HospitalInspections.org

Based on observation and staff interview, the facility failed to provide smoke resistant partitions to separate hazardous areas from the rest of the building in 1 of 2 smoke compartments. This condition would allow smoke and fire gases to migrate into the exit corridors. The facility has a capacity of 24, with a census of 2 on the date of survey.

Findings are:
Observation on 9-19-23 at 11:05 am revealed an unsealed 2 inch by four inch hole in the south wall of the boiler room.

During an interview on 9-19-23 at 11:05 am, Maintenance Staff A and B acknowledged the findings.

Based on observation and staff interview, the facility failed to maintain the proper spacing between fire sprinklers. This condition would allow one sprinkler to cool the other sprinkler thus preventing the second sprinkler from opening and flowing water when needed. The facility is licensed for 24 beds, with a census of 2 on the day of survey.

Findings are:
Observation on 9-19-23 at 11:24 am revealed a wall had been removed in the front entryway, which allowed two sprinklers to be within four feet of each other.

During an interview on 9-19-23 at 11:24 am Maintenance Staff A and B confirmed the findings.



NFPA 13, 2010 ed. 8.6.3.4 Minimum Distances Between Sprinklers.

8.6.3.4.1 Unless the requirements of 8.6.3.4.2, 8.6.3.4.3, or 8.6.3.4.4 are met, sprinklers shall be spaced not less than 6 ft (1.8 m) on center.