Exit Door Alarm Failure Creates Elopement and Accident Hazard
Penalty
Summary
A deficiency was identified when one of four exit doors on the resident floors was found to be unarmed, failing to sound an alarm when opened. During an observation, a staff member was seen opening the exit door to the stairwell without the alarm activating or using a key to deactivate it, despite signage indicating that the alarm should sound if the door is opened. Certified Nursing Assistant (CNA) 1 confirmed during an interview that the door should alarm when opened but did not know why it was not functioning. The Housekeeping Supervisor also attempted to arm the door with a key but was unsuccessful, stating that the alarm must be broken. The Director of Nursing (DON) acknowledged in an interview that the lack of an alarm on the exit door poses a risk, as someone who is confused could open the door and potentially have an accident or fall. The facility's policy, revised in January 2025, states that the environment should be as free from accident hazards as possible and that staff are trained to identify and report such hazards. However, the failure to maintain the alarm system on the exit door represents a lapse in these safety measures.