Failure of Fire-Rated Corridor Doors to Close and Latch
Penalty
Summary
Surveyors observed that the fire-rated cross corridor double doors located outside the Salon did not fully close and latch when released from their magnetic hold open devices. This failure was identified during an inspection on April 24, 2025, at approximately 10:50 AM. The doors are required to resist the passage of smoke and, in this case, did not meet the necessary standards for protecting corridor openings as outlined by NFPA 19.3.6.3. The deficiency was confirmed through an interview with the maintenance director at the time of observation. The inability of these doors to close and latch properly could allow heat, smoke, and fire to pass from one compartment to another, potentially affecting up to 50 occupants. No specific residents or their medical conditions were mentioned in the report.
Plan Of Correction
1. Fire-rated cross corridor double doors outside the Salon were adjusted to close properly. 2. Audit completed of fire-rated doors to ensure proper closing. Corrections made as needed. 3. Administrator/Designee completed education to Maintenance Department on requirement that fire doors fully close and latch when released from the magnetic hold open devices. 4. Maintenance Director/Designee will complete random audits of corridor double doors to ensure doors close and latch properly with findings submitted to QAPI for review and recommendations. 5. Maintenance Director is responsible for maintaining compliance.