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Home My WebLink Aboutsprinkler and alarm test report July 2024YARMOUTH FIRE DEPARTMENT EIRE SPRIIIIKLER & ERE ALART] IEST REfuRf IUAME OF PREI+'ISE9: ADDRESi: IELEPHO E NUNBER: WINDSOR NU & REHABILITATION CENTER 265 NORTH MATN STREET- SOUTH YARMOIJTH MA O CONTROL PATIELS A flU CATORS STA D.BT AAT\ERYS SNOKE DEiECIORS HEAT DE|EC|ORS PULL STA|IONS RELLS/HORNS SPRINKLERS IAI'PER SMTCHES ARBON t'|aflOXIDE SERWCE COifi]ENT': /(pl 7 ^q*t SERWCE SERWCE SERVICE SERWCE SERWCE SERWCE SERVICE SERWCE SERWCE SERYTCE OK OK OK OK OK OK OK OK OK OK 7q.;w ,a /rq-;4, I4ICHAEL K. MAHANEY HAVE TNSPECTEO WINDSOR NURSING & REHABILITANON CENTER OIV AIID fHE ABOW ftSIED IiET'IS ARE WORKING PROPERLT ACCORDIIIC TO T'AIIUFAC|URERS ,,: ./. ,/ / . .,, RECON4HENDAfIONS. INSPECTORS SIG ATURE;DAfE; COMPANY NAI',E AND ADDRESS: MKN4 FIRE TECHNOLOGIES. INC. 774.263-5924/774-263-5930 2 TABER STREET. FAIRHAVEN. FORM 1993 RECEIVED RT YARMOUTH FIRE DEPAR|MENT: o?719 Ul INTEGRITUS HEALTHCARE DIRECTOR OF MAINTENANCE ',.-. --{ MKM Office .a'aw, customer .r( cow: Fire Dept rememDer 9/77ffi ff$e .$--$& 2 TAEER ,7REET, FAIRHAVEN MA 02719 774-263-5924/77+263- 5930/ EMAIL : mkmfi ret&hnolqies@comcdst. net SPRI N KLE R/ FIR E A IA R M SYSTEM INSPECTTON REPORT ***fn memory of Lt Jason l,renatd of tlre Wot$ter, lrA Firc R6cue &gntdnent******fn memory of Fitc Alarm SupC Dickie Oliver of the Falmouth, lrA Fhe R&ue &Fartt rent******fn memory of Fi,cllghtcr Eric Fernand$ of the llew Eedford, ltlA Firc Re*ue Depattment*** ITITEGRIruS HEALIIIARE CUS'TOMER NAME: ADDRESS: CONTACT: IELEPHONE: DATE OF TNSPECTION: # OF INSPECTION: REPORT #: WINDSOR NURSING & REHABILTTATION CENTER 265 NORTH T4AIN STREET. SOUTH YARMOUTH. MA FACILTTv MAINTF NCE DIRECTOR 7 24 ACCOUNT #: WNH/SE413-4 TWO OF FOII (214\ FIR E DEPA RTMENT CONTA CTED : ETRE DEPARTIYIENT TELEPHONE #: FIRE DEPARTMENT CONTA CT: FIRE DEPARTMENT MAIUNG AODRESS: CENTRAL STATION CONIACTED : CENTRAL 5TANON TELEPHONE #: YARMOUTH FI RESCUE DEPARTMENT 508-398-2212 FIRE PREVE N BUREAU 96 OLD MAI N , SO. YARMOUTH. I4A CAPE COD AI A M COMPANY 800-468-8300 CENTRAL STATION TYPE OF SYSTEM/S: ONE WET SPRINKLER SYSTEM/FIRE ALARM SYSTEM FOR ENTIRE FACILITY MASTER/RADIO BOX i & LOATION: COMMUNICATOR/PRIMARY & SECONDARY PHONE UNES To : DIALERS D AT EACH INDMDUAL PANEL / FI ALARI4 AND CARBON MONOXIDE PANELs FIRE AURM CON|ROL PANEL - MAKE/MODEULOAATION: FIREUTE MS9200UD FOR FIRE ALARM SYSTEM LOCATED IN BASEMENT BOILER ROOM/SILENT KNIGHT PANEL FOR CARBON MONOXIDE SYSTEM LOCATED AT 1ST FLOOR N ENTRANCE FOYER NOTES/COMMENTS: lAzl '/lUj/(zi[uINSPECTORS NAME: PRESTDENT: UCENSE 15: 265 NORTH MAIN STREET SOUTH YARMOUTH, MAPAGE 1 MKIVI TEST INSPECTION AND SERVICE DIVISION FDNT343 NOTE+**PUT JUMPER IN TERMINAL BLOCK DIRECNY ATTACHED TO AURM REUY FOR DOOR DJSABLE*** NOIT***FOR SILENT TEST DI948LE NAC CIRCUITS 1 THROUGH 4*** /l MI*TAEL K. MAIANEY t ' .- ut sntnrLra comrucToR tN7102 / A SPRIflKLER JOURNEYT'IA|| $003669/RHODE ISUND SPRII'\K|aR CONTRACTOR #RIm39 / RHODE ISUIiD SPRINKLER )OUNEYMAN sNlW67/MA FIRE AURM CONTRAOOR #$r / A nRE ATARM TECI|NICIA SlfiSO / t4A SEA1NTY sYS' IEIIS #NT512 / MA DEP ACKNOW TESTER #4376 / NEW ENGUND WATER WORKS B4CK FLOW REPAIR #2562 WINDSOR NURSING REHAB -r€cHNOLOGIES. INC. ,58.FrRE (3473) SPRINKLER/FIRE ALARM SYSTEM INSPECTION REPORT DEWCEtlE DESCRTPTTOfl RRE ALARM PANEVRADIO BOX REMOTE ANNUNOATOR WATER FLOW IND SWITCH WATER FLOW PRES SWITCH OUTSIDE ELECTRIC BELL TAMPER SWTTCH WET PIPE VALVE INSPECTORS TEST VALVE WATER MOTOR GONG DOUBLE CHK BACKFLOW STD PUMPER CONNECTION arY TESTED NA NAE THTS TNSP FACP ANNUN FS WFPS OEB 75 WPV ITV WMG DCBP PCONN NENEYENEYENEY[]Nf] YEN[]YENEYEN[]YENEYNNEYENEYflN flY NA NA NA NA NA NA NA NA NA NA @@g @ad N N N N N N N N N N N A1 1 .t 1 1 2 1 .t 1 1 1 NA NA NA NA NA NA NA NA NA N N N N N N N N N --. ----a-- tlEEnEEEEtl EEEDEEE E SP RI N KL E R S YSTE TI' I N FOR II'A TION I. GENERAL 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 covered with automatic sprinklers? f. Are all new additions or buildings also sprinklered? g. Is all storage/debris properly stored 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. Pult'lPli. EIRE OEPT, COilNECnOilS b. Are fire department 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, WET SYSTET4 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? Number of wet systems: Make/Model: NA NA NA NA NA NA Y [] tttlYEna N N N N GEM 4" WET ALARM VALVE IN ENT SUPPLY ROOM 4. AIARfrIS a. Water motor gong test satisfactory? b. Electric device (bell, horn, strobe) test satisfactory? c. Supervisory alarm service test satisfactory? /ra. ALARl.l UALVE/CHECK ilITERNAL E(AMINATION a. Date internal exam conducted: JULY 13.2022 b. Next scheduled internal exam?JULY.2027 4b. FIRE SERWCE BACKFLOW PRFYENfiOil a. Model: 200OSS Manufacturer: Ames Size: 4" inch NAENENENAEN f] Results of Tests: P Results Serial #: 01385 FAILb. Date Tested: c. Report Filed?YE WINDSOR NURSING REHAB Auo 10.t7 PAGE 2 N TOTAL arv ACTIUATE QKZ RESET9E /. EE 265 NORTH MAIN STREET SOUTH YARMOUTH, MA _.-ftcHNoLoGIES/ INC. -.6,58.FrRE (3473) SPRINKLER/RRE ALARM INSPECTION REPORT SPRTN KL E R S YSTEM IAI FOR MATTO N 5. SPRTflKIERI' AIYD PTPT G a. Sprinkler heads in qood condition, 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 condltion 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 reca lls or voluntary replacement? h. Are there any 3/4" or smaller endlines present on piping grid? If yes approximate Yo of system: 0olo 6, CONTROL YALWS a. Are all sprinkler system main contrcl valves and all other related sprinkler valves in the appropriate open/closed position? b. Are all sprinkler system control valves sealed or supervis€d in the appropriate open/closed position? c. Are all valves in good condition? Y Y NA NA NA N N N N N N EEE NA NA NA NAEtIYE NA f] II Yd Etl NA NA NA N N N QTY 2 SUPERWSED OaEN LIEK Elgfl NONOYESYES 7. WATER FLOW TEST RESULTS a. City/Municipal water supply PSI: b. Was water flow test performed and results satisfactory? TEST PIPE LOATON: 2. MAIN DRAIN TO DOMEfiC CONNECTION IN ADJACENT MEDICAL C]TY CONNECTION: LE OSY 2" INCH ,ITTS UTTUZED? MAIN DRAIN VALVE OK? GOOD COND,? AURIq ACTIVATTON 77ME IN SEC? aCa F Y vd Netf NE&ZAN ***fnqecto6 Test Connaction Inslde Padent Room #A-7*** NOTTS/COI,IMENTS: ***nK Fira ledrno'logiq Inc. bs thia intpection oo tlra lact tlrat 6e prwnc EFbn/' wcte iotulld aN aqqroved by the AH, for the odj.rryncy br vhldt it rveJ daalgnadL*** STATE OF MA UFE ilFETYADDITTONS: a. Were spinkler system control valves wo*d and luffi? b. Have sprinkler system pressure gauges ben calibratd/replacd? Date of Calibration/Replaement: July 14 2022 Nert: July 11 2027 c. Have stickeE with info ben plaed on or near gauges? d. Have syfiem riser tag/s been updatd and postd appropriately? e, Transmission of alarm to central sbtton? NA NA N N N N N NA NA NA EE EEE 265 NORTH MAIN STREET SOUTH YARMOUTH, MAWINDSOR NURSING REHAB PAGE 3 tlEtl fr @ g NAENf] TEST PIPE ORIFTCE SIZE: STATTC PRESSURE BErcRE: RESIDUAL PRESSURE DURING: - STAllC PRESSURE AFTER: ./ GOODRECOVERY? Y6 /AAENE {,(g .S-rllr Speciafrzing in Inspectian, testing ant frtaintenance of '|,!ater cBase[ (Fte Srotectian antAutomatic Fire j.tarm Slstcms t &€:' WINDSOR NURSING & REHAB CENTER Yarmouth Fire Dept: 508-398-ZZl2 265 North Main Street South Yarmouth, MA 02664 Maint 508-394-3514 Cape Cod Alarm: 800-z+68-8300 Test; lan, Apr, Jul, Oct DEVICE APR FIRE ALARM CONTROL PANEL OK OK OK***Breaker for FACP in Electrical Eoiler Room EMPB #35*+* BATTERIES 2-LzYo 18 Am Hour Located near FACP Basement Boiler Room In Old Sim lex FACP OK OK OK***New Batteries 4 020x** Fire Alarm Panel Vo o 25.8 25.0 25.0 AUTOMATIC FIRE ALARM CONNECTION OK OK OK YES YES YES REMOTE ANNUNCIATORS OK OK OK ADDRESSABLE SMOKE DETECTORS 1-D001 - Basement Hal OK OK OK 4-D004 - Basement Office OK OK 6-D006 - Basement Hal OK 7-D007 - Basement Hal OK 8-D008 - Basement Hal OK 9-D009 - Basement Hal OK 10-D010 - 1't Floor Elevator Machine Room No Recall Present OK OK11-D011 - l't Floor Hallwa Outside Patient Room A-1 OK12-D012 - 1* Floor Hal Outside Patient Room A-5 OK13-D013 - 1* Floor Ha Outside Patient Room A-7 OK14-0014 - 1* Floor Hal Near A Wi Nurses Station OK15-D015 - 1* Floor Hallwa Near A Wi Nurses Station OK16-D016 - 1i Floor Hallwa Outside Patient Room A-12 OKl7-D077 - 1* Floor Hal Outside Patient Room A-16 OK18-D018 - 1n Floor Hal Outside Patient Room A-18 OK19-D019 - 1n Floor Hallw Outside Patient Room A-20 OK20-D020 - 1n Floor Hall Outside Patient Room A-24 OK21-D02 1 - 1$ Floor Windsor Dini Hall PAGE 1 OF 3 q trulTo.-l l-Firelite MS-9200 UD FACP Located in Basement Boiler Room 1-Digital Dialer to Cape Cod Alarm Central Station (Acct. #6-0205) Siqnal Transmitted to Central Station? l-Firelite Front Main Entrance Foyer 2-D002 - Basement Hallway 3-D003 - Basement Hallway 5-D005 - Basement Hallway JAN DEVICE ADDRESSABLE SMOKE DETECTORS contin -,072 - f Floor Windsor Dinin Room H h 23-D023 - 1$ Floor Windsor Dini Room JAN APR ]UL OCT 24-D024 - lst Floor Windsor Dini ng Room 25-0025 - 1st Floor Main Din Room OK 26-D026 - 1* Floor Main Dini Room 27-D027 - 1* Floor Main Dini Room 28-D028 - 1$ Floor Hallw Outside Diet Kitchen OK 29-D029 - 1* Floor Main Lobby OK 30-D030 - 1s Floor Admissions Office (Hiqh)OK 31-D031 - 1$ Floor Hallway Outside Kitchen 32-D032 - 1i Floor Elevator No Recall Present OK 33-D033 - 1* Floor Hal Outside Patient Room B-24 34-0034 - 1* Floor Hal Outside Patient Room B-22 35-D035 - 1$ Floor Hal Outside Patient Room B-18 36-D035 - 1* Floor Hallway Outside Patient Room 8-16 OK 37-D037 - 1* Floor Hallway Outside Patient Room 8-12 OK 38-D038 - 1$ Floor B Wi Hal OK 39-D039 - ls Floor B Wi Hal Near Nurses Station 40-D040 - 1$ Floor B Wi Hallwa Near Nurses Station 4l-D047 - 1* Floor Hal Outside Patient Room B-7 42-D042 - 1* Floor Hall Outside Patient Room B-5 43-D043 - 1* Floor Hallw Outside Patient Room B-1 44-D044 - 1$ Floor Hall Near A Wi Rear Exit OK 45-D045 - 1* Floor Hallw Near A Wi Bath Hal OK 46-D050 - Basement Mechanical Above FACP OK ADDRESSABLE HEAT DETECTORS 1-D046 - Basement Boiler Room Old Generator Room OK ADDRESSABLE DUCT SMOKE DETECTORS 1-D080 - Kitchen Roof Top Unit (Dininq Room Ceillng/Magnet) ADDRESSABLE MANUAL PULL STATIONS 1-M051 - Basement OK Z-M062 - Basement OK 3-M063 - 1't Floor A Wing Rear Exit OK 4-M064 - 1$ Floor Main Lobby Area OK 5-M065 - l* Floor Kitchen OK 6-M066 - 1$ Floor A Winq Street Side OK 7-M067 - ls Floor A Winq OK OK8-M068 - 1$ Floor A Wing OK9-M069 - Windsor Room OK10-M070 - 1* Floor B Win OK11-M071 - 1* Floor Elevator Lobby OKl2-M072 - 1* Floor B Wi Street Side OK13-M073 - 1* Floor Dini Room OK1,2-Basement Hallway Outside Break Room (2)Employee OKOutside Administration Offlce 2 Outside Patient Rooms #A1 0&#A9 2 3 4-Basement Hal 5 6-1n Floor Hal 8-1" Floor Hal 16utsid z#&1A7sRoomA#e Patient7 III II PAGE 2 OF 3 FIRE RELEASE oK-r---r--- ffi ffi oK-T ---r--- ----r-------r--- I tl -oK-l LJll H Ior loK ---t OK oK- --t tt#+ loxlf o-C t oK-T_lloKllorlF-----+----------.1toKtlorl DEVICE AUTOMATIC FiRE DOOR RELEASE MAGS continued -,J-1* FIOOr Ha Outside Patient Rooms #A24 & #A25 2 11 12-1't Floor Main Dini Room 2 APR ]UL ocr 13,14-1st Floor Hallway Outside Patient Rooms #B24 & #825 (2) 15,15-1s Floor Hallway Outside Patient Rooms #818 & #B19 (2) 17,18-1n Floor Hallway Outside Patient Rooms #B9 & #B10 (2) AUDIO/VISUAL NOTiFICANON DEVICES l-Basement Laundry Room (Strobe Only) 2-Basement Hallway Outside Employee Break Room (Chime & Visual) 3-Basement Hallway Outside Adult Day Care Services (Chime & Visual)OK 4-Basement Hallway Outside Therapy Office (Chime & Visual)OK 5-1't Floor Hallway Outside Patient Rooms #86 & #88 (Chime & Visual)OK 6-1't Floor Hallway Outside B Wing Clean Utility Room (Chime & Visual)OK 7-1$ Floor Hallway Outside Patient Rooms #821 & #823 (Chime & Visual)OK 8-lst Floor Kitchen (Horn & Skobe) 9-1't Floor Main Dining Room (Strobe Only) 10-1* Floor Hallway Ceiling Outside Patient Room #A24 (Horn & Strobe) 11-1{ Floor Hallway Outside Patient Room #A17 (Horn & Strobe) 12-1* Floor Hallway Outside A Winq Day Room (Horn & Strobe) 13-1st Floor Hallway Outside Patient Rooms #A8 & A6 (Horn & Strobe) SPRINKLER SYSTEM EQUIPMENT - SEE ATTACHED SPRINKLER REPORT 30 Minute Battery Back-up Test (No AC Power) Load Test on Batteries After Readinqs -#7 AH_VOLTS - AH_VOLTS -OK Next Battery Replacement: April 2028 l-Kitchen Ansul System Alarm to FACP OK l-Smoke Detector Sensitiviry Test Completed 4-12-23 Next: 2028 /y) /at4{--Y1-,/ /' ).L)l ,i* rft-\-tZ "2 Jar4Z&1Cu,('7< Technician Name & Signature PAGE 3 OF 3 2 TABER STREET, FAIRHAVEN, MA 02719 Date Noted Problem/Defi ciencies/Comments: JAN t oK-f---T---f- IoK-T_---T_--_l ffit oK-T_---T_--- toK-Ft oK-T_---T_---T_-toK-Ft oK-T_-__ltoK-f--f---T_---f___l loxl loxr-T___lt oK-foK-foK-f- foK I I tEat oKl----r--- oKl I lorlor foK l I t./u 774.263.5924 ot 774.263.5930 or mkmfi retechnologies@comcast'net .1*o/ tF,W q B WINDSOR I{URSITTG & REHAB CENTER 265 North Main Street South Yarmouth, MA 02664 508 394-3514 NOTES/COMMENTS: Yarmouth Fire: (508) 398.2212 C-ape Cod Alarm Company 8@468-8300 Account #: S1032 Y ocToBER 2024 ocr DEVICEDEVICE CARBON MONOXIDE DETECTORS OKl-Silent Knisht IFP-50 Control Panel @ Front Main Entrance Foyer U CMD Basement Laundry Room OK2/ CMD Basement Furnace Room OKBATTERIES3/ CMD Basement Boiler Room OK2-12 Volv7.o Amp Hour in Panel Cabinet 4/ CMD Kltchen Area Load Test Results: 1- Vdb Amp Hour OK OK2VdE Amp Hour Date of Battery Install - 2023 Nod 2026 a I ***These particular devices are not tied into the rnain fire alarm control panel.*** n?/CL4EV-- /ttir,l /t)tXtA^El a-4 / aq, ia/+ WbLzhg in Inr?qaio\(en 8 ^nf,grlai,ruaaacc of 'hhw futed fin lProtzrtion an{Adoiutic qiry Akt n $sknt rumember 9/11 - 34il CARBONE MONOXIDE CONTROL PANEL OK ocr I Technician Narne & Signature Date of Examination PAGE 1 of 1 2 TABER SrREEI, FAIRHAVEN, MA 02719 774.263.5924 or 774.253.5930 or mkmfiretechnologies@corncast.net frtQ q&€,', Specialurng in Inspectian, testing an[ *laintenance of 'l,later $ase[ Fire (kotection anl]utomatic (Fire ltam Sytems WINDSOR NURSING & REHAB CENTER 265 North Main Street South Yarmouth, MA 02664 (s08) 9e6-6763 Yarmouth Fire Dept: 508-398-2212 Test: lan, Apr, lul, Oct Door lragnetic Releasing Systems Test { DEVICE JAN APR JUL ocr ALARM/RELEASE PERFORMANCE DOOR MAGNMC RELEASING MECHANISMS 1 - Basement Stairwell Near Employee Break Rm OK OK OK PASSE FALf PASS El FAIL 2 - Basement Stairwell Near Laundry Room OK OK OK PASS XI FAIL f PASS FAIL 3 - North Stairwell Near Grade Level Landinq OK OK OK PASS E FAIL f 4 - 1$ Floor Stairwell B Winq North OK OK OK PASSEI FAILf PASS xI FAIL 5 - 1s Floor Northeast Exit Near Patient Room B-1 OK OK OK PASS El FAIL f PASS EI FAL 6 - 1$ Floor Center Stairwell Near Elevator OK OK OK PASSEI FALf PASS EI FAIL 7 - 1* Floor Main Entrance OK OK OK PASS DiI FAiII PASS EI FAIL 8 - 1i Floor Main Entrance OK OK OK PASSXI FAILf PASS xl FAIL 9 - 1$ Floor Northeast Exit OK OK OK PASSEI FAILf OK OK OK PASSEI FALf: 11 - lst Floor Dining Room Exit OK OK OK PASSE FALf PASS EI FAIL 12 - 1s Floor Activities Room OK OK OK PASS EI FAL f PASS EI FAL 13 - 1n Floor Activities Room OK OK OK PASS El FAIL OK OK OK PASS FAIL 15-Driveway Exit Southeast OK OK OK PASS EI FAL E PASS X FAIL Noted Problem/Defi ciencies/Comments: +Door Codes are recorded in I on Folder for Wi t4>r.B/ .//_/) (7 #r', Technician Name & Signature PAGE 1 of 1 2 TABER STREET, FAIRHAVEN, MA 02719 Date of Examination 774,263,5974 ot 774,263.5930 or mkmfiretechnologles@mmcast.net PASS X FAIL E PASS XI FAIL f] 10 - 1$ Floor Kitchen Exit PASS X FAIL E PASS X FAIL D 14 - Patio Exit PASS X FAIL E ,n)/&/*4L (dlau