Corridor Door Latching Deficiency
Penalty
Summary
The facility failed to meet the corridor door requirements as evidenced by an observation and interview conducted on January 16, 2025. During the observation at 11:25 a.m., it was noted that the door to resident room #74 did not latch properly in the frame. This deficiency was confirmed through an interview with the maintenance manager at the same time, who acknowledged the issue with the door. The report highlights that the corridor doors are required to resist the passage of smoke and have positive latching hardware, as per the NFPA 101 standards and CMS regulations. However, the door in question did not meet these standards, as it failed to latch, potentially compromising the safety measures intended to prevent the spread of smoke in the event of a fire. The deficiency was identified in one of over twenty corridor doors inspected during the survey.
Plan Of Correction
Resident room #74 now positively latches. The Maintenance Director and/or designee will complete an audit of all doors to ensure that all doors positively latch. Audits will be completed quarterly for compliance.