HomeMy WebLinkAbout171 Bourbon Street - License - Fire Mars State of Connecticut DBS
Department of Developmental Services
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Dannel P. Malloy Terrence W. Mary,PED
Governor Commissioner
Ms. Susan Valvo June 21,2011 Kathryn du Pree
Prime Care,Inc. Deputy Commissioner
P.O. Box 3247
Waterbury, CT 06705-0247 Eugene Harvey
Director
RE Bourbon Street R-459 171 Bourbon Street South Windsor
Dear Ms. Valvo
Based on a review of documentation provided by your agency,the Department of Developmental Services has
established your facility's "Evacuation Difficulty Score" (E-Score"),under the 2003 NFPA 101, Life Safety Code. This
score and related information is detailed below.
This "E-Score"is valid only as long as the information listed below is still valid, and only for the clients listed below,
provided there are no changes in their physical or mental condition, since the survey date.It is your responsibility to
notify this office of any new clients not listed below, or of changes in client conditions or staffing levels that have
changed since the date of the survey. Please contact Fire Chief Timothy E. Baldwin at Southbury Training School Fire
Department,P.O.Box 872, Southbury, CT 06488-0901. Telephone: 203-586-2638/Fax: 203-586-2722.
This documentation, along with a copy of the survey provided by your agency, should be kept in your files to be made
available for the fire marshal's use during the annual licensure inspection of your facility.
E-Score Evaluation Date:February 08, 2011 DDS Region:NR
DMR Number Client Individual E-Score Evacuation Capability:SIOw
00019466 BRULOTTE, SUZANN 1 E-Score Status:Annual
Vertical Distance:0.8-All bedrooms on floors with direct exits
00005178 PLUNKETT,M EILEEN 20 Staff Score:20- 1 staff immediately available
00008981 CLOUKEY, DELORES 18 Provider Survey By:C.Sheehan
00018272 CLEGG, DEBORAH 1 E-Score Evaluator:Marshall
00052762 BLUM, CHRISTINA 6
E-Scores are calculated using the following formula:
E-Score: 1.84
Sum of all individual e-scores times the vertical distance
divided by the staff score.
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ithy .Ba dwin, Fire ief
Dept. of Developmental Services
cc: Fire Marshal
Regional Director
File
FIRE MARSHAL PLEASE NOTE:DMR must comply with the Healthcare Insurance Po&l tb4YEnTARjRkfl&APA.This law provides for the privacy and security of healthcare information and
has regulations which"covered entities"such aFqtB jst ro@A.cPo pia( e*@01)84 j4rg4d,0ePWKd t2l8 c8 ftn27i@idual has given DMR permission.The
privacy rule includes information that can be used to identify individuals u as,�utt not'rat&d to name,D number, ations or addressed Y are not covered by HIPAA but we ask that you help us respect
the rights of the consumers we serve and therefore request that you ke tdetitti8�oddid�als�191�seekktdnFu t U64
www.ct.gov/dds • e-mail: ddsct.wes ct.gov
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