HospitalInspections.org

Based on interview and record review, the facility failed to ensure the building fire alarm system was maintained as required by NFPA fire alarm standards. This deficient practice affected five of five smoke compartments, staff, and all the residents. The facility has the capacity for 55 beds with a census of 26 on the day of the survey.

The findings include:

During the Life Safety Code tour on 03/01/12, at 12:10 PM, an interview and record review with the Director of Maintenance (DOM) revealed the facility fire alarm system was inspected on an annual basis. Annual inspections are permissible as long as the facility maintains a record of other required testing frequencies as outlined in the fire alarm code. The DOM stated he had not been testing and documenting the fire alarm system and or components quarterly, semi-annually, etc. as required by the fire alarm code.

Reference: NFPA 70 (1999 Edition).

7-3.2* Testing.
Testing shall be performed in accordance with the schedules in Chapter 7 or more often if required by the authority having jurisdiction. If automatic testing is performed at least weekly by a remotely monitored fire alarm control unit specifically listed for the application, the manual testing frequency shall be permitted to be extended to annual. Table 7-3.2 shall apply.

Based on interview and record review, the facility failed to ensure the building fire alarm system was maintained as required by NFPA fire alarm standards. This deficient practice affected five of five smoke compartments, staff, and all the residents. The facility has the capacity for 55 beds with a census of 26 on the day of the survey.

The findings include:

During the Life Safety Code tour on 03/01/12, at 12:10 PM, an interview and record review with the Director of Maintenance (DOM) revealed the facility fire alarm system was inspected on an annual basis. Annual inspections are permissible as long as the facility maintains a record of other required testing frequencies as outlined in the fire alarm code. The DOM stated he had not been testing and documenting the fire alarm system and or components quarterly, semi-annually, etc. as required by the fire alarm code.

Reference: NFPA 70 (1999 Edition).

7-3.2* Testing.
Testing shall be performed in accordance with the schedules in Chapter 7 or more often if required by the authority having jurisdiction. If automatic testing is performed at least weekly by a remotely monitored fire alarm control unit specifically listed for the application, the manual testing frequency shall be permitted to be extended to annual. Table 7-3.2 shall apply.