Inadequate Illumination of Egress Pathways
Penalty
Summary
During a Life Safety Code Survey conducted from February 24 to February 28, 2025, it was observed that the facility failed to ensure proper illumination of the means of egress for four of seven exits. Specifically, the outdoor exit discharge pathways lacked sufficient lighting to the public way. Observations made on February 24, 2025, between 1:11 PM and 1:24 PM revealed that there was no exterior lighting present to illuminate several sections of the exterior egress pathways. These included a 100-foot-long section between the exits from the A1 and D2 corridors, a 50-foot-long section between the exits from the D2 corridor and physical therapy, a 100-foot-long section between the exits from the D1 and C2 corridors, and a 50-foot-long section between the exits from the C2 corridor and the main entrance. During an interview conducted on the same day at 1:24 PM, the Environmental Services Director stated they were unaware of the lack of lighting between exits or the need for additional lighting. The director acknowledged the presence of lighting at the exits but indicated that additional lighting could be added for the pathways.
Plan Of Correction
Plan of Correction: Approved March 19, 2025 K281 Corrective Action - To ensure the facility meets the requirements of illumination of means of egress, including exit discharge, is arranged in accordance with 7.8 and shall either be continuously in operation or capable of automatic operation without manual intervention. 1) The facility will install lighting: in the 100 foot long section of exterior egress pathway between the exits from A1 and D2 corridors; the 50 foot long section of exterior egress pathway between the exits from D2 and D2 physical therapy; the 100 foot long section of exterior egress pathway between the exits from D1 and C2 corridors; and the 50 foot long section of exterior egress pathway between the exits from the C2 corridors and the main entrance so that the egress paths are illuminated in compliance with the Life Safety Code. 2) The Director of maintenance will conduct a complete inspection of all means of egress to identify any additional areas that may require increased lighting in compliance with the Life Safety Code. Annual inspection of egress path lighting will be added to the facility’s electronic work order system. 3) The Administrator will oversee in-services to all maintenance department staff in regard to the life safety requirements for means of egress lighting. 4) All means of egress will be audited monthly for 3 months and as needed based on the audits findings. Audits will verify all egress lighting meets the requirement of the Life Safety Code. The Administrator will monitor this process and review the results monthly at QAPI meetings. If continued improvement is required, the committee may make further recommendations. The Administrator will assume overall responsibility for the correction of K281.