wall and in use in occupied resident rooms #122, #123, #125, #202, #203, #205, #207, #209, #211, #215, #216, #229, #221, #101, #103, #105, #109, #111, #113, #115, #116, #118, and #119. The residents in the rooms with portable space heaters was observed to be free from injury and in no acute distress. Observation on 1/18/24 at 4:30 p.m. revealed a portable space heater the facility previously utilized in a resident room was tested with an infrared thermometer and was observed heating over 300 degrees Fahrenheit. Record review of a facility document titled [Facility Name] House Rules, not dated, revealed the following: SAFETY HAZARDS: Please REFRAIN from the following: .Space Heaters. 675690 Page 2 of 2