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MILLE LACS HEALTH SYSTEM
No Description Available
Tag No.: K0025
Based on observation and staff interview, the facility failed to maintain 1 of several smoke barrier walls construction that meet the requirements of NFPA Life Safety Code 101 2000 edition sections 19-3.7.3 and 8.3. This deficient practice could affect 4 of 28 patients as well as an undetermined number of staff, and visitors by allowing smoke to propagate from one smoke compartment to another.
Findings include:
On facility tour between 10:00 AM to 2:00 PM on 06/08/2016, observation revealed that there is a penetration found around the cable tray that is passing through the 1 hour smoke barrier above the ceiling tiles in the smoke barrier wall located above the FD 12 smoke barrier door.
This deficient condition was verified by a Facilities Director.
No Description Available
Tag No.: K0056
Based on observations, the automatic sprinkler system is not installed and maintained in accordance with NFPA 13 the Standard for the Installation of Sprinkler Systems 1999 edition. The failure to maintain the sprinkler system in compliance with NFPA 13 (99) could allow system being place out of service causing a decrease in the fire protection system capability in the event of an emergency that could affect 60 of 60 residents, as well as an undetermined number of staff, and visitors.
Findings include:
On facility tour between 10:00 AM to 2:00 PM on 06/08/2016, observations reveled that the fire sprinkler system gauges located at the main sprinkler riser have not been replaced or recalibrating since 2008.
This deficient condition was verified by a Facilities Director.
LIFE SAFETY CODE STANDARD
Tag No.: K0025
Based on observation and staff interview, the facility failed to maintain 1 of several smoke barrier walls construction that meet the requirements of NFPA Life Safety Code 101 2000 edition sections 19-3.7.3 and 8.3. This deficient practice could affect 4 of 28 patients as well as an undetermined number of staff, and visitors by allowing smoke to propagate from one smoke compartment to another.
Findings include:
On facility tour between 10:00 AM to 2:00 PM on 06/08/2016, observation revealed that there is a penetration found around the cable tray that is passing through the 1 hour smoke barrier above the ceiling tiles in the smoke barrier wall located above the FD 12 smoke barrier door.
This deficient condition was verified by a Facilities Director.
LIFE SAFETY CODE STANDARD
Tag No.: K0056
Based on observations, the automatic sprinkler system is not installed and maintained in accordance with NFPA 13 the Standard for the Installation of Sprinkler Systems 1999 edition. The failure to maintain the sprinkler system in compliance with NFPA 13 (99) could allow system being place out of service causing a decrease in the fire protection system capability in the event of an emergency that could affect 60 of 60 residents, as well as an undetermined number of staff, and visitors.
Findings include:
On facility tour between 10:00 AM to 2:00 PM on 06/08/2016, observations reveled that the fire sprinkler system gauges located at the main sprinkler riser have not been replaced or recalibrating since 2008.
This deficient condition was verified by a Facilities Director.