36C26118Q9422-001.docx

STATEMENT OF WORK

FIRE INSPECTION SERVICES VA PALO ALTO HEALTHCARE SYSTEM

1. Introduction

1.1 The VA Palo Alto Health Care System (VAPAHCS) has a requirement for an inspection and survey to determine Life Safety code compliance (Life Safety Assessment) with the latest Edition of National Fire Protection Association (NFPA) Life Safety Code. The Contractor shall provide all labor, tools, materials, equipment, apparatuses and supervision to perform the inspection and survey.

1.2 This service is required for approximately 50-60 contracted skilled nursing facilities, residential care, nursing homes, and adult day care facilities (see spreadsheet attached as Attachment I for locations). The amount of facilities to be inspected may vary from year to year.

1. Background

2.1 This Life Safety Assessment will be used to meet the VAPAHCS requirements for Joint Commission accreditation and development of Plans for Improvement (PFI) as determined by VAPAHCS.

1. Period of Performance

3.1 The period of performance is for the base year beginning October 1, 2018 and continuing with four option years.

1. Scope

4.1 The contractor shall provide a Statement of Condition (SOC) including Life Safety Code Assessment (LSCA) in accordance with the latest NFPA code.

5.0 Performance Requirements

5.1 New facilities - Contractor shall complete the inspection of a new facility within twenty-one (21) days after notification is received from the Contracting Officer Representative (COR) or Facility Designated POC.

5.2 Annual inspections for existing facilities - A scheduled inspection list will be provided to the contractor quarterly. Additional inspections may be arranged with the contractor with a fourteen (14) calendar day minimum notice. Annual inspections shall take place within seven (7) days of annual anniversary of last inspection.

5.2 Contractor shall coordinate inspections with the appropriate facility administrators and shall provide VA a monthly schedule of inspections. The facilities director or persons responsible for the facility will be given a 5 business days’ notice prior to the contractor inspecting the facility. The exception to this is when the need of the veteran is immediate.

5.3 Contractor shall complete the inspection and provide deliverables to the COR or Designated Facility POC within three (3) days after inspections are completed.

5.4 Contractor shall use the VA checklists (Attachments II –XI) as a guide for the appropriate occupancy of the facilities as defined by the LSC. Contractor may suggest changes to improve the efficiency and validity of the checklists.

5.5 Contractor shall sign in with POC at facilities and sign out upon completing inspections.

6.0 Deliverables

6.1 Contractor shall provide the COR or Facility Designated POC with the following deliverables within three (3) days after inspection:

1. A copy of the completed and signed inspection checklist

1. Contractor shall develop a written report with a detailed list of each Life Safety Code deficiency including: a) unique identifier, b) locations of the deficiency, c) a description of the deficiency, d) recommended correction action, e) cost estimate for correcting identified deficiency and f) the specific code reference.

6.2 Contractor shall keep a running spreadsheet of facility inspected, address, square footage, and point-of-contact at the facility. An updated spreadsheet shall be submitted to the COR and Contracting Officer each quarter.

7.0 Hours of Operation

7.1 Inspections shall take place Monday through Friday from 8:00 AM – 4:00 PM, unless otherwise arranged and agreed to by facility or COR.

8.0 Contractor Qualifications

8.1 Contractor shall be a licensed Fire Protection Engineer or degreed Fire Protection Engineer from an ABET accredited program. All surveys shall be reviewed and signed off by a licensed Fire Protection Engineer.

8.2 The Contractor shall have a minimum of three (3) years’ experience in providing this type of service.

9.0 Designation of Contracting Officer’s Representative (COR)

9.1 The Contracting Officer (CO) will appoint a Contracting Officer Representative (COR) to perform tasks related to the execution and surveillance of this contract. The COR will be designated to represent the Contracting Officer (CO) in furnishing technical guidance and advice under this contract. The foregoing is not be construed as authorization to interpret or furnish advice and information to Contractor relative to the financial or legal aspect of the contract. Those matters are the responsibility of the CO and shall not be delegated.

9.2 The CO is responsible for the administration of this contract. The CO is the only individual authorized, to extent indicated in this contract, to take actions on behalf of the Government, which may result in changes in the contract terms, to include deviation from the statement of work, details, and performance schedules. Communications pertaining to contractual matters shall be addressed to the CO. No changes in or deviation from the scope of work shall be affected without a written modification to the contract executed by the CO. No oral statements of any person whosoever will in any matter or degree, modify or otherwise affect the terms of this contract.

9.3 The Contractor will receive a copy of Delegation Letter which will identify the COR appointed by the CO.

10.0 Payment and Invoices

10.1 Invoices shall be submitted to DFAS Austin as stated in SF 1449.

10.2 Payment will be made in arrears of the specified billing period after receipt of a properly prepared invoice provided all required work has been performed in accordance with contract and this Statement of Work.

11.0 Security

11.1 The C&A requirements do not apply to this service requirement and a Security Accreditation Package is not required. Contractor personnel will have NO access to VA sensitive information in their work/service area.

11.2 All contractors, whether they have access to PHI or not, are required to complete the VA Privacy and Information Security Awareness and Rules of Behavior (VA10176) training.

See attached document: Attachment I – Facility Inspection List.

See attached document: Attachment II – Checklist for Existing Day Care Occupancy and Homes.

See attached document: Attachment III – Checklist for Existing Business Occupancies.

See attached document: Attachment IV – Checklist for Residential Board and Care Facilities.

See attached document: Attachment V – Checklist for Sprinkler Protected State Veterans Nursing Home Care Facilities.

See attached document: Attachment VI – Checklist for Medical Foster Homes.

See attached document: Attachment VII – Checklist for New Sprinkler Protected Small Residential Board and Care Facilities.

See attached document: Attachment VIII – Checklist for One and Two Family Dwellings.

See attached document: Attachment IX – Checklist for Existing Small Residential and Care Facilities.

See attached document: Attachment X – Checklist for Existing Hotel Dormitories Facilities.

See attached document: Attachment XI – Checklist for Existing Large Residential Board and Care Facilities.

See attached document: Attachment XII – Checklist for Existing Nursing Home Care Facilities.

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Attachment III - Existing Business Occupancies.docx Life Safety Code Checklist

Existing Business Occupancies 2009 Edition (Rev: 11/09)

Life Safety Inspection Report

Existing Business Occupancies

(All Code References are NFPA 101 - 2009 unless otherwise noted)

This checklist is a summation of the major requirements found in Chapter 39 “Existing Business Occupancies” of the Life Safety Code. The user is cautioned to consult the code prior to answering the following questions.

Facility Name:

Facility Address:

Facility Point of Contact:

Phone No:

Circle one: Approved with no recommendations

Approved contingent upon resolution of recommendations

Disapproved

Inspected By:

Title:

Date:

Recommendations:

Item #

Standard

Reference

Yes

No

N/A

1-1

There are no minimum construction requirements for existing business occupancies.

39.1.6

X

2-1

Do all means of egress meet Chapter 7 requirements?

Are exits separated, do they have adequate headroom, are exits free from storage or other impediments?

39.2.1.1

2-2

Are doors complying with 7.2.1 provided?

· Is the egress direction obvious and direct?

· Are doors at least 28" minimum clear width?

· Is the floor elevation on each side of the door within 1/2" for at least the width of the door leaf?

· Are thresholds no higher than 1/2"?

· Are doors side hinged or pivoted swinging type (see Item #2-6 for permitted sliding fire doors)?

· Do doors serving 50 or more people swing in the direction of egress?

· Do exit enclosure doors and doors from high hazard areas swing in the direction of egress?

· Is the force needed to manually open egress doors less than 15 pounds to release the latch, 30 pounds to set the door in motion, and 15 pounds to open to its full width?

39.2.2.2.1

7.2.1.1.2

7.2.1.2.3.2(4)

7.2.1.3.1

7.2.1.3.3

7.2.1.4.1

7.2.1.4.2(1)

7.2.1.4.2(2,3)

7.2.1.4.5

2-3

If key operated locks are provided on doors to principal exits:

· Is there a sign (with at least 1" high letters) on or adjacent to the door that reads "THIS DOOR TO REMAIN UNLOCKED WHEN THE BUILDING IS OCCUPIED"?

· Is the locking device of a type that is readily distinguishable as being locked?

· Is a key immediately available to any occupant inside the building when it is locked?

39.2.2.2.2

7.2.1.5.4.1(2)

7.2.1.5.4.1(3)

7.2.1.5.4.1(4)

2-4

If installed, do delayed egress locks comply with 7.2.1.6.1?

· Is the building provided with complete supervised automatic fire detection or automatic sprinkler detection?

· Do doors unlock upon activation of the approved sprinkler system or approved fire detection system?

· Do doors unlock upon power loss?

· Does an irreversible process release the lock within 15 seconds when a force is applied for 3 seconds to the release device (exit hardware)?

· Must the locking device be manually reset?

· Is there a sign on the door adjacent to the release device that reads "PUSH UNTIL ALARM SOUNDS - DOOR CAN BE OPENED IN 15 SECONDS"?

39.2.2.2.5

7.2.1.6.1

7.2.1.6.1(2)

7.2.1.6.1(3)

7.2.1.6.1(4)

7.2.1.6.1(4)(d)

7.2.1.6.1(5)

2-5

If installed, do access controlled locks comply with 7.2.1.6.2?

· Is a sensor provided on the egress side arranged to detect the occupant approaching that unlocks the door?

· Does the door unlock upon power loss to the sensor?

· Does the door unlock upon power loss to any part of the access control system?

· Are the doors arranged to unlock from a manual release device located 40" to 48" above the floor within 5 feet horizontally from the door and is this device clearly identified by a sign that reads "PUSH TO EXIT."

· When the manual device is activated is the power to the lock interrupted independent of the control systems and does the door remain unlocked for at least 30 seconds?

· If provided, does activation of the building fire protective signaling system unlock the door in the direction of exit travel and the doors remain unlocked until the fire protective system is manually reset?

· The activation of manual fire alarm boxes that activate the building fire protective signaling system specified in 7.2.1.6.2(6) shall not be required to unlock the doors.

· If provided, does activation of the building sprinkler system or fire detection system unlock the door?

39.2.2.2.6

7.2.1.6.2(1)

7.2.1.6.2(1)

7.2.1.6.2(2)

7.2.1.6.2(3)

7.2.1.6.2(4)

7.2.1.6.2(5)

7.2.1.6.2(6)

7.2.1.6.2(7)

7.2.1.6.2(8)

2-6

Are existing horizontal or vertical rolling fire doors that are in an egress path:

· Held open by fusible links 165 F or higher temperature?

· Are fusible links located no higher than 10' above the door?

· Is the fusible link in immediate proximity to the door opening?

· Is the fusible link not located above the ceiling?

· Is the door not credited with providing any protection required by the Life Safety Code?

39.2.2.2.8

39.2.2.2.8(1) & (2)

39.2.2.2.8(3)

39.2.2.2.8(4)

39.2.2.2.8(5)

39.2.2.2.8(6)

2-7

Do horizontal and vertical rolling security grills that are used as part of the required means of egress from a tenant space comply with 7.2.1.4.1(3)?

· Are the grills open to their full position when the building is occupied by the general public?

· Is a sign readily visible on or adjacent to the door that reads “THIS DOOR TO REMAIN OPEN WHEN THE BUILDING IS OCCUPIED”?

· Are doors and grills not brought to the closed position when the space is occupied?

· Are doors and grilles are operable from within the space without the use of any special knowledge or effort?

· When two or more means of egress are required, are not more than half equipped with grills?

39.2.2.2.7

7.2.1.4.1(3)(a)

7.2.1.4.1(3)(b)

7.2.1.4.1(3)(c)

7.2.1.4.1(3)(d)

7.2.1.4.1(3)(e)

2-8

Do stairs comply with 7.2.2?

· Are handrails provided within 44 inches of the required egress width?

· Are stairs enclosed by 2-hour fire rated construction if connecting 4 or more stories and 1-hour fire rated construction for 3 or less stories?

· Are doors to stairs rated at 1-hour for 1-hour enclosures and 1- 1/2-hour for 2-hour enclosures?

· Are fire doors self or automatic closing?

· Is glazing installed in fire doors and fire barriers appropriate?

· Are identification signs installed at the landings of stairs serving 5 or more stories indicating the terminus of the top and bottom of the enclosure, the stair identification, and the story of and direction to the exit discharge?

39.2.2.3.1

7.2.2.4.1.2(2)

7.1.3.2.1(1) & (2)

Table 8.3.4.2

8.3.3.3

8.3.3.4-8.3.3.6

7.2.2.5.4.1

2-9

Is the minimum clear width of any corridor or passageway serving an occupant load of 50 or more persons at least 44" in clear width?

(Note: If a corridor serves fewer than 50 persons, the minimum 36-inch width - mandated by 101: 7.3.4.1 for egress components in general - would apply.)

39.2.3.2

2-10

Are at least 2 separate exits provided for every story and are they accessible from every part of every story and mezzanine? (Single exit exceptions exist in the code.)

39.2.4.1

2-11

Are dead end corridors limited to 50' maximum length?

39.2.5.2

2-12

Is the common path of travel limited to 75' for non-sprinkler protected floors and 100' for sprinkler protected floors?

39.2.5.3.1 through 39.2.5.3.3

2-13

Is the travel distance to the exit 200 feet or less in non-sprinkler protected floors and 300 feet or less for sprinkler protected floors?

39.2.6.2 & 39.2.6.3

2-14

Do exits discharge to a public way or at an exterior exit discharge?

Note: Up to 50% of the exits may discharge through the level of exit discharge provided the provisions of 7.7.2 are met.

39.2.7

7.7

2-15

Are means of egress as defined in 7.8.1.1 continuously illuminated during occupancy to at least the 1 ft-candle intensity level?

39.2.8

7.8.1.3(2)

2-16

Is emergency lighting installed in buildings;

· that are 3 or more stories in height?

· that have occupancies loads of 100 or more people above or below the exit discharge level?

· that have occupancy loads of 1000 or more?

· that are windowless or underground structures?

39.2.9.1

39.2.9.1(1)

39.2.9.1(2)

39.2.9.1(3)

39.2.9.2

2-17

Are means of egress marked in accordance with 7.10?

39.2.10

3-1

Are vertical openings enclosed?

39.3.1.1

3-2

Are hazardous areas including, but not limited to areas used for general storage, boilers and furnace rooms, and maintenance shops that include woodworking and painting areas separated by 1-hour fire barriers and 3/4 hour fire doors or provided with sprinkler protection?

39.3.2.1

3-3

Are high hazard areas provided with 1-hour fire rated enclosures and automatic sprinkler protection?

39.3.2.2

3-4

Is interior wall and ceiling finish Class A or Class B in exits and corridors and Class A, Class B or Class C in office areas?

Note: If the building is sprinkler protected Class C finish is permitted in exits and corridors.

39.3.3.2.1 39.3.3.2.2

3-5

Is a fire alarm system installed if:

· the building is 3 or more stories in height?

· the occupancy is subject to 100 or more occupants above or below the level of exit discharge?

· the total building occupancy is 1000 or greater?

39.3.4.1

3-6

Is initiation of the required fire alarm system by manual means, or the building wide fire detection system, or the complete fire sprinkler system?

39.3.4.2

3-7

Does the required fire alarm system provide occupant notification automatically or is occupant notification provided manually by voice communication or by a public address system in accordance with 9.6.3.9.2?

39.3.4.3(1)

39.3.4.3(2)

3-8

Are portable fire extinguishers provided?

39.3.5

3-9

There are no requirements for corridors.

39.3.6

4-1

Are high rise buildings provided with complete automatic sprinkler protection?

39.4.2.1 image4.emf

Attachment IV - Residential Board and Care Facilities.docx

Existing Large Board and Care Facilities, NFPA 101-2009

Fire Safety Inspection Report

Existing Large

Residential Board and Care Facilities

(All Code References are NFPA 101-2009 unless otherwise noted)

This checklist is a summation of the requirements found in Chapter 33, Existing Residential Board and Care Occupancies of the 2009 Edition of the Life Safety Code. This checklist is not intended to be comprehensive. The user is cautioned to consult the code prior to answering the following questions.

Facility Name:

Facility Address:

Date Inspected:

Number of Residents: Evacuation Capability: *

Date home opened as Board and Care Home:

*Method used to determine evacuation capability:

1) Timed evacuation drills: (Time: minutes)

2) Definition in 3.3.70 and A.3.3.70:

3) NFPA 101A:

Recommendations:

Home / is / is not/ recommended for continued placement.

Inspected By:

Approved By: __________________________

Item

Standard

Reference

Yes

No

N/A

General

1-1

If the building contains multiple occupancies, and if the board and care occupancy has a single means of egress, does the sole means of egress only pass through residential or healthcare occupancies?

33.1.2.1 33.1.2.3

1-2

In a building containing multiple occupancies, is the board and care occupancy NOT located above a non-residential or non-healthcare occupancy unless one of the following conditions is met?

(1) The board and care occupancy and exits therefrom are separated from the nonresidential or non-health care occupancy by construction having a minimum 2-hour fire resistance rating, or;

(2) The nonresidential or non-health care occupancy is protected throughout by an approved, supervised automatic sprinkler system and the occupancy is separated by construction having a minimum 1-hour fire resistance rating.

33.1.2.4

Building Construction

1-3

Does the building construction meet the basic requirements of NFPA 101, Table 33.3.1.3? [See last page for Table 33.3.1.3.]

[One and two-story facilities may be of any construction type that meets the requirements for one-hour or greater fire resistance rating, is Type IV (2HH), is fully sheathed, or is fully sprinkler protected.]

[One-story facilities having 30 or fewer residents with prompt evacuation capability with egress directly to the exterior at ground level may be of any type of construction.]

33.3.1.3

Means of Egress - Components

2-1

Do doors in exit enclosures and doors in high hazard content areas swing in the direction of egress and are all doors that are required to swing in the direction of egress tested annually?

[Doors of individual living units that open directly into an exit enclosure do not have to swing in the direction of exit travel.]

7.2.1.4.2 33.7.7

2-2

Are the doors in the means of egress compliant with the following?

(1) Doors complying with 7.2.1 shall be permitted. Minimum width shall be in accordance with 7.2.1.2.3.1(1) through 7.2.1.2.3.2(9).

(2) Doors within individual rooms and suites of rooms shall be permitted to be swinging or sliding.

(3) No door in any means of egress, other than those meeting the requirements of (4) or (5) below, shall be locked against egress when the building is occupied.

(4) Delayed-egress locks shall be permitted.

(5) Access-controlled egress doors shall be permitted.

(6) Revolving doors shall be permitted.

33.3.2.2.2

2-3

Are doors and associated hardware in good repair?

4.6.13.1

Means of Egress - Capacity

2-4

Is the clear width of the corridors a minimum of 44 inches?

[Corridors serving an occupant load less than 50 may be a minimum width of 36 inches.]

33.3.2.3.3

33.3.2.3.4

Means of Egress - Number

2-5

Are at least two exits provided on every story?

33.3.2.4

2-6

Are the exit stair enclosures (and space beneath, if present) free of storage?

[Enclosed, usable space shall be permitted under stairs, provided that the space is separated from the stair enclosure by the same fire resistance as the exit enclosure. Entrance to such enclosed usable space shall not be from within the stair enclosure. (See also 7.1.3.2.3.)]

7.2.2.5.3

7.2.2.5.3.2

Means of Egress – Arrangement

2-7

Are common paths of travel 110 feet or less in existing facilities?

[Common paths of travel are permitted up to 160 feet if the facility is sprinkler protected throughout.]

33.3.2.5.2

33.3.2.5.3

2-8

Are dead-end corridors no greater than 50 feet?

33.3.2.5.4

Means of Egress - Travel Distance

2-9

Is the travel distance within any room, suite or living unit to a corridor door 75 feet or less?

[Travel distance within any room suite, or living unit to a corridor door may be up to 125 feet, if the building is sprinkler protected throughout.]

33.3.2.6.1

33.3.2.6.2

2-10

Is the travel distance between any room door and the exit 100 feet or less?

[Travel distance from a room door to an exit may be up to 200 feet for exterior ways of exit access. Travel distance from a room door to an exit may be 200 feet if the building is sprinkler protected and the exit access is separated by rated construction(1 hr, for 3 stories or less, 2 hr for >3 stories.)]

33.3.2.6.3.1

33.3.2.6.3.2 33.3.2.6.3.3

Means of Egress - Discharge

2-11

Does the exit discharge comply with 7.7?

33.3.2.7

2-12

Are exit stairs that continue beyond the level of discharge provided with an approved means to dissuade occupants from traveling past the level of exit discharge (physical barriers)?

7.7.3.2

Means of Egress - Lighting and Marking

2-13

Is emergency lighting provided to illuminate the means of egress when the facility has more than 25 sleeping rooms?

[If each sleeping room has a direct exit to the outside of the building at ground level, no emergency lighting is required.]

33.3.2.9

2-14

Is the means of egress marked appropriately with exit signs?

33.3.2.10

Protection - Vertical Openings

3-1

Are vertical openings protected in accordance with 8.6?

[Unprotected vertical openings not part of required egress shall be permitted where such openings do not endanger required means of egress, provided that the building is protected throughout by an approved automatic sprinkler system and the exits and required ways of travel thereto are adequately safeguarded against fire and smoke within the building, or where every individual room has direct access to an exterior exit without passing through a public corridor.]

[In buildings two or fewer stories in height, unprotected vertical openings shall be permitted provided that the building is protected throughout by an approved automatic sprinkler.]

33.3.3.1.1

33.3.3.1.1.2

33.3.3.1.1.3

3-2

Are all floor openings, from floors below the level of exit discharge that are used only for storage, heating equipment, or purposes other than residential occupancy, to floors used for residential occupancy protected?

33.3.3.1.3

Protection - Hazardous Areas

3-3

Are exits arranged such that they are not adjacent to, or located above, rooms that contain high-pressure boilers, refrigerating machinery, transformers or other service equipment subject to possible explosion?

33.3.3.2.1 8.7

3-4

Are hazardous areas protected by either one-hour fire-rated enclosures with self-closing fire doors or automatic sprinkler protection (no door required)?

33.3.3.2.2

Protection - Interior Finish

3-5

Are interior wall and ceiling finishes Class A or Class B?

[In sprinkler-protected facilities, Class B coverings may be used where Class A is required, and Class C may be used where Class B is required.]

33.3.3.3.2

10.2

Protection - Corridors and Separation of Sleeping Rooms

3-6

The requirements for walls, doors, and door hardware for corridors and for sleeping rooms are based on one of the six following options. Select the option (in Items 3-6A to 3-6F below) for the facility and place an “X” in the N/A column for those options not used.

Option 1: Building sprinklered throughout.

Option 2: Prompt evacuation, not >2 stories, with a protected path from sleeping rooms.

Option 3: Prompt evacuation, not >2 stories, with not > 30 residents.

Option 4: Detection and limited furnishings in path to exit from other than sleeping rooms.

Option 5: Sprinklers in corridor and in center of each doorway on corridor.

Option 6: No sprinkler protection in facility.

Notes:

(1) Sleeping rooms are always required to be separated.

(2) At least one egress path that is separated from all other spaces (protected) to an exit is required from all resident use areas in all options except Options 1, 2, and 4.

(3) At least one egress path that is separated from all other spaces (protected) to an exit is required from sleeping rooms in all options except Option 1 and Option 4.

33.3.3.6

X

3-6A

Option 1: Where sprinkler protection is provided throughout the facility:

Sleeping Rooms:

Walls constructed as smoke partitions, door must resist the passage of smoke (No hardware requirements, but should have a latch.) (33.3.3.6.6.3)

Other than Sleeping Rooms:

No requirements (except for hazardous areas in impractical facilities).

33.3.3.6.1.1

33.3.3.6.3.2 33.3.3.6.4.3

33.3.3.6.6.3

3-6B

Option 2: Prompt evacuation capability facilities in buildings two or fewer stories in height, where not less than one required means of egress from each sleeping room provides a path of travel to the outside without traversing any corridor or other spaces exposed to unprotected vertical openings, living areas, and kitchens, shall not be required to comply with 33.3.3.6.1

Sleeping Rooms:

(1) Walls ½ hour fire resistance rating, and

(2) 20 minute doors or solid bonded wood core doors or equivalent, and

(3) Doors equipped with automatic closer or self closer with occupant control locks.

Other than Sleeping Rooms: No requirements for walls and doors provided they are not part of the one required protected path from the sleeping rooms. If on the path from a sleeping room, then:

(1) Walls ½ hour fire resistance rating, and

(2) 20 minute doors or solid bonded wood core doors or equivalent, and

(3) Doors equipped with a self or automatic closer.

33.3.3.6.1 33.3.3.6.1.2

33.3.3.6.2

33.3.3.6.3.1

33.3.3.6.4

33.3.3.6.6.1 33.3.3.6.6.2

33.3.3.6.1.2

33.3.3.6.6

33.3.3.6.4

33.3.3.6.6.1

3-6C

Option 3: Prompt evacuation capability facilities in buildings two or fewer stories in height, and that house not more than 30 residents.

Sleeping Rooms:

(1) Walls constructed as smoke partitions, and

(2) 20 minute doors or solid bonded wood core doors or equivalent, and

(3) Doors equipped with automatic closer or self closer with occupant control locks.

Other than Sleeping Rooms:

(1) Walls constructed as smoke partitions, and

(2) 20 minute doors or solid bonded wood core doors or equivalent, and

(3) Doors equipped with a self or automatic closer.

33.3.3.6.1 33.3.3.6.3.3

33.3.3.6.2

33.3.3.6.3.3

33.3.3.6.4

33.3.3.6.3.3

3-6D

Option 4: Rooms or spaces, other than sleeping rooms, provided with a smoke detection and alarm system connected to activate the building evacuation alarm. Furnishings, finishes, and furniture, in combination with all other combustibles within the spaces, shall be of minimum quantity and arranged so that a fully developed fire is unlikely to occur. (Be careful when evaluating the item in bold.)

Sleeping Rooms:

(1) Walls ½ hour fire resistance rating, and

(2) 20 minute doors or solid bonded wood core doors or equivalent, and

(3) Doors equipped with automatic closer or self closer with occupant control locks.

Other than Sleeping Rooms: No requirements.

33.3.3.6.1 33.3.3.6.1.3

33.3.3.6.4

33.3.3.6.6.1

33.3.3.6.1.3

3-6E

Option 5: Where automatic sprinkler protection is provided in the corridor in accordance with 31.3.5.8 (sprinklers are required in the corridor and one in each corridor door opening inside the room centered on the door opening unless the door is 20 minute rated or solid bonded wood core).

Sleeping Rooms:

(1) Wall ½ hour fire resistance rating, and

(2) Door must resist the passage of smoke and have a latch.

(3) Doors equipped with automatic closer or self closer with occupant control locks.

Other than Sleeping Rooms:

(1) Wall ½ hour fire resistance rating, and

(2) Door must resist the passage of smoke and have a latch.

33.3.3.6.1 33.3.3.6.4.4

33.3.3.6.4.4

33.3.3.6.1

33.3.3.6.4.4

3-6F

Option 6: No sprinklers in existing building.

Sleeping Rooms:

(1) Wall ½ hour fire resistance rating, and

(2) 20 minute doors or solid bonded wood core doors or equivalent, and

(3) Doors equipped with automatic closer or self closer with occupant control locks

Other than Sleeping Rooms:

(1) Wall ½ hour fire resistance rating, and

(2) 20 minute doors or solid bonded wood core doors or equivalent, and

(3) Doors equipped with a self or automatic closer.

33.3.3.6.1

33.3.3.6.2

33.3.3.6.3.1

33.3.3.6.4

33.3.3.6.6.1 33.3.3.6.6.2

33.3.3.6.6

33.3.3.6.3.1

Protection – Subdivision of Building Spaces

3-7

Is every sleeping room floor divided into at least two smoke compartments of approximately the same size unless otherwise permitted by 1-3 below? [Smoke dampers are not required.]

(1) Buildings that are sprinkler protected are not required to have smoke barriers.

(2) Buildings classified as prompt or slow where each sleeping room has an exterior way of exit access arranged in accordance with 7.5.3 are not required to have smoke barriers.

(3) Buildings where the aggregate length of the corridor on each floor is not more than 150 feet are not required to have smoke barriers.

33.3.3.7.1 33.3.3.7.2

33.3.3.7.4

33.3.3.7.5

33.3.3.7.6

Protection – Extinguishment Requirements

3-8

If the is a high-rise building, is it protected throughout by an automatic sprinkler system in accordance with NFPA 13?

33.3.3.5.2

3-9

Where an automatic sprinkler system is installed for either total or partial building coverage, it is electrically supervised and meets the following?

[Note: In buildings four or fewer, systems in accordance with NFPA 13R, are permitted.]

Automatic sprinklers are not required in closets 24 square feet or less or in bathrooms 55 square feet or less, provided that such spaces are finished with noncombustible or limited-combustible materials.

33.3.3.5.1 33.3.3.5.5

33.3.3.5.1.1

33.3.3.5.1.2

3-10

Are portable fire extinguishers provided near all hazardous areas?

33.3.3.5.6

Protection – Fire Alarm System

3-11

Is there a fire alarm system installed in the facility unless all of the following are met?

(1) Each sleeping room has exterior exit access in accordance with 7.5.3, and

(2) The building is not more than three stories in height.

33.3.3.4.1

3-12

Where a fire alarm system is required (See 3-11), is the fire alarm system initiated by each of the following?

(1) Manual pull stations at exits unless there are other effective means (such a complete sprinkler or detection system) for notification of fire, and

(2) One manual pull box at a convenient central control point under continuous supervision of responsible employees, and

(3) Any required sprinkler system, and

(4) Any detection system other than sleeping room smoke alarms.

33.3.3.4.2

3-13

Where a fire alarm system is required (See 3-11), is there an audible occupant notification system provided that operates automatically and without delay that is audible in all sleeping areas?

33.3.3.4.4

3-14

Where a fire alarm system is required (See 3-11), is a means provided to immediately notify the fire department in case of fire?

[Telephone notification is acceptable; it should not be of any type or arrangement that requires a coin or the unlocking of a device to contact the fire department.]

33.3.3.4.6.1

3-15

Are single station smoke alarms powered from the building electrical system provided in each sleeping room except as provided below?

[Existing battery-powered smoke alarms, rather than building electrical service-powered smoke alarms, shall be accepted where, in the opinion of the Authority Having Jurisdiction, the facility has demonstrated that testing, maintenance, and battery replacement programs ensure the reliability of power to the smoke alarms.]

[Sleeping room smoke alarms are not required in facilities having an existing corridor smoke detection system that is connected to the building fire alarm system.]

33.3.3.4.7.1

33.3.3.4.7.2

33.3.3.4.7.3

3-16

Where a fire alarm system is required (See 3-11), is a smoke detection system installed in corridors and all living areas?

[A smoke detection system is not be required in living areas of buildings having a prompt or slow evacuation capability that are protected throughout by an approved automatic sprinkler system.]

[A smoke detection system is not required in unenclosed corridors, passageways, balconies, colonnades, or other arrangements with one or more sides along the long dimension fully or extensively open to the exterior at all times.]

33.3.3.4.8.1

33.3.3.4.8.2

33.3.3.4.8.3

Inspection, Testing and Maintenance Requirements

4-1

Are fire extinguishers inspected on a monthly basis and serviced annually in accordance with NFPA 10?

4.6.13

4-2

Are fire sprinkler systems inspected, tested, and maintained in accordance with NFPA 25?

4.6.13

4-3

Are fire alarm systems and smoke alarms inspected, tested, and maintained in accordance with NFPA 72?

4.6.13

Operating Features

5-1

Are stoves and combustion heaters located so they do not block escape in case of fire caused by malfunction of the unit?

33.3.6.2.2

5-2

Are all fuel-fired heaters vented?

33.3.6.2.3

5-3

Is there a written fire emergency plan available that addresses areas of refuge, the special needs of residents (deafness, blindness, other physical limitations), and evacuation of the building when necessary?

33.7.1.1

5-4

Does the emergency plan include special staff responses to ensure the safety of any resident? This can require the plan to be amended or revised when any resident has special needs as they are admitted to the home.

[If the board and care facility has an evacuation capability classification of impractical, those residents who cannot meaningfully assist in their own evacuation or who have special health problems are not required to actively participate in the drill. Healthcare occupancy Chapter 19 requirements apply.]

33.7.1.2

5-5

Are all employees periodically instructed and kept informed with respect to their duties and responsibilities under the plan and is such instruction reviewed by the staff not less than every 2 months?

33.7.1.3

5-6

Are residents trained in the proper actions to take in event of a fire and does this training include what to do if the primary escape route is blocked?

33.7.2.1

5-7

Are emergency egress and relocation drills conducted not less than 6 times per year on a bimonthly basis with not less than 2 drills conducted during the night?

33.7.3.1

5-8

Do emergency egress and relocation drills involve the actual evacuation of residents to a designed assembly area and are residents required to use the designated means of egress during the drills?

33.7.3.3

5-9

Are smoking regulations established for the board and care facility?

33.7.4.1

5-10

Where smoking is permitted, are noncombustible safety-type ashtrays or receptacles provided in smoking areas?

33.7.4.2

5-11

Are new draperies, curtains and similar loose hanging furnishings and decorations flame resistant (NFPA 701)? [In a sprinkler protected building, they only have to be flame resistant in common areas.]

33.7.5.1.1 33.7.5.1.2

5-12

Does newly introduced upholstered furniture meet the cigarette ignition test prescribed by NFPA 260?

[Newly introduced upholstered furniture belonging to residents in sleeping rooms are not be required to be tested, provided that a smoke alarm is installed in the sleeping rooms.]

33.7.5.2.1

10.3.2.1 (1)

33.7.5.2.2

5-13

Does newly introduced upholstered furniture have limited rates of heat release when tested in accordance with ASTM E 1537, Standard Test Method for Fire Testing of Upholstered Furniture, as follows:

(1) The peak rate of heat release for the single upholstered furniture item shall not exceed 80 kW.

(2) The total heat released by the single upholstered furniture item during the first 10 minutes of the test shall not exceed 25 MJ.

[Not required in a sprinkler protected building.]

[Newly introduced upholstered furniture belonging to residents in sleeping rooms are not be required to be tested, provided that a smoke alarm is installed in the sleeping rooms.]

33.7.5.2.1 10.3.3

10.3.3

33.7.5.2.2

5-14

Are newly introduced mattresses tested in accordance with 16 CFR 1632, “Standard for the Flammability of Mattresses and Mattress Pads” (FF 4-72) with results showing a char-length not exceeding 2 inches?

[Newly introduce mattresses belonging to residents in sleeping rooms are not be required to be tested, provided that a smoke alarm is installed in the sleeping rooms.]

33.7.5.3.1 10.3.2.2

33.7.5.3.2

Do newly introduced mattresses have limited rates of heat release when tested in accordance with ASTM E 1590, Standard Test Method for Fire Testing of Mattresses, as follows:

(1) The peak rate of heat release for the mattress shall not exceed 100 kW.

(2) The total heat released by the mattress during the first 10 minutes of the test shall not exceed 25 MJ.

[Not required in a sprinkler protected building.]

[Newly introduce mattresses belonging to residents in sleeping rooms are not be required to be tested, provided that a smoke alarm is installed in the sleeping rooms.]

33.7.5.3.1 10.3.4

10.3.4

33.7.5.3.2

Page 1 of 1 (Revised 2/13)

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Attachment V - Sprinkler Protected State Veterans Nursing Home Care Facilities.docx VHA State Veterans Home Per Diem Program

Sprinkler-Protected State Veterans Nursing Home Care Facilities, NFPA 101-2009

VHA State Veterans Home Per Diem Program

Safety Inspection Report

Checklist for Sprinkler-Protected State Veterans Nursing Home Care Facilities

This checklist {current as of 04/28/2011} is a summation of the requirements found in Chapter 19, Existing Healthcare Occupancies of the Life Safety Code. This checklist is not intended to be comprehensive. The user is cautioned to consult the code prior to answering the following questions.

Facility Name:

Facility Address:

State License No: and Expiration Date:

Inspected By:

Date Inspected:

See Below **

Item

Standard

Reference

Yes

No

N/A

Building Construction

1-1

Is the building containing the nursing home protected throughout by a fire sprinkler system?

Note: Nursing Homes under the State Home Per Diem Program are required to be sprinklered throughout, no later than August 13, 2013. This inspection report is intended for existing nursing homes that are sprinklered throughout in accordance with 19.3.5.1. For nursing homes that are not sprinklered throughout, this checklist does not fully address requirements for features such as, but not limited to, corridors, hazardous areas, and smoke barriers. Refer to Chapter 19 of NFPA 101.

19.3.5.1

1-2

Is emergency power available to operate illumination of all exit signs and lighting for the means of egress, fire alarm and medical gas alarms, emergency communication systems, and generator task illumination?

38 CFR 51.200

19.5.1.2

1-3

Does the emergency power system meet the requirements of NFPA 101, Life Safety Code?

Note: NFPA 101 States: Existing installations shall be permitted to be continued in service, provided that the systems do not present a serious hazard to life. NFPA 99 is not retroactive to existing systems and equipment.

38 CFR 51.200

1-4

Is emergency power provided for electrical life support devices?

38 CFR 51.200

1-5

Is the emergency power source an on-site emergency standby generator of sufficient size to serve the connected load or another approved source?

Note: NFPA 101 States: Existing installations shall be permitted to be continued in service, provided that the systems do not present a serious hazard to life. NFPA 99 is not retroactive to existing systems and equipment.

38 CFR 51.200

1-6

Is emergency lighting provided throughout the means of egress?

19.2.9, 7.9.1.1

1-7

Does the building construction meet the basic requirements of NFPA 101, paragraph 19.1.6.1?

19.1.6

1-8

Are all hazardous areas (including boiler rooms, bulk laundries, paint shops, repair shops, rooms with > 64 gal of soiled linen, storage rooms, trash rooms, and laboratories) enclosed by smoke resisting partitions and self- or automatic-closing doors?

19.3.2.1 19.3.2.1.5

1-9

Do all wall and ceiling finishes have a Class A, Class B, or Class C flame spread rating?

19.3.3.2

1-10

Is automatic elevator recall (Phase I and II Fire Fighters Emergency Operations) provided for all elevators that have a travel distance of 25 feet or more, above or below the level that best serves emergency or fire fighting or rescue personnel?

19.5.3 9.4.3.2

ASME A17.3

1-11

Are laundry chute openings onto the corridors protected by 1-hour fire rated, self-closing doors with approved and listed frames (or sealed by fire-resistive construction)?

19.5.4.1

1-12

Are all exit stairs enclosed by 1-hour or greater rated construction?

7.1.3.2.1 (1)

7.1.3.2.1 (2)

1-13

Are all other vertical openings (shafts, chutes, elevator hoistways, etc.) enclosed by 1-hour or greater rated construction?

19.3.1.1

Means of Egress - Arrangement

2-1

Are exit stairs, which continue more than one-half story beyond the level of exit discharge, interrupted at the level of exit discharge by partitions, doors, gates, or other effective means?

7.7.3.2

2-2

Are all corridors serving patient sleeping rooms a minimum of 48 inches in clear width? (See also 6-2)

19.2.3.4

2-3

Are projections into the corridor in compliance with the referenced section?

19.2.3.4 7.3.2

2-4

Are there two remote exits on every story, accessible from every part of every story, and accessible from each smoke compartment? (Egress is permitted through an adjacent smoke compartment.)

19.2.4

2-5

Is corridor access compliant with the referenced section?

19.2.5.6

2-6

Are suites in compliance with the referenced section?

19.2.5.7

2-7

Does every corridor provide access to at least two approved exits without passing through any intervening rooms or spaces other than corridors or lobbies?

19.2.5.4

2-8

Are the means of egress properly marked with exit signage?

19.2.10

Means of Egress - Doors

3-1

Are doors to hazardous areas equipped with self-closing or automatic-closing devices?

19.3.2.1.3

3-2

Are exit stair enclosure doors and horizontal exit doors (if provided) positive latching and self-closing (or automatic-closing per 19.3.1.8)?

19.3.1.7

3-3

Do exit access doors swing in the direction of exit travel when serving an occupant load of 50 or more?

7.2.1.4.2

3-4

Are corridor doors equipped with a suitable means to keep the door closed when a force of 5 pounds is applied at the latch edge of the door? (Not required for rooms such as bathrooms that have no combustibles stored in them.)

19.3.6.3.5 19.3.6.3.6

3-5

Area all doors in a means of egress at least 32 inches wide?

19.2.3.6

3-6

Are doors within a means of egress equipped with hardware that will open without the use of a tool or key from the egress side, except as permitted by (A) and (B) below?

(A) Where the clinical needs of patients require specialized security measures or where patients pose a security threat, and provided staff can readily unlock the doors at all times; or,

(B) Where patient special needs require specialized protective measures for their safety, and provided that all of the following are met:

(1) Staff can readily unlock doors at all times.

(2) A total (complete) smoke detection system is provided throughout the locked space, or locked doors can be remotely unlocked at an approved, constantly attended location within the locked space.

(3) The building is protected throughout by an automatic sprinkler system.

(4) The locks are electrical locks that fail safely so as to release upon loss of power to the device.

(5) The locks release by independent activation of each of the following:

(a) Activation of the smoke detection system required by (2) above, and

(b) Waterflow in the automatic sprinkler system required by (3) above.

19.2.2.2.4 19.2.2.2.5.1 19.2.2.2.5.2 19.2.2.2.6

3-7

Where doors are locked against egress for other than as permitted in 3-6 above, do the locks meet the locking arrangements required for:

1. delayed-egress or

2. access controlled locks or

3. elevator lobby exit access door locking?

19.2.2.2.4 7.2.1.6.1 7.2.1.6.2 7.2.1.6.3

Smoke Barriers

4-1

Is each story that contains more than 30 patient sleeping beds divided into at least two smoke compartments?

19.3.7.1

4-2

Is the smoke compartment area 22,500 sq ft or less, and the travel distance to reach a smoke barrier door 200 ft or less?

19.3.7.1 (1)

4-3

Are all doors in smoke barriers self- or automatic-closing?

19.3.7.8

4-4

Are smoke barrier doors substantial, such as 1-3/4 inch solid bonded wood core doors or equivalent, and if a door contains a vision panel, is it wired glass in a steel frame or fire rated glazing?

19.3.7.6

4-5

Is the clearance between meeting edges of smoke barrier doors limited to 1/8 inch or less?

19.3.7.8 A.8.5.4.1

4-6

Are penetrations in smoke barrier walls properly sealed to resist the passage of smoke?

19.3.7.3 8.5.1

Protection - Sprinkler - Fire Alarm - Kitchen

Sprinkler System

5-1

Are sprinkler systems electrically supervised by the fire alarm system?

19.3.5.3

5-2

If provided, are laundry chutes provided with sprinkler protection at the top, bottom, and every other floor between?

19.5.4.3

9.5 & 9.7

5-3

If privacy curtains are used, (1) are the privacy curtains provided with mesh that has openings in the mesh equal to 70 percent or greater (usually at least ½ inch measured on the diagonal) and does the mesh extend a minimum of 18 in. from the sprinkler deflector, or (2) are sprinklers and curtains located such that the curtains do not obstruct sprinkler discharge?

19.3.5.10 A.19.3.5.10

NFPA 25-2008 5.2.1.2, A.5.2.1.2

5-4

Is a minimum of 18 inches vertical clearance maintained between the top of all storage and ceiling sprinkler deflectors?

NFPA 25-2008 5.2.1.2, A.5.2.1.2

Fire Alarm System

5-5

Are areas open to the corridor provided with direct staff supervision or provided with smoke detection connected to the fire alarm system?

19.3.6.1

5-6

Are manual fire alarm pull boxes provided?

19.3.4.1 19.3.4.2

5-7

Is occupant notification provided?

19.3.4.3.1 9.6.3.1

Kitchen Suppression

5-8

Are grease producing appliances in the kitchen protected by an automatic fire suppression system?

19.3.2.5, 9.2.3

5-9

Is a readily accessible means available to manually activate the automatic extinguishing system?

19.3.2.5, 9.2.3

NFPA 96-2008

10.5

General Maintenance

6-1

Are doors and associated hardware in good repair?

4.6.13.1

6-2

Is the means of egress (exit access, exits, and exit discharge) free of any obstructions or impediments to full and instant use? This includes the accumulation of snow and ice.

7.1.10

6-3

Are stairwells kept free of obstructions and storage?

7.1.3.2.3 7.2.2.5.3

Inspection and Testing Requirements

7-1

If battery powered emergency lights are used, are they tested monthly for thirty (30) seconds and are they functionally tested annually for not less than 1½ hours?

7.9.3

7-2

Are sprinkler system main drain tests performed annually and are records maintained?

NFPA 25-2008

13.2.5

7-3

Are sprinkler water flow alarms and valve supervisory tamper switches tested semi-annually?

NFPA 72-2007, Table 10.4.4 (15)

7-4

Are fire pumps churn tested weekly and flow tested annually?

NFPA 25-2008

8.3

7-5

Is the automatic fire extinguishing system protecting cooking equipment inspected, tested, and maintained by a properly trained and qualified company on at least a semi-annual basis and does the testing confirm that:

(1) the operation of the kitchen automatic extinguishing system automatically shuts off all sources of fuel and heat to the equipment protected by the system, and

(2) the shut down devices are of the type that require manual resetting prior to fuel or power restoration?

19.3.2.5, 9.2.3

NFPA 96-2008

11.2.1 10.4.1 10.4.4

7-6

Are hoods, grease removal devices, fans and ducts cleaned on a scheduled basis?

[Cleaning frequencies will vary depending upon use and the types of foods being prepared. Cleanings must be at least semiannual but more frequent cleanings may be required.]

19.3.2.5, 9.2.3

NFPA 96-2008

11.3

7-7

If a generator set is utilized for emergency power, is it inspected weekly and tested under load, for at least 30 minutes, on a monthly basis?

19.5.1.1, 9.1.3

NFPA 110-2005

8.4.1

7-8

Does the fire alarm system automatically transmit an alarm to the municipal fire department?

19.3.4.3.2

7-9

Does documentation exist to show that the fire alarm system is tested in accordance with NFPA 72-2007?

9.6.1.3

7-10

Does documentation exist showing that quarterly fire drills are conducted on all shifts and under varied conditions?

19.7.1.6

7-11

Are fire extinguishers inspected approximately every thirty (30) days and serviced annually?

NFPA 10-2007

7.2.1, 7.3.1

Operational Features

8-1

Where the sprinkler system or fire alarm system is out of service (for more than 4 hours in a 24 hour period) has the facility notified the fire department and established a fire watch or evacuated the building?

9.6.1.6 9.7.6.1

8-2

Does the facility have a written fire safety plan and are the employees trained in the use of the plan?

19.7.2.2 19.7.2.3

8-3

Does the facility have a smoking policy that addresses all items in the referenced section?

19.7.4

8-4

Are portable space heating devices prohibited in healthcare occupancies unless they meet both of the following:

(1) they are used only in non-sleeping staff and employee areas, and

(2) the heating elements do not exceed 212°F (100°C)?

19.7.8

8-5

Do Alcohol-Based Hand Rub dispensers comply with the requirements of the referenced section?

19.3.2.6

**All answers are based upon visual inspection or information provided by the facility personnel to the inspector.

Recommended Corrective Actions:

Page 1 of 1 Rev: 4/28/11

Checklist State Vets Home Per Diem Pgm 2009 Existing Final Draft 4-28-11 (DK1).doc

Page 6 of 6 Rev 4/28/11

Checklist State Vets Home Per Diem Pgm 2009 Existing Final Draft 4-28-11 (DK1).doc image6.emf

Attachment VI - Medical Foster Homes.docx…