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Based on observation, record review and interview, the facility failed to provide a resilient all-weather path and safe access to a public way from two of three patient wings of the building in accordance with Chapters 7.1.10.1 and 7.7.1 of the 2000 NFPA 101. The lack of a hard path to safety, negotiable in all types of weather is an impediment to elderly and handicapped patients and could have a potential negative effect on survival rates during a catastrophic event if ordered to evacuate the premises. The facility census was 14.

Findings included:

1. The 2000 NFPA 101 Standards chapter 7 requires:

- Means of egress shall be continuously maintained free of all obstructions or impediments to full instant use in the case of fire or other emergency. 2000 NFPA 101, 7.1.10.1

- Exits shall terminate directly at a public way or an exterior exit discharge. Yards, courts, open spaces, or other portions of the exit discharge shall be of required width and size to provide all occupants with a safe access to a public way. 2000 NFPA 101, 7.7.1

- Abrupt changes in elevation of walking surfaces shall not exceed ¼ inches. Changes in elevation exceeding ¼ inches, but not exceeding ½ inches, shall be beveled 1 to 2. Changes in elevation exceeding ½ inches shall be considered a change in level and shall be subject to the requirements of 7.1.7. 2000 NFPA 101, 7.1.6.2

- Walking surfaces shall be nominally level. The slope of a walking surface in the direction of travel shall not exceed 1 in 20 unless the ramp requirements of 7.2.5 are met. The slope perpendicular to the direction of travel shall not exceed 1 in 48. Means of egress shall be continuously maintained free of all obstructions or impediments to full instant use in the case of fire or other emergency. 2000 NFPA 101, 7.1.6.3

2. Observation on 03/16/15 at 1:45 PM showed the exit discharge from west end of the 300 hall opened onto an outdoor concrete step, four feet wide by three feet deep and dropped approximately 10 inches to a relatively level grass lawn. The nearest accessible paved public way was the southwest parking lot at the southwest corner of the building, approximately 178 feet away.

3. Observation on 03/16/15 at 2:58 PM showed the exit discharge from the north end of the 200 hall opened onto an outdoor concrete step, four feet wide by three feet deep and dropped approximately 10 inches to a relatively level grass lawn. The nearest accessible paved public way was the southwest parking lot, at the southwest corner of the building, approximately 278 feet away.

4. During an interview on 03/18/15 at 11:00 AM, Staff ZZ Director of Maintenance acknowledged the observations and stated that none of their previous surveys had cited or discussed an all-weather path to safety.

Based on observation and interview, the facility failed to secure storage of medical and other compressed gases in accordance with NFPA 99, 4.3.1.1.2 and 4.3.5.2.1 with racks, chains or other fastenings to individually secure all cylinders to prevent them from falling or inadvertently being tipped over during change-outs. If the valve stem is broken or severed, the forceful release of compressed gases can cause the cylinder to become an unguided projectile that moves with enough force to penetrate a brick or concrete wall and cause injury or death to staff and patients. The facility census was 14.

Findings included:

1. Observation on 03/18/15 at 9:55 AM showed approximately 11 H-size cylinders of compressed nitrogen gas chained in groups of three and the northwest side of the facility. The cylinders were chained in several groups and attached to a manifold that supplied the facility's medical gas lines. Without an assured restraint (more significant than the brass tubing connection to the manifold) cylinders with uncapped and exposed valve stems are vulnerable to damage if one or more were tipped over.

2. During an interview on 03/18/15 at 9:55 AM, Staff ZZ Director of Maintenance, stated that he was aware cylinders of compressed gases should be secured, however he did not know they needed to be individually secured.

Based on observation, record review and interview, the facility failed to provide a resilient all-weather path and safe access to a public way from two of three patient wings of the building in accordance with Chapters 7.1.10.1 and 7.7.1 of the 2000 NFPA 101. The lack of a hard path to safety, negotiable in all types of weather is an impediment to elderly and handicapped patients and could have a potential negative effect on survival rates during a catastrophic event if ordered to evacuate the premises. The facility census was 14.

Findings included:

1. The 2000 NFPA 101 Standards chapter 7 requires:

- Means of egress shall be continuously maintained free of all obstructions or impediments to full instant use in the case of fire or other emergency. 2000 NFPA 101, 7.1.10.1

- Exits shall terminate directly at a public way or an exterior exit discharge. Yards, courts, open spaces, or other portions of the exit discharge shall be of required width and size to provide all occupants with a safe access to a public way. 2000 NFPA 101, 7.7.1

- Abrupt changes in elevation of walking surfaces shall not exceed ¼ inches. Changes in elevation exceeding ¼ inches, but not exceeding ½ inches, shall be beveled 1 to 2. Changes in elevation exceeding ½ inches shall be considered a change in level and shall be subject to the requirements of 7.1.7. 2000 NFPA 101, 7.1.6.2

- Walking surfaces shall be nominally level. The slope of a walking surface in the direction of travel shall not exceed 1 in 20 unless the ramp requirements of 7.2.5 are met. The slope perpendicular to the direction of travel shall not exceed 1 in 48. Means of egress shall be continuously maintained free of all obstructions or impediments to full instant use in the case of fire or other emergency. 2000 NFPA 101, 7.1.6.3

2. Observation on 03/16/15 at 1:45 PM showed the exit discharge from west end of the 300 hall opened onto an outdoor concrete step, four feet wide by three feet deep and dropped approximately 10 inches to a relatively level grass lawn. The nearest accessible paved public way was the southwest parking lot at the southwest corner of the building, approximately 178 feet away.

3. Observation on 03/16/15 at 2:58 PM showed the exit discharge from the north end of the 200 hall opened onto an outdoor concrete step, four feet wide by three feet deep and dropped approximately 10 inches to a relatively level grass lawn. The nearest accessible paved public way was the southwest parking lot, at the southwest corner of the building, approximately 278 feet away.

4. During an interview on 03/18/15 at 11:00 AM, Staff ZZ Director of Maintenance acknowledged the observations and stated that none of their previous surveys had cited or discussed an all-weather path to safety.

Based on observation and interview, the facility failed to secure storage of medical and other compressed gases in accordance with NFPA 99, 4.3.1.1.2 and 4.3.5.2.1 with racks, chains or other fastenings to individually secure all cylinders to prevent them from falling or inadvertently being tipped over during change-outs. If the valve stem is broken or severed, the forceful release of compressed gases can cause the cylinder to become an unguided projectile that moves with enough force to penetrate a brick or concrete wall and cause injury or death to staff and patients. The facility census was 14.

Findings included:

1. Observation on 03/18/15 at 9:55 AM showed approximately 11 H-size cylinders of compressed nitrogen gas chained in groups of three and the northwest side of the facility. The cylinders were chained in several groups and attached to a manifold that supplied the facility's medical gas lines. Without an assured restraint (more significant than the brass tubing connection to the manifold) cylinders with uncapped and exposed valve stems are vulnerable to damage if one or more were tipped over.

2. During an interview on 03/18/15 at 9:55 AM, Staff ZZ Director of Maintenance, stated that he was aware cylinders of compressed gases should be secured, however he did not know they needed to be individually secured.