Attachment Q_SVH DOM Small Board and Care Life Safey Checklist.pdf

VHA State Veterans Home Per Diem Program Domiciliary

Physical Environment Inspection Report

Checklist for Existing Small Board and Care Facilities

All Code References are from NFPA 101-2012 according to 38 CFR Part 51.350

This checklist is a summation of the requirements found in Chapter 33, Existing Residential Board and Care

Occupancies of the 2012 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. (Current as of 1-10-

2021)

Facility Name:

Facility Address:

Date Inspected:

Inspected By:

Number of Residents: Evacuation Capability: *

*Method used to determine evacuation capability, need to determine if Prompt, Slow or Impractical to begin the inspection:

1) Timed evacuation drills: (Time: minutes)

2) Definition in 3.3.76 and A.3.3.76:

3) NFPA 101A:

Item Standard Reference Yes No NA

General

1-1 If the board and care occupancy is in the same building with other 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?

33.1.3.1

33.1.3.3

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.

33.1.3.4

VHA State Veterans Home Per Diem Program

Existing Small Board and Care Facilities, NFPA 101-2012

Item Standard Reference Yes No NA

Minimum Construction Requirements

1-3 Does the building construction meet the basic requirements of

NFPA 101, paragraph 33.2.1.3?

There are no requirements for facilities with an evacuation capability of “prompt.” The interior of facilities rated “slow” must be fully sheathed with a material having at least a 15-minute fire rating (plaster and lath or gypsum wallboard). Facilities rated “impractical” shall be of any construction type except Type

II (000), Type III (200) or Type V (000) unless the building is sprinkler protected throughout in accordance with 33.2.3.5.

33.2.1.3

33.2.1.3.2.1

Means of Escape - Stair Enclosures

1-4 Except as identified in Items 1-6 and 1-7, are interior stairs used as a primary means of escape enclosed with 30-minute fire rated construction with openings protected by doors having construction comparable to the stair enclosure?

Note: Stairs that connect a story at street level to only one other story shall be permitted to be open to the story that is not at street level.

33.2.2.4.1

33.2.2.4.5

1-5 If an enclosed interior stair serves as the primary means of escape, is it arranged so that occupants are not required to pass through a portion of a lower floor, unless that route is separated from all spaces on that floor by construction having a minimum 30-minute fire rating?

33.2.2.4.3

1-6 For prompt and slow facilities in buildings 3 stories or less protected throughout by quick response (QR) or residential sprinkler systems, stair enclosures are not required provided there is a primary means of escape from each sleeping area that does not require occupants to pass through a portion of a lower floor unless that route is separated from all spaces on that floor by construction having a minimum ½ hour fire resistance rating. If the interior stair is the primary means of escape, it must be protected from the

1st floor by 30-minute rated construction even if the building is sprinkler protected.

33.2.2.4.6

1-7 Stair enclosures are not required for prompt evacuation capability facilities housing 8 or fewer residents in buildings 2 stories or less in height, which are fully sprinklered with QR or residential heads.

A second means of escape from each sleeping room must be provided and smoke alarms must be installed to use this exception.

33.2.2.4.7

33.2.2.4.8

1-8 Are vertical openings protected so as not to expose a primary means of escape?

33.2.3.1.1

1-9 Are exterior stairs protected against blockage caused by fire within the building?

33.2.2.6.3

Item Standard Reference Yes No NA

Protection – Hazardous Areas – Interior Finish – Sleeping

Rooms

1-10 1. Are hazardous areas that are on the same floor as, and are in or abut a primary means of escape or a sleeping room:

Provided with a 1-hour fire rated enclosure with a 45-minute self or automatic closing positive latching door or; sprinkler protected with smoke a smoke resistant enclosure and self or automatic closing doors?

2. Are hazardous areas other than those in (1) above:

Provided with a 30-minute fire rated enclosure with a self or automatic closing door, or; sprinkler protected? (No enclosure requirements if sprinklered.)

33.2.3.2 and

33.2.3.2.4

33.2.3.2.5

1-11 Are Interior wall and ceiling finish?

(1) Class A or Class B in facilities other than those having prompt evacuation capability?

(2) Class A, B, or C in facilities having prompt evacuation capability.

33.2.3.3.2

1-12 For non-sprinklered, slow evacuation capability facilities, do the corridor walls and doors separating the sleeping rooms have:

1. ½ hour fire-rated walls

2. 1-3/4 inch thick substantial doors

3. ¼ inch wired glass (if vision panels are provided)

4. doors that are self or automatic closing?

33.2.3.6.1

33.2.3.6.4

1-13 For non sprinklered, prompt evacuation capability facilities, are the sleeping rooms separated from the escape route by:

1. walls that resist the passage of smoke

2. 1-3/4 inch thick substantial doors

3. ¼ inch wired glass (if glass is provided)

4. doors that are self or automatic closing?

33.2.3.6.1

33.2.3.6.1.1

1-14 For sprinklered, slow or prompt evacuation facilities, do the corridor walls separating the sleeping rooms have:

1. wall that resist the passage of smoke

2. 1-3/4 inch thick substantial doors

3. no glass requirements

4. doors need latches or closers that are able to keep them closed

33.2.3.6.1

33.2.3.6.1.2

1-15 Have all louvers, transoms, and transfer grills been sealed or removed?

33.2.3.6.3

Means of Escape – Arrangement

2-1 Are there two means of escape from each occupied story that do not involve windows or (1) is the facility rated prompt and one of the means of escape from each story does not involve windows, or

(2) is the facility sprinklered and the facility (i.e. overall building) has two means of escape?

33.2.2.1.1

33.2.2.1.4

33.2.2.1.5

Item Standard Reference Yes No NA

2-2 Does each sleeping room have a second means of escape? Prompt facilities may use windows as a second means of escape if the windows are within 20 feet of grade level or directly accessible to fire department rescue apparatus: or the window opens to an exterior balcony.

[This may be a door, stairway, passage, hall or an outside window or door operable from the inside without the use of tools and providing a clear opening of not less than 20 inches in width, 24 inches in height, and 5.7 sq. ft. in area. The sleeping room is not required to have a secondary means of escape if the facility is protected throughout by an automatic sprinkler system and there are at least two means of escape from each story.]

33.2.2.3.1

(3) (a)(b)(c)

2-3 Does the primary means of escape from every sleeping room and living area provide a safe path of travel, which is not exposed to unprotected vertical openings, to the outside?

33.2.2.2.1

2-4 In slow and impractical evacuation capability facilities that are not sprinkler protected with QR sprinklers, is the primary means of escape for each sleeping room separated from all living areas and kitchens?

33.2.2.2.3

2-5 Where sleeping rooms or living areas are above or below the level of exit discharge, is the primary means of escape an enclosed interior stair, exterior stair, horizontal exit, or existing fire escape stair?

33.2.2.2.2

Means of Escape – Doors

3-1 Other than bathroom doors, are all doors and paths of travel to a means of escape at least 28 inches wide?

33.2.2.5.1

3-2 Are bathroom doors 24 inches or larger? 33.2.2.5.1.1

3-3 Are closet doors designed to allow opening from the inside and are bathroom doors designed to allow opening from the outside during an emergency?

33.2.2.5.3

33.2.2.5.4

3-4 Are doors in the means of escape able to be opened without keys from the inside?

Note: Delayed egress and access controlled locks are permitted.

33.2.2.5.5

Protection – Sprinkler – Fire Alarm

Sprinkler System

4-1 Where an automatic sprinkler system is installed for total or partial building coverage does it activate the fire alarm system?

Note: Existing systems that protect isolated hazards that have 6 or fewer sprinklers and newly installed piping serving no more than 2 heads are exempt.

33.2.3.5.3

33.2.3.5.6

9.7.1.2

Item Standard Reference Yes No NA

4-2 Where an automatic sprinkler system is installed in the facility and there is an attic in the facility, is the attic protected in accordance with (1) or (2) below?

(1) An attic used for living purposes, storage, or fuel-fired equipment is protected with automatic sprinklers that are part of the required, approved automatic sprinkler system in accordance with 9.7.1.1.

(2) An attic not used for living purposes, storage, or fuel-fired equipment meets one of the following criteria:

(A) Attic is protected throughout by a heat detection system arranged to activate the building fire alarm system in accordance with Section 9.6.

(B) Attic is protected with automatic sprinklers that are part of the required, approved automatic sprinkler system in accordance with 9.7.1.1.

(C) Attic is of noncombustible or limited-combustible construction.

(D) Attic is constructed of fire-retardant-treated wood in accordance with NFPA 703.

33.2.3.5.7

Fire Alarm System

4-3 Is there a manual fire alarm system in accordance with NFPA 72 provided with occupant notification throughout or, are there interconnected smoke alarms throughout with at least one manual station on each floor that can activate the alarms? Note: Other manually activated continuously sounding alarms acceptable to the AHJ may be permitted.

33.2.3.4.1.1

33.2.3.4.1.2

33.2.3.4.2

9.6

4-4 For non-sprinklered facilities, are smoke alarms, powered by the building electrical system, located:

1. On all levels including basements, and

2. In living areas including living rooms, dens, dayrooms and similar spaces; and

3. Can the smoke alarms be heard in all sleeping areas when activated?

[For most facilities this will require all smoke alarms to be interconnected with smoke alarms located in the bedrooms.]

33.2.3.4.3.1

9.6.2.9

33.2.3.4.3.2

33.2.3.4.3.3

33.2.3.4.3.5

4-5 For buildings protected throughout by sprinkler systems utilizing

QR or residential sprinklers, are smoke alarms powered by the building electrical system installed in all sleeping rooms? (Other detection not required). Battery powered detectors may be permitted in the sleeping rooms if documentation demonstrating an adequate testing, maintenance, and battery replacement program exists that is acceptable to the VA.

33.2.3.4.3.6

33.2.3.4.3.7

General Maintenance

5-1 Are all designated means of egress continuously maintained free of all obstruction or impediments to full instant use in case of fire or emergency

33.2.2

Item Standard Reference Yes No NA

Inspection, Testing and Maintenance Requirements

For sprinkler systems installed in accordance with NFPA 13 or NFPA 13R Items 6-1 through 6-4 ONLY apply:

6-1

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

NFPA 25-

2011 5.2.1.2

A.5.2.1.2

6-2

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

NFPA 25-

13.2.5

6-3

Are electric fire pump churn tested monthly and diesel fire pumps churn tested weekly; and are all fire pumps flow tested annually?

NFPA 25-

2011, 8.3.

6-4

Where the fire alarm system is out of service (for more than 4 hours in a 24 hour period) or where the sprinkler system is out of service (for more than 10 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.

NFPA 25-

2011, 15.5

6-5 Where an automatic sprinkler system is installed in accordance with NFPA 13D, is it inspected, tested, and maintained per the reference paragraphs?

33.2.3.5.8.1 –

33.2.3.5.8.15

6-6 Are fire alarm systems and smoke alarms inspected, tested, and maintained in accordance with NFPA 72?

9.6.1.3

4.6.12

6-7

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? Permanent record of the EPSS inspections, tests, exercising, operation, and repairs shall be maintained and readily available.

19.5.1.1, 9.1.3

NFPA 110

8.4.1

Operational Features

7-1 Are stoves and combustion heaters located so they do not block escape in case of fire caused by malfunction of the unit?

33.2.5.2.2

7-2 Are all fuel-fired heaters vented?

33.2.5.2.3

7-3 Does administration have, in effect and available to all supervisory personnel, written copies of a fire emergency plan for protecting residents in the event of fire, for keeping persons in place, for evacuating persons to areas of refuge, and for evacuating persons from the building when necessary?

33.7.1.1

7-4 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.]

33.7.1.2

33.7.3.6

7-5 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

Item Standard Reference Yes No NA

7-6 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

7-7 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

7-8 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

7-9 Are staff sleeping arrangements located such that they will be awakened by any fire alarm in the building?

33.2.3.6.1.3

7-10 Are smoking regulations established for the board and care facility?

33.7.4.1

7-11 Where smoking is permitted, are noncombustible safety-type ashtrays or receptacles provided in smoking areas?

33.7.4.2

7-12 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

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