When ICF/IID programs deal with state issues, the three words that most hate to hear is "State is here." It's the sign that an investigation, complaint, or a survey is about to start. Usually none of those situations inspires any level of comfort. Most facilities dread getting the paperwork together, answering the questions, supplying the information needed, and dealing with the potential of deficient practice being cited. In Texas, once a health team shows up for survey, you can anticipate that Life Safety Code or LSC is not far behind. As a result of LSC, the program generally goes from a sigh of relief that the surveyors have left the building, to the feeling of "Here we go again" as the LSC rolls through the door. Suddenly there is an entirely new set of questions being thrown at the facility. You end up showing fire alarm permits, fire marshal inspection (not always easy to get in many parts of Texas by the way) and dealing with a variety of other questions. Everything suddenly shifts from the health, safety and well-being of the individuals living in the home, to the safety of the individuals from a view of the home being safe. LSC doesn't care whether the individuals have gone for annual vision exams or not, but they sure do care if you haven't gotten an inspection required for a part of the home.
Fortunately, I have found that the LSC survey can often be a vital and very important part of the survey process. While you may not always agree with their findings, you can always be sure their findings are an attempt to ensure the safety of individuals, staff and visitors to the home. During a survey recently, we found an example of how important having the second set of eyes of the LSC surveyor can be to the facility.
The survey had gone great with only a few minor LSC issues being pointed out. At the end of the survey, the surveyor asked for our Smoke Sensitivity Test. We talked about it and the surveyor said I could email it to him.
After a quick call to the alarm company, they sent the inspection paper and told us that there should be a blue tag in the alarm box with the sensitivity test information on it. We copied both and sent them to the survey team. Within a short time a call returned that indicated the paperwork we sent was not what they needed. They gave us specific information to look for from the fire alarm company.
Another call and clarification with the fire alarm company brought some "alarming" information to light. The fire alarm company stated that according to their records, they had never done a smoke sensitivity test of the system at the home. Needless to say we were shocked.
The end result was a deficiency for failure to have the smoke sensitivity test completed. However, the more important end result was that the process of the LSC survey had resulted in our facility finding that we did not have a smoke sensitivity test. It was an issue that could have easily put all individuals living in the home at risk, and a clear example of why LSC surveys have an important role in the ICF/IID program.
