The Centers for Medicare and Medicaid Services (CMS) found that River Park Hospital was out of compliance with a condition of Medicare participation and was in violation of West Virginia licensure rules. An interview with the Director of Nursing revealed that the facility had moved its forensic inpatients into an area of the hospital which had previously been used as an adolescent outpatient program in the 1990’s and then as the facility’s billing office. River Park had renovated this area before moving the patients, but apparently did not submit its plans to the Office of Health Facility Licensure and Certification (OHFLAC) for approval. In its response, the facility wrote that it had considered the conversion to be “face-lifting” a unit to re-open it, which did not require approval from OHFLAC. CMS also found that the construction done in the conversion did not meet the minimum standards for health care facilities. For instance, the clothes dryer was vented into a container of water instead of being vented to the outside of the building. The unit contained door hinges, door knobs and faucet handles that should have been replaced because they were not safe for suicidal patients. The unit also contained just one shower stall for 10 adult patients. CMS found that looping and ligature suicide hazards were not limited to just this unit, but were present in all 8 patient care units of the hospital. For this reason CMS found that River Park did not meet the Medicare condition of participation for physical environment. In order to correct its deficiencies and gain permission to re-open the forensic unit, River Park had to secure its ceiling tiles, replace sprinklers, door hinges and handles, water faucet handles, shower mixing valves and self-closing door devices. Padlocks, which were present in patient rooms throughout the facility, had to be replaced with anti-ligature lock hardware.