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K0374
E

Smoke Barrier Door Deficiency

Philadelphia, Pennsylvania Survey Completed on 02-13-2025

Penalty

No penalty information released
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to maintain doors in smoke barrier walls to resist the passage of smoke, affecting one of six levels within the component. During an observation on February 13, 2025, it was noted that the double smoke doors next to room 505 did not close smoke tight. Additionally, the double smoke doors next to room 526 had voids in the door frame where hardware had been removed. These issues were confirmed during an interview at the exit conference with the Chief Operating Officer, Administrator, and Maintenance Director.

Plan Of Correction

1. No Residents were affected by this practice. 2. All other smoke doors were approved and functional. 3. Locksmith repaired the smoke door by room 505. Voids were closed up with steel fasteners by room 526 on 2/24/25. 4. Maintenance Dept will continue to monitor during weekly Preventative Maintenance rounds, and will bring findings to monthly Safety & QAPI Meetings overseen by the Administrator, x3 months.

See complete original report
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