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ADVOCATE LUTHERAN GENERAL HOSPITAL
Corridor - Doors
Tag No.: K0363
Based on observation, not all corridor doors are installed and maintained as required. This deficient practice could affect patients, staff, and visitors in the building because smoke and fire could pass into corridors if the corridor doors are not installed in a compliant manner.
Findings include:
A. On 04/25/19 at 8:16am, while accompanied by the MM, observation determined that the pair of doors from the Second Floor Elevator Lobby W-280 are secured against egress in a manner prohibited by 19.2.2.2.4.
On 12/15/21 doors were observed to have manual release push buttons installed on the pull side of doors (elevator lobby side) but no sensor activation to release magnets to comply with Access Controlled Egress Door requirements of 7.2.1.6.2. Alternatively, Delayed Egress hardware was not installed to comply with 7.2.1.6.1 to permit egress from the elevator lobby into the secured Peds unit where access to exit stairs is available.
20224
B. Corrected 12/15/21