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Based on record review and interviews, the facility failed to document the inspection, testing and maintenance of the facility's duct smoke detectors.
1. The facility failed to test in place the duct smoke detectors according to manufacture's recommendations as required by NFPA 72 (2010 edition)Table 14.4.2.2(g)(1).
2. The facility failed to verify the correct pressure differential ( within the manufacturer's published ranges) between the inlet and exhaust tubes as required by NFPA 72 (2010 edition ) Table 14.4.2.2(g) (6).
NFPA 101 (2012 edition) chapter 9.6.1.3
The findings include:
During record review January 30, 2017 with the Maintenance Director:
1. The facility furnished documents for the function testing of the duct smoke detectors. In a telephone interview on speaker-phone the fire alarm technician stated the duct smoke detectors were tested in place by spraying canned smoke into the smoke detector head. The manufacturer's recommendations require canned smoke, with the aid of an extension be sprayed into the duct work through a test port within the duct smoke detector housing.
2. The facility failed to document the pressure differential between the sampling tubes. In an interview the Maintenance Director acknowledged the documentation was not available.