cument do This...21202 Pacific HWYS, SeaTac,WA98198 Provider Number Approval Status Facility Type 2130 Disapproved Residential Care On 07/09/2018 the Office of the State Fire …

Washington State PatrolFire Protection Bureau

Phone: (360)596-3900

Business Name

Address

City, State, Zip

Falcon Ridge Assisted Living

21202 Pacific HWYS,

SeaTac,WA98198

Provider Number

Approval Status

Facility Type

2130

Approved

Residential Care

On 08/15/2018 the Office of the State Fire Marshal conducted an inspection at your facility.

All violations noted during previous related inspection(s) have been corrected.

Owner or Owner's Representative

^f^natur^ip v^cxn CLm.z- L^cJ^ Msii i^4^^)Tje_

Print Name and Title

Deputy State Fire Marshal Dylan Montgomery2505 112THSTETacomaWA 984455104(425) 577-0362

^g^atui-e

Right of appeal. Any person may appeal any decision made by the Fire Protection Bureau in accordance with WAC 212-12.

1 of 1 Initials of Authorized Facility Representative:

This

docu

men

t was

pre

pare

d by

Res

iden

tial C

are

Serv

ices

for t

he L

ocat

or w

ebsit

e.


Phone: (360)596-3900

Business Name

Address

City, State, Zip


21202 Pacific HWYS,

SeaTac,WA98198

Provider Number

Approval Status

Facility Type

2130

Disapproved

Residential Care


Code Requirement Statement of Violation

1 Admin New Requirements

EFFECTIVE JULY 1,2018.

703.2 Opening protectives. Opening protective sahll bemaintained in an operative condition in accordance with NFPA80.

NFPA80 Chapter 19 Installation, Testing, and Maintenance ofFire Dampers.19.4 Periodic Inspection and Testing.19.4.1 Each damper shall be tested and inspected 1 year afterinstallation.19.4.1.1 The test and inspection frequency shall then be every4 years, except in hospitals, where the frequency shall be every6 years.

907.10 National Institute for Certification in EngineeringTechnologies.907.10.1 Scope. This section shall apply to new and extistingfire alarms systems.907.10.2 Design review. All construction documents shall bereviewed by a N I GET III in fire alarms or a licensed professionalengineer (PE) in Washington prior to being submitted forpermitting. The reviewing professional shall submit a stamped,signed, and dated letter; or a verification method approved bythe local authority having jurisdiction indicating the system hasbeen reviewed and meets or exceeds the design requirementof the Washington and the local jurisdiction (effective July 1,2018).907.10.3 Testing/maintenance: Alt inspection, testingmaintenance and programing not defined as "electrical trade"by chapter 19.28 RCW shall be completed by a NICET II in firealarms (effective July 1, 2018).

1 of 6 Initials of Authorized Facility Representative: .TTA/

This

docu

men

t was

pre

pare

d by

Res

iden

tial C

are

Serv

ices

for t

he L

ocat

or w

ebsit

e.


Phone: (360)596-3900

Business Name

Address

City, State, Zip


21202 Pacific HWYS,

SeaTac,WA98198

Provider Number

Approval Status

Facility Type

2130

Disapproved

Residential Care



2 Activation test.

An activation test of the emergency lighting equipment shall becompleted monthly. The activation test shall ensure theemergency lighting activates automatically upon normalelectrical disconnect and stays sufficiently illuminated for aminimum of 30 seconds.

(IFC 604.6.1 2015)

The following violation was observed:

The facility failed to conduct monthly 30 second battery backuptests on emergency lighting.

3 Activation test record.

Records of tests shall be maintained The record shall includethe location of the emergency lighting tested, whether the unitpassed or failed, the date of the test, and the personcompleting the test.

(IFC 604.5.1.1 2015)


The facility failed to document monthly 30 second batterybackup tests on emergency lighting.

4 Power test.

For battery-powered emergency lighting, a power test of theemergency lighting equipment shall be completed annually.The power test shall operate the emergency lighting for aminimum of 90 minutes and shall remain sufficiently illuminatedfor the duration of the test.

(IFC 604.6.2 2015)


The facility failed to conduct annual 90 minute battery backuptests on emergency lighting

5 Power test record.

Records of tests shall be maintained. The record shall includethe location of the emergency lighting tested, whether the unitpassed or failed, the date of the test, and the personcompleting the test.

(IFC 604.5.2.1 2015)


The facility failed to document annual 90 minute batterybackup tests on emergency lighting.

6 Multiplug adapters.

Multiplug adapters, such as cube adapters, unfused plug stripsor any other device not complying with NFPA 70 shall beprohibited.

(IFC 605.4 20122015)


The facility has an unapproved multi plug adapter in Rm 49.

2 of 6 Initials of Authorized Facility Representative: TO/

This

docu

men

t was

pre

pare

d by

Res

iden

tial C

are

Serv

ices

for t

he L

ocat

or w

ebsit

e.


Phone: (360)596-3900

Business Name

Address

City, State, Zip


21202 Pacific HWYS,

SeaTac,WA98198

Provider Number

Approval Status

Facility Type

2130

Disapproved

Residential Care



7 Unapproved Conditions

Open junction boxes and open-wiring splices shall beprohibited. Approved covers shall be provided for all switch andelectrical outlet boxes.

(IFC 605.6)

The following violations were observed:

The facility has broken outlet covers in the following locations:

1. Theater2. Rm 203. Activity Rm

8 Fire walls, fire barriers and fire partitions.

Required fire walls, fire barriers and fire partitions shall bemaintained to prevent the passage of fire. All openingsprotected with approved doors or fire dampers shall bemaintained in accordance with NFPA 80.

(IFC 703.1.3 2015)


The facility failed to maintain it's fire barriers and haspenetrations in the following locations:

1. Above the ceiling tile above the old Med Rm2. Above the door to the boiler Rm

9 Opening protectives.

Opening protectives shall be maintained in an operativecondition in accordance with NFPA 80. Where allowed by thefire code official, the application of field-applied labelsassociated with the maintenance of opening protectives shallfollow the requirements of the approved third-party certificationorganization accredited for listing the opening protective. Firedoors and smoke barrier doors shall not be blocked orobstructed, or otherwise made inoperable. Fusible links shall bereplaced promptly whenever fused or damaged. Fire doorassemblies shall not be modified.

IFC 703.2


The facility has resident room fire doors blocked open in thefollowing locations:

1.Rm49

3 of 6 Initials of Authorized Facility Representative: C30/

This

docu

men

t was

pre

pare

d by

Res

iden

tial C

are

Serv

ices

for t

he L

ocat

or w

ebsit

e.


Phone: (360)596-3900

Business Name

Address

City, State, Zip


21202 Pacific HWYS,

SeaTac,WA98198

Provider Number

Approval Status

Facility Type

2130

Disapproved

Residential Care



10 Door Operation

Swinging fire doors shall close from the full-open position andlatch automatically. The door closer shall exert enough force toclose and latch the door from any partially open position.

(IFC 703.2.3)


The facility has fire doors that do not have enough self closingforce to close and latch automatically in the following locations:

1.Rm312. Rm 123. Rm 514. Rm 495. Rm 40

11 Inspection, testing and maintenance.

Fire detection, alarm, and extinguishing systems, mechanicalsmoke exhaust systems, and smoke and heat vents shall bemaintained in an operative condition at all times, and shall bereplaced or repaired where defective. Nonrequired fireprotection systems and equipment shall be inspected, testedand maintained or removed.

(IFC 901.6 2012,2015)


The facility failed to conduct monthly extinguisher checks.

The facility failed to produce documentation for annual backflow test.

The facility's fire alarm control panel is in trouble mode andneeds to be addressed.

4 of 6 Initials of Authorized Facility Representative: ^5^C

This

docu

men

t was

pre

pare

d by

Res

iden

tial C

are

Serv

ices

for t

he L

ocat

or w

ebsit

e.


Phone: (360)596-3900

Business Name

Address

City, State, Zip


21202 Pacific HWYS,

SeaTac,WA98198

Provider Number

Approval Status

Facility Type

2130

Disapproved

Residential Care



12 Securing compressed gas containers, cylinders and tanks.

Compressed gas containers, cylinders and tanks shall besecured to prevent falling caused by contact, vibration orseismic activity. Securing of compressed gas containers,cylinders and tanks shall be by one of the following methods:

1. Securing containers, cylinders and tanks to a fixedobject with one or more restraints.

2. Securing containers, cylinders and tanks on a cart orother mobile device designed for the movement of compressedgas containers, cylinders or tanks.

3. Nesting of compressed gas containers, cylindersand tanks at container filling or servicing facilities or in seller'swarehouses not accessible to the public. Nesting shall beallowed provided the nested containers, cylinders or tanks, ifdislodged, do not obstruct the required means of egress.

4. Securing of compressed gas containers, cylindersand tanks to or within a rack, framework, cabinet or similarassembly designed for such use.

Exception: Compressed gas containers, cylinders and tanks inthe process of examination, filling, transport or servicing.

(IFC 5303.5.3 2012,2015)


The facility has an unsecured oxygen cylinder in Rm 31 .

5 of 6 Initials of Authorized Facility Representative: CTCV

This

docu

men

t was

pre

pare

d by

Res

iden

tial C

are

Serv

ices

for t

he L

ocat

or w

ebsit

e.


Phone: (360)596-3900

Business Name

Address

City, State, Zip


21202 Pacific HWYS,

SeaTac,WA98198

Provider Number

Approval Status

Facility Type

2130

Disapproved

Residential Care



13 Fire Drills

In all Group I, Group E, and Group R2 Occupancies licensed bythe state, at least h/velve planned and unannounced fire drillsshall be held every year. Drills shall be conducted quarterly oneach shift in Group I and Group R2, Occupancies and monthlyin Group E Occupancies to familiarize personnel with signalsand emergency action required under varied conditions. Adetailed written record of all fire drills shall be maintained andavailable for inspection at all times. When drills are conductedbetween 9:00 p.m. and 6:00 a.m., a coded announcement maybe used instead of audible alarms. Fire drills shall include thetransmission of a fire alarm signal and simulation of emergencyconditions. The fire alarm monitoring company shall be notifiedprior to the activation of the fire alarm system for drill purposesand again at the conclusion of the transmission and restorationof the fire alarm system to normal mode.

(WAC 212-12-044)


The facility failed to provide documentation for fire drillsconducted on the following shifts:

1.1st quarter 2018 Day, Swing, Noc Shifts2. 2nd quarter 2018 Day, Swing, Noc Shifts3. 4rth quarter 2017 Day, Swing, Noc Shifts

Next inspection scheduled on or after: 08/08/2018

Right of appeal. Any person may appeal any decision made by the Fire Protection Bureau in accordance with WAC 212-12.

Owner or Authorized Representative

'ire

UP ^rAci n C/ /7-^f -^ L/, C. k. tv\c\ 'i n ^-ene- n o^Print Name and Title

Deputy State Fire Marshal Dylan Montgomery2505 112THSTETacomaWA 984455104(425) 577-0362

^/~

6 of 6 Initials of Authorized Facility Representative: CTCY/

This

docu

men

t was

pre

pare

d by

Res

iden

tial C

are

Serv

ices

for t

he L

ocat

or w

ebsit

e.

Documents

cument do This...21202 Pacific HWYS, SeaTac,WA98198 Provider Number Approval Status Facility Type 2130 Disapproved Residential Care On 07/09/2018 the Office of the State Fire …