HospitalInspections.org

Heat from a fire stratifies to the suspended ceiling and travels along the suspended ceiling to activate the sprinkler. When suspended ceiling tiles are missing or damaged, it delays the activation of the automatic fire sprinkler system.

The facility failed to ensure the proper position of suspended ceiling tiles in areas protected by the automatic fire sprinkler system.

Observation determined two (2) suspended ceiling tiles were missing in the facility. One in the Emergency Room Lobby and one in an Electrical Mechanical Room.

Failure to ensure the proper position of suspended ceiling tiles in areas protected by the automatic fire sprinkler system increases the risk of injury and death by fire.

This deficiency affected one (1) of two (2) smoke compartments on the first level of the Hospital.

The facility failed to ensure doors in smoke barrier walls were self-closing and resisted the passage of smoke. 18.3.7.8

Observation determined:
1) The pair of cross-corridor doors near the Nurses Station on the first-floor smoke barrier failed to self-close to the fully closed position and resist the passage of smoke.
2) The pair of cross-corridor doors near the Cardio Room on the lower-level smoke barrier failed to self-close to the fully closed position and resist the passage of smoke.

Failure to ensure smoke barrier doors were self-closing and resisted the passage of smoke increases the risk of injury and death from fire.

This deficiency affected two (2) of four (4) smoke compartments.