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1000 NORTH 15TH STREET

HUMBOLDT, IA 50548

No Description Available

Tag No.: K0069

Based on record review and interview, the facility failed to inspect the Hood Suppression system every 6 months as required. This could affect the Kitchen smoke compartment and all occupants in one of four smoke compartments in the building . This facility has a capacity of 21 and a census of 2 residents.

Findings include:

During the record review of the facility's fire safety components on 7-31-15, revealed the hood suppression system was inspected on 4-21-14 and 12-1-14 by Simplex. The facility was unable to provide documentation of an inspection for the system six months after the December 2014 inspection.

Maintenance Staff (A) confirmed this record review.

No Description Available

Tag No.: K0144

Based on observation and interview, the facility failed to ensure the buildings emergency generator was properly equipped with a remote manual stop mechanism in accordance with National Fire Protection Association (NFPA) 110, 1999 Edition. This deficient practice affects all occupants throughout the facility. This facility has a capacity of 21 and a census of 2.

Findings include:

Observations and interview on 7-31-15 at 10:45 a.m., revealed the facilities emergency generator was not equipped with a remote manual stop mechanism (emergency shut-off). This remote manual stop mechanism shall be placed somewhere near the emergency generator, but not inside the generators main panel.

Maintenance Staff (A) verified this observation.

No Description Available

Tag No.: K0147

Based on observation and interview, it was determined the facility failed to maintain the buildings electrical wiring system in accordance with National Fire Protection Association (NFPA) Standard 70, National Electrical Code, 1999 edition, placing the Staff of the facility at risk in the event of a fire. The facility had a capacity of 21 and a census of 2 at the time of the survey.

Findings Include:

Observation and interview on 7-31-15 at 10:41 a.m., revealed the facility failed to maintain the electrical system in the Transfer Switch room. Panel ES1 was missing the breaker directory.

Maintenance Staff (A) verified observation.

LIFE SAFETY CODE STANDARD

Tag No.: K0069

Based on record review and interview, the facility failed to inspect the Hood Suppression system every 6 months as required. This could affect the Kitchen smoke compartment and all occupants in one of four smoke compartments in the building . This facility has a capacity of 21 and a census of 2 residents.

Findings include:

During the record review of the facility's fire safety components on 7-31-15, revealed the hood suppression system was inspected on 4-21-14 and 12-1-14 by Simplex. The facility was unable to provide documentation of an inspection for the system six months after the December 2014 inspection.

Maintenance Staff (A) confirmed this record review.

LIFE SAFETY CODE STANDARD

Tag No.: K0144

Based on observation and interview, the facility failed to ensure the buildings emergency generator was properly equipped with a remote manual stop mechanism in accordance with National Fire Protection Association (NFPA) 110, 1999 Edition. This deficient practice affects all occupants throughout the facility. This facility has a capacity of 21 and a census of 2.

Findings include:

Observations and interview on 7-31-15 at 10:45 a.m., revealed the facilities emergency generator was not equipped with a remote manual stop mechanism (emergency shut-off). This remote manual stop mechanism shall be placed somewhere near the emergency generator, but not inside the generators main panel.

Maintenance Staff (A) verified this observation.

LIFE SAFETY CODE STANDARD

Tag No.: K0147

Based on observation and interview, it was determined the facility failed to maintain the buildings electrical wiring system in accordance with National Fire Protection Association (NFPA) Standard 70, National Electrical Code, 1999 edition, placing the Staff of the facility at risk in the event of a fire. The facility had a capacity of 21 and a census of 2 at the time of the survey.

Findings Include:

Observation and interview on 7-31-15 at 10:41 a.m., revealed the facility failed to maintain the electrical system in the Transfer Switch room. Panel ES1 was missing the breaker directory.

Maintenance Staff (A) verified observation.