HospitalInspections.org

The standard is not met as evidence by:

While surveying the facility with the maintenance manager, based on observation, the facility failed to maintain required smoke barrier protection at door to surgical corridor. Door is required to resist the passage of smoke and door is substantially warped at base.

This standard is not met as evidence by:

While touring the facility with the maintenance manager it was observed, throughout the entire facility, corridors are obstructed with stored items e.g. gurneys, x-ray machines, linen containers, wheel chairs and such..

k062 D
This standard is not met as evidence by:

While surveying the facility, with the maintenance manager, it was observed on 11-16-2015 the fire sprinkler gauges have exceeded or are due for calibration. Documentation states sprinkler gauges were last calibrated in March 2010 or some gauges were missing calibration dates.

This in accordance with the standard(NFPA 25 SECTION 2-3.2 1998 edition as ref.by the standard).

The standard is not as evidence by:

Based on observations while touring the facility with the maintenance manager it was observed the facility failed to maintain the O2 storage room IAW the standard. The evidence includes the observation of combustible material located with in 5' of O2 storage exceeding 300 cubic feet in quantity. The current storage practice does not comply with provisions of NFPA 99 Section 8-3.1.11.2 (c) (2). The material was removed by maintenance manager at time of inspection.

The standard is not met as evidence by:

While surveying the facility with the maintenance manager, based on observation, the facility failed to maintain required smoke barrier protection at door to surgical corridor. Door is required to resist the passage of smoke and door is substantially warped at base.

This standard is not met as evidence by:

While touring the facility with the maintenance manager it was observed, throughout the entire facility, corridors are obstructed with stored items e.g. gurneys, x-ray machines, linen containers, wheel chairs and such..

k062 D
This standard is not met as evidence by:

While surveying the facility, with the maintenance manager, it was observed on 11-16-2015 the fire sprinkler gauges have exceeded or are due for calibration. Documentation states sprinkler gauges were last calibrated in March 2010 or some gauges were missing calibration dates.

This in accordance with the standard(NFPA 25 SECTION 2-3.2 1998 edition as ref.by the standard).

The standard is not as evidence by:

Based on observations while touring the facility with the maintenance manager it was observed the facility failed to maintain the O2 storage room IAW the standard. The evidence includes the observation of combustible material located with in 5' of O2 storage exceeding 300 cubic feet in quantity. The current storage practice does not comply with provisions of NFPA 99 Section 8-3.1.11.2 (c) (2). The material was removed by maintenance manager at time of inspection.