IR 07200202/2030001

Princeton Community Hospital; NRC Form 591M Part 1, Inspection Report 03010772/2023001

ML24078A276
Person / Time
Site:	07200202, 03010772
Issue date:	12/12/2023
From:	Patel N NRC Region 1
To:	Olson D Princeton Community Hosp
References
IR 2023001
Download: ML24078A276 (1)

Text

NRC FORM 591 M PART 1 NUCLEAR REGULATORY COMMISSION (04-2022)

10 CFR 2.201 SAFETY INSPECTION REPORT AND COMPLIANCE INSPECTION LICENSEE/LOCATION INSPECTED NRC/REGIONAL OFFICE Princeton Community Hospital Region 1 12th Street Extension Rd Princeton, WV 24740 475 Allendale Suite 102 King of Prussia, PA 19406

REPORT NUMBER(s) 2023001 DOCKET NUMBER(S) LICENSE NUMBER(S) DATE(S) OF INSPECTION 030-10772 47-16307-01 12/12/2023; Exit 02/26/2024

LICENSEE:

The inspection was an examination of the activities conducted under your license as they relate to radiation safety and to compliance with the Nuclear Regulatory Commission (NRC } rules and regulations and the conditions of your license. The inspection consisted of selective examinations of procedures and representative records, interviews with personnel, and observations by the inspector. The inspection findings are as follows: Based on the inspection findings, no violations were identifie. Previous violation(s) close.The vio!ations(s), specifically described to you by the inspector as non-cited violations, are not being cited because they were self-identified, non-repetitive, and corrective action was or is being taken, and the remaining criteria in the NRC Enforcement Policy, to exercise discretion, were satisfie Non-cited violation(s) were discussed involving the following requirement(s):

0 During this inspection, certain of your activities, as described below and/or attached, were in violation of NRC requirements and are being cited in accordance with the NRC Enforcement Polic This form is a NOTICE OF VIOLATION, which may be subject to posting in accordance with 10 CFR 19.1 (Violations and Corrective Actions)

license Condition 14 of NRC license N, Amendment 35, in part, that the licensee shall conduct its program in accordance with the statements, representations, and procedures contained in the letter dated March 17, 202 Contrary to above, from March 17, 2022 until December 12, 2023, the licensee did not conduct its program in accordance with the statements, representations, and procedures contained in the letter dated March 17, 202 Specifically, one of the two stress rooms used in their cardiology department was not mentioned in the facility diagram submitted in letter dated March 17, 202 This is a Severity Level IV violation (NRC Enforcement Policy, Section 6.3).

For corrective actions, the licensee submitted an amendment request to update their cardiology department facility diagram on December 12, 202 Statement of Corrective Actions

I hereby state that within 30 days, the actions described by me to the Inspector will be taken to correct the violations identified. This statement of corrective actions is made in accordance with the requirements of 10 CFR 2.201 (corrective steps already taken, corrective steps which will be taken, date when full compliance will be achieved). I understand that no further written response to NRC will be required, unless specifically requeste TITLE PRINTED NAME SIGNATURE DATE

LICENSEE'S p REPRESENTATIVE A' Al 1 CJ, OL.50#; /l1t:> p__,__a ~l#P 3jl'5/ZoZ'f

NRC INSPECTOR Neira Patel Netra Patel Digitally sign d by Neira Patel

. Date: 202.12 10:39:34 -04'00'

BRANCH CHIEF Anne Defrancisco Anne E DeFrancisco rngital~slgoedb Anne Defrancisco

• , Date: 2024.03.11 1 :27:05 -04'00'

NRC FORM 591M PART 1 (04/2022) Page 1 of 1