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Home My WebLink Aboutsprinkler-alarm test report 2024002\!sil YARN'OUTH EIRE DEPARTNaETIT EIRE SPRIIIKLER E EIRE AIARI'I TEST REPINT INTTGRITUS HEALTHCARE WlNDSOR NURSING & REHABIUTATTON CENITR 265 NORTH MAIN STREET, SOUTH YART4OUTH, MA 02664 DIRFCTOR OF MAINTFNAN'F 'ryz LOfrtROL PA ELS AIINUNCANONS SIAND.BY B,/I|iERYS S',IOKE DE|ECTORS HEAT DETECft)RS PULL S|AfiO 9 BEtts/HcrRfls 3PRI KLERS TA''PER S'WNCHB CAR@II NOTIOXIDE SERWCE COU E /g: OK OK OK OK OK OK OK OK SERWCE SERWCE SERWCE SERWCE SERWCE SERWCE SERWCE SERWCE SERWCE SERWCE ,. OK _oK I MICHAEL K. II4AHANEY ITAW INSPEC|ED WINDSOR NURSING & REHABILJTATION CENTER ON AND IHE ABOW TES|ED I|E'IS ARE WORKIIIG PROPERLY AGORDI O fO MAIIUFACTURERS REAOirtlE DAtrO S. Ifl SPECTORS SIGIIA TUR E:DAfE: COl.rPAllY ItlAtlE AflD ADDRESS: MKl4 RRE TECHNOLOGIES. INC. 774-263-5924/774-263-5930 2 TAEER STREET. FAIRHAVEN. FORM 1993 RECEIWD BY YAR"OUTH FIRE DEPARiMENI: 02719 AI'E OF PRENTSES: AODRESS: |ELEPHOflE UI'BER: a o ir/,0 / /L t4 't.,"JD.Vfr )b"t4 'o 20 )+ COPY: MKM Office YELLOW COPY: customer PINK COPY: Fire Dept MKM TEST INSPECNON AND SERVICE DIVISION ,cm,emhr 9/17E ,}$'-&q 2 TABER STREEI, FAIRHAVEN MA 02719 77+253- 5924/77+ 263- 5930/ EMAIL : nkmfi Ednolqies@@mcast net SPRINKL ER,/ EIR E A LA R M SYSTE N INSPECTION REFORT FDNY343 r** fn ilemory of Oll@r John Borg6 of t re Taunbn, ll/l Polie rt^lvttoant*** ***In nemory of Fi@tvhtcr SEvc Pierc€ of lhe Fairt avcn, ,rA Firc Reue DcBranent*** ,**fn memoty of Pollc€ K4 "Kitt" of tlre Sralnaa€ hlid Depararrent*** TTI TEGRITUS HEA L THCA RE CUSTOMER NAME: WINDSOR NURSING & REHABIUTATION CENTER ADDRESS: CONTACT: TELEPHONE: OATE OF TNSPECfiON: # OF INSPECNON: RENRT #: 265 NORTH MAIN STREET, SOUTH YARMOUTH, MA 02664 FACILITY MAINTENANCE DIRECTOR MAIN TEL: 508-39+3514 FAX:508-39+0515(T:7Dfu 76 'SCvSt+ FORTY-SEVEN (47) 42024 ACCOUNT #: WNH/SF4 13-4 THREE OF FOUR (314) FIR E DEPA RTM ENT CONTACTED : FTRE DEPARTNENT TELEPHONE #: FIR E DEPA RTM ENT CONTACT: FIRE DEPARTMEW MAIUNG ADDRESS: CENTRAL STANON CONTACTED: CENTRAL STANON TELEPHONE #: YARMOUTH FIRE RESCUE DEPARTMENT 508-398-2212 FIRE PREVENTION BUREAU 96 OLD MAIN STREET, SO, YARMOUTH, MA 02664 CAPE COD ALARM COMPANY 800-468-8300 FOR CENTRAL STATION TYPE OF SYSTEM/S: ONE WET SPRINKLER SYSTEM/FIRE ALARM SYSTEM FOR ENTIRE FAqUTY |4ASTER/RADIO BOX # & LOOAfiON: COMMUNICATOR/PRIMARY & SECONDARY PHONE UNES TO : DTALERS LOCATED AT EACH INDMDUAL PANEL / FIRE ATARM AND CARBON MONOXIDE PANELS FIRE AURM CONTROL PANEL - NAKE/MOOEULOAT|ON: FIREUTE MS92OOUD FOR FIRE ALARM SYSTEM LOCATED IN BASEMET{T BOILER ROOM/SILENT KNIGHT PANEL FOR CARBON MONOXIDE SYSTEM LOCATED AT 1ST FLOOR MAIN ENTRANCE K}YER NOTE***PUIT ]UMPER IN TERMINAL ELOCK DIRECNY ATTACHED TO AURM REUY rcR DOOR DI948LE*** NOTE***FOR SILENT TEST DI548LE NAC CIRCUNS 1 THROUGH 4*** NOTES/COMMENTS: PRESIDENT: ucE sE #5: MIOIAA K. MAHAIIEYta SPRI XLER @N|RAOOR *N7102 / MA SpRIflKt"ER -TOUR EyHAt*fr369/RHODE ISU D SRIttKttR CO4|TRACTOR *RrN3g / RHODE ISUND SRI|IKLER .D) Eyt4A #RrM067/M FIRE AURM C@|TRACTOR #83fi / tl,A FIRE AURM TECHflTCAN '193D / MA SECUR|TY SyS- TEMS #N1512 / rlA DEP & CKFLOW TESIER $4376 / EW E cUitD WATER WORKS BACK FLOW REPATR *2562 255 NORTH MAIN STREET SOUTH YARMOUTH, MAPAGE 1 w E ,rA/Ettr-,TNSPECTORS NAME: WINDSOR NURSING REHAB FIRE TECHNOLOGIES, INC. 1.888.658.FrRE (3473) DEWCErYE SPRINKLER/FIRE ALARM SYSTEM INSPECTION REPORT FACP ANNUN FS WFPS OEB 75 WPV ITV WMG DCBP rcONN DESCRTPfTON FIRE ALARM PANEVRADIO BOX REMOTE ANNUNCTATOR WATER FLOW IND SWTTCH WATER FLOW PRES SWITCH OUTSIDE ELECTRIC BELL TAMPER SWTTCH WET PIPE VALVE INSPECTORS TEST VALVE WATER MOTOR GONG DOUBLE CHK BACKFLOW STD PUMPER CONNECIION Number of wet systems: Make/Model: c. Report Filed? NAEN EoNE (1) TOTAL QfY ATY TESTED AC'TIUAfE aKz NAEN NAEN RESET 9!{? 1 1 1 1 1 z 1 1 .l 1 1 ry+ ,------i---7+Z/ DnDtlEEEEt]E NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA EEEEEEEEE N N N N N N N N N NA NA NA NA E I SP RI N KL ER S YSTEI4 IN FO RMA TION 7. GETIERAL a. Is the building or premises presently occupied? b, Is the occupancy class same as previous inspection? c. Are all applicable systems in service and in normal condition? d. Are all applicable systems the same as the previous inspection? e. Is the building completely coverd with automatic sprinklers? f. Are all new additlons or bulldlngs also sprinklered? g. Is all storage/debris properly storcd away from sprinkler heads? h. Was the property free from fire since the last inspection? I. Are areas covered by wet sprinkler piping properly heated? 2, TANKS, PU}'$. EIRE DEPT. CONNECTIOTIS b, Are fire departnent pumper connections in satisfactory condition, couplings free, caps present, check valves not leaking? 2 1/2" Siamese located outside East to right of Main Entrance 3, WETSTSTEM a. Are cold weather valves in the proper open/closed position? b. Are anti-freeze systems in operating condition? c. Are alarm valves, waterflow indicators and retarding chambers in working order? EEE E Y NA NA N N NY f] NAE 4.AIARDIS a. Water motor gong test satisfactory? b. Electric device (bell, horn, strobe) test sausfactory? c. Supervisory alarm service test satisfactory? 4a. ATA R}, YALUE / CHECK TNTERIIAL EXAMIIYATIOTI JULY 2027 4b. FIRE SERWCE BACKFLOW PREVENTIOIII a. Model: 2000SS b. Date Tested: Auq 10, 2017 JULY 13 2022 Serial #: 01385 FAILY[]Results ofTests: Pl6S NEJ 265 NORTH MAIN STREET SOUTH YARMOUTH, MAWINDSOR NURSING REHAB ENEENNENEfIN t]ENEENEENEtlN tl EN t]ENEENE NAEN f]NAEN E NAEN ENAEN E NAfJN flNAEN E NAEN ENAEN E NAEN E GEM 4' WET ALARM VALVE IN BASEMEI'{T SUPPLY ROOM Y dAAEN Y ETNAEN Y E NAEN a, Date internal exam conducted: b. Next scheduled internal exam? Manufacturer: Ames Size: 4" inch EEE Results: PAGE 2 FIRE TECHNOLOGIES, INC. 1.888.658.RRE (3473) 5. SPRIIIKLERS ATID PIPING @ion, not obstructed and corrosion free? b. Are all sprinkler heads less than 50 years old? c. Extra sprinkler heads, sprinkler wrench and cabinet readily available? d, Is the condition of sprinkler piping, drain valves, hangers, pressure gauges, open sprinkler heads, strainers, satisfactory? e. Are all sprinkler heads of the proper temperature rating? f. If present, is the system hand hose grid in good condition? g, Are any existing automatic sprinkler heads presently listed in any manufacturers literature regarding recalls or voluntary replacement? h. Are there any 3/4" or smaller endlines present on piping grid? If yes approximate 9o of system: oyo 6. COilTROL UALWS a. Are all sprinkler system main control valves and all other related sprinkler valves in the appropriate open/closed position? b. Are all sprinkler system control valves sealed or supervised in the appropriate open/closed position? c. Are all valves in good condition? Y Y NAf]NNAf]NNAEN NAENNAEN NAf,]N d, N N N N tlE NA NA N N N N N NA NA YES NAf]NE TYE suPERwsEp oEEfl LoeK slGNgTY 2CTTY CONNECTION: 7. WATER FLOW TEST RESI'LTs a. City/Municipal water supply PSI: b. was water flow test performed and results satisfactory? TEST PIPE LOATTON: 2' MAIN DRAIN TO DOMESTIC CONNECflON IN ADJACEIIT MEDICAL NONOYES ?t TEST PTPE ORIEICE SIZE: STANC PRESSURE BEFORE: GOOD RECOVERY? Y 2' INCH4.1_:?)- tl::, 't NE ]TVS UNUZED? MAIN DRNN VALVE OK? GOOD COND.? AURII4ACflUANON NME IN SEC? NAENE NAf:] NE ta> ,**Jnqecbts f85,t connelnon Insl,l€ Patlent Roorn #A-lt,* NOTTS/COMMENTS: r **rl&q nE Todt rologiq Inc. hw thb lnq€don on t ro lad dpt tlp pent tt't6t r,/e rwr lttuld and tpproved by dE AH, br tlr€ oeuqncy tbr whld, lt was dslgnadL*** STATE OF MA UFE SAFETY ADDMONS: a. Were sprinkler systern control vafu6 wo*d and lufu? b. Have spinkler system pressure gauges ben alibratd/rcplad? Date of Calibratron/Replaement: July 11 2022 Next: JUU 13,2027 c, Have stickers with info ben plad on or near gauges? d. Have system riser bqls fun uNatd and postd apptupriately? e, Transmission of alam to centnl sbtion? EE EEE NA NA NA NA NA tltf EEE 265 NORTH MAIN fiREET SOUTH YARMOUTH, MAWINDSOR NURSING REHAB PAGE 3 SPRINKL E R S YSTE M IN FOR MA TION SPRINKLER/FIRE ALARM INSPECTION REPORT E]tfE d @ J &d osY YA NAf] NE@-6 / d9 wa w qdg. ,__\- Speciafrzittg in Inspectbn, testing anlgllaintmance of Water Aaset Fire (hotectbn afltAutonath lFire lkrm S1s*ns WINDSOR ilURSING & REHAB CEIITER Yarmouth Fire Dept: 508-398-2212 255 North Main Street South Yarmouth, MA 02664 Maint 508-394-3514 DEVICE ]UL OCT FIRE ALARM CONTROL PANEL OK OKl-Fkelite MS-9200 UD FACP Located in Basement Boiler Room OK OK ***Breaker for FACP in Electrical/Boiler Room EMPB #35**x BATTERIES 2-12VolV18 Amp Hour Located near FACP Basement Boiler Room (In Old Simplex FACP)OK OK OK OK*** New Batteries 4 I 2023t ++ Fire Alarm Panel Voltage Output 25.8 25.0 25.0 24.8 AUTOMATIC FIRE ALARM CONNESTION l-Digital Dialer to Cape Cod Alarm Central Station (Acct. #5-0206)OK OK OK OK Siqnal Transmitted to Central Station?YES YES YES YES REMOTE ANNUNCIATORS l-Firelite Front Main Entrance Foyer OK OK OK OK ADDRESSABLE SMOKE DETECTORS 1-D001 - Basement Hallway OK 2-D002 - Basement Hallway OK 3-D003 - Basement Hallway OK OK 5-D005 - Basement Hallway OK 6-D006 - Basement Hallway OK 7-DOO7 - Basement Hallway OK 8-D008 - Basement Hallway OK 9-D009 - Basement Hallway OK 10-D010 - li Floor Elevator Machinery Room (No Recall Present)OK 11-D011 - ls Floor Hallway Outslde Patient Room A-1 OK L2-D0LZ - 1* Floor Hallway Outside Patient Room A-5 OK 13-D013 - 1* Floor Hallway Outside Patient Room A-7 OK 14-D014 - 1* Floor llwa Near A Wi Nurses Station OK 15-D015 - 1* Floor Hallwa Near A Wi Nurses Stataon OK 15-D016 - ls Floor Hallwa Outside Patient Room A-12 OK 77-D017 - 1$ Floor Hal outside Patient Room A-16 OK 18-D018 - 1* Floor Hall Outside Patient Room A-18 OK 19-D019 - 1* Floor Hal OuLside Patient Room A-20 OK 20-D020 - 1* Floor Hall Outside Patient Room A-24 OK 21-D021 - 1* Floor Windsor Dini Hall OK IIII PAGE 1 OF 3 Cape Cod Alarm: 800-458-8300 Test: Jan, Apr, Jul, Oct ITANTAPR I 4-D004 - Basement Office DEVICE ADDRESSABLE SMOKE DETECTORS continued 22-DO22 - 1$ Floor Windsor Dini Room Hi h 23-D023 - ls Floor Windsor Dini Room 24-D024 - ls Floor Windsor Dini Room 25-D025 - 1* Floor Main Dini Room OK 25-D025 - 1* Floor Main Dini Room 27-D027 - 1* Floor Main Dini Room 28-D028 - 1$ Floor Hall Outside Diet Kitchen OK 29-D029 - 1$ Floor Main Lob 30-D030 - 1$ Floor Admissions Office H h OK 31-D031 - 1$ Floor Hall Outside Kitchen OK 32-D032 - 1* Floor Elevator Lo No Recall Present 33-D033 - ln Floor Hal Outside Patient Room B-24 OK 34-0034 - 1$ Floor Hal Outside Patient Room B-22 35-D035 - 1* Floor Hallw Outside Patient Room B-18 35-D036 - 1* Floor Hal Outside Patient Room B-15 37-D037 - 1* Floor Hall Outside Patient Room B-12 38-D038 - 1* Floor B Wi Hal 39-D039 - li Floor B Wi Hall Near Nurses Station 40-D040 - 1* Floor B Win Ha Near Nurses Station 41-0041 - 1* Floor Hall Outside Patient Room B-7 42-D042 - 1$ Floor Hal Outside Patient Room B-5 43-D043 - 1* Floor Hal Outside Patient Room B-1 44-D044 - 1$ Floor Hal Near A Win Rear Exit OK 45-D045 - 1* Floor Hall Near A Win Bath Hallwa OK zl6-D050 - Basement Mechanical Above FACP OK ADDRESSABLE HEAT DETECTORS 1-D046 - Basement Boiler Old Generator Room ADDRESSABLE DUCT SMOKE DETECTORS 1-D080 - Kitchen Roof T Unit Dini Room Ceili net OK ADDRESSABLE MANUAL PULL STATIONS 1-M061 - Basement OK 2-l'4062 - Basement 3-M063 - 1$ Floor A Win Rear Exit 4-M064 - 1s Floor Main Lo Area 5-l\4055 - 1$ Floor Kitchen OK 5-M066 - 1* Floor A Win Street Side OK 7-M067 - 1* Floor A Wi 8-M058 - 1i Floor A Wi 9-M069 - Windsor Room 10-M070 - 1n Floor B Wi 11-M071 - 1* Floor Elevator Lob OK l2-M072 - 1* Floor B Wi Street Side 13-M073 - 1* Floor Dini Room AUTOMATIC FIRE DOOR RELEASE MAGS 1 2-Basement Hall Outside Em Break Room 2 OK 3 4-Basement Hall Outside Administration Offi ce 2 OK 5 5-1* Floor Hall Outside Patient Rooms #A10 & #A9 z OK 7 8-1* Floor Hal Outside Patient Rooms #A15 & #A17 2 OK OK PAGE 2 OF 3 traul tIcr IAPRJUL -"+_-+--+-_-]oK-]---r--r--oK-1---T--T--] oKl IoK-r--r--H oKl I t -r---T_--t----T_---r-T--_l lorl I I---r----r---l ttt ffif--T---l oK-f-- ffiF=F Ioxlloxltt oK-r- tl I = I oKl I I I oKloKloKl-----------{-oKt-------------t-oKl lorlloxlloxl = oKloK-r-- oKloK-r- DEVICE AUTOMANC FIRE DOOR RELEASE MAGS continued Noted Problem/Deficiencies/Comments: APR JUL ocT OK9,10-1s Floor Hallway Outside Patient Rooms # A;14 & #M5 (2) OK11,12-1$ Floor Main Dininq Room (2) OK13,14-1n Floor Hallway Outside Patient Rooms #8.24 &. #825 (2) OK OK15,16-1't Floor Hallway Outside Patient Rooms #818 & #819 (2) OK17,18-1s Floor Hallway Outside Patient Rooms #89 & #810 (2) AUDIO/VISUAL NOTIRCATION DEVICES UK OK1-Basement Laundry Room (strobe Only) 2-Basement Hallway Outside Employee Break Room (Chime & Visual) OK OK3-Basement Hallway Outside Adult Day Care Services (Chime & Visual) OK OK4-Basement Hallway Outside Therapy Office (Chime & Visual) OK OK5-lstFloor Hallway Outside Patient Rooms #85 & #88 (Chime & Visual) OK OK6-1't Floor Hallway Outside B Winq Clean Utility Room (Chime & Visual) OK OK7-1st Floor Hallway Outside Patient Rooms #B2l & #823 (Chime & Visual) OK8-1st Floor Kitchen (Horn & Strobe) OK9-1't Floor Main Dining Room (Strobe Only) OK10-1s Floor Hallway Ceiling Outside Patient Room #A24 (Horn & Strob€) OK11-1* Floor Hallway Outside Patient Room #A17 (Horn & Strobe) OK OK12-1i Floor Hallway Outside A Wing Day Room (Horn & Strobe) OK OK13-1s Floor Hallway Outside Patient Rooms #A8 & A6 (Horn & Shobe) SPRINKLER SYSTEM EOUIPMENT - SEE ATTACHED SPRINKLER REPORT 30 Minute Battery Back-up Test (No AC Power)OK OK Load Test on Batteries After Readinqs -#1 AH - VOLTS - OK OK#2 At1 -',/ /voLTs - / -)) Next Battery Replacement: April 2026 l-Kitchen Ansul System Alarm to FACP OK 1-Smoke Detector Sensitivity Test completed 4-12-23 Next: 2028 v /.az (D 41 Technician Name & Signature PAGE 3 OF 3 2 TABER STREET, FAIRHAVEN, MA 02719 77 4.263.5924 or 774.263.5930 or mkmfi retechnologies@comcast.net fANl T f I I lorl II oKl IoK-r---r---F tt oK-foK-foK-T-oK trrtt lox I I = tt =oKlor I --l I OK I lorl oK-r---l----r---1--H --T-oK--foK nttClzEc 4 i //r/td/ I ,4L4.4\E ,a 'J2 Date GYre &q Speciafrzirg in ltsVcctb+ Iesthg aathlsiitauacc of Wst r(ks.l qire tPmtcction antAltonatb fie "flhn Sytemr r€memb€r 9/11 - 343 508 394-3574 NOTES/COMMENTS: E Yarmouth Fire: (508) 398.2272 Cape Cod Alarm Company 800-468-8300 Account #: 5-1032 -t l- TERLY ocfoBER 2024 DEVICE DEVICE ocr CARBONE MONOXIDE CONTROL PANEL CAREON MONO)f, DE DETECTORS OKl-Silent Kniqht IFP-50 Control Panel @ Front Main OKEntrance Foyer 1/ CMD Basement Laundry Room 2/ CMD Basement Furnace Room OK BATTERIES 3/ CMD Basement Boiler Room OK 2-12 Volv7.o Amp Hour in Panel Cabinet 4/ CMD Kitchen Area OK Load Test Results: 1-. - . Volts . Amp Hour OKz-/ 4 vote'/Z Amp Hour OK Date of Battery Install - 2023 Next 2026 II I II **rThese particular devices are not tied into the main fire alarm control panel,*** n)/Cz/ru-- k nyr4*,q Clrah,N-acffi*R 3b f Technician Name & Signature PAGE I of 1 2 TABER STREET, FAIRHAVEN, MA 02719 'J Date of Examination 774,263,5924 ot 774.263,5930 or mkmffretectrnologies@comcast.net WINDSOR NURSING & REHAB CEI{TER 265 North Main Street South Yarmouth, MA 02664 locrl /ruchollq<.)t/ q \- Specbfrzinq in Inspeaion, {esthg anlgLainterunce of 'l,laur cBased Firc cho*ction antr Autonatic $ire A km Sys*ms WI]TDSOR NURSIilG & REHAB CENTER 265 North Main Street South Yarmouth, MA 02664 (s08) 995-5753 Yarmouth Fire Dept: 508-398-2212 Test: Jan, Apr, Jul, Oct Door l+lagnetic Releasing Systems Test I DEVICE JAN APR ocr ALARM/RELEASE PERFORMANCE DOOR MAGNENC RELEASiNG MECHANISMS 1 - Basement Stairwell Near Employee Break Rm OK OK OK OK PASS El FAIL PASS FAIL 2 - Basement StaiMell Near Laundry Room OK OK OK OK PASS X FAIL PASS XI FAIL 3 - North Stairwell Near Grade Level Landinq OK OK OK OK PASS EI FAIL PASS EI FAIL 4 - 1$ Floor Stairwell B Winq North OK OK OK OK FAIL 5 - 1i Floor Northeast Exit Near Patient Room B-1 OK OK OK OK 6 - 1d Floor Center Stairwell Near Elevator OK OK OK OK PASS EI FAIL PASS FAIL 7 - 1* Floor Main Entrance OK OK OK OK PASS FAIL PASS FAIL 8 - 1$ Floor Main Entrance OK OK OK OK PASS EI FAIL PASS EI FAIL 9 - 1* Floor Northeast Exit OK OK OK OK PASS EI FAIL 10 - lj Floor Kitchen Exit OK OK OK OK PASS El FAIL PASS 11 - 1i Floor Dinino Room Exit OK OK OK OK PASS El FAL ]PASS EI FAIL 12 - ln Floor Activities Room OK OK OK OK PASS EI FAIL PASS FAIL 13 - ls Floor Activities Room OK OK OK OK PASS E[ FAIL PASS E[ FAIL 14 - Patio Exit OK OK OK OK PASS EI FAIL PASS FAIL 15 - Driveway Exit Southeast OK OK OK OK PASS XI FAL PASS EI FAIL Noted Problem/Deficiencies/Comments : *Door Codes are recorded i Technician Name & Signature PAGE 1 of 1 2TABER STREET, FAIRHAVEN, MAO27I9 ' Date of Examinauon 774.263,5924 or 774.263,5930 or mkmfiretechnologies@comcast.net Ilua FAIL EPASS PASSEI FAILII r PASS I L TFASSE FAIL TFASSE FAIL FAIL f I+ /, )/cr-a{/e-- y'. tux-ttTB/ )a///////tila4