HomeMy WebLinkAbout124 Woodland Drive - License - Fire Mars t State of Connecticut
9 Department of Developmental Services DDS
Dannel P. Malloy Terrence W. ,tilacy,Ph.D.
Governor Commissioner
February 26,2014 Joseph\C'. Drexler,Esq.
Deputy Commissioner
Mr.Paul Rosin Fritz Gorst
Community Residences,Inc. Nx'est Region
732 West Street Suite 12 Regional Director
Southington, CT 06489
RE: Woodland Drive R-1042 124 Woodland Drive South Windsor
Dear Mr.Rosin;
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 26,2014
lient DDS Region: NR
DDS Number C
Individual E-Score Evacuation Capability: Prompt
00021558 SMITH, SCOTT 1 E-Score Status: Annual
00043881 BROWN, ALLEN 1 Vertical Distance: 0.8-All bedrooms on floors with direct exits
00057215 INGRAM, ZACHARY 6 Staff Score:
40-2 staff immediately available
DC939044 VITALI, NICHOLAS
00057441 TORRES,JOSE 1 Provider Survey by: Rashad Williams
1 E-Score Evaluator: Bowolick
E-SCORE 0.2 E-Scores are calculated using the following formula:
Sum of all individual e-scores times the vertical distance
divided by the staff score.
Timothy E.Baldwin,Fire Chief
cc:Fire Marshal Dept.of Developmental Services
Regional Director
File
FIRE MARSHAL PLEASE NOTE:DDS must comply with the Healthcare Insurance Portability and Accountability Act of 1996(HIPAA).This law provides for the privacy and security of healthcare information and has
regulations which"covered entities"such as DDS must follow.The sharing or disclosure of information is allowed only as required and permitted by law,or when an individual has given DDS permission.The
privacy rule includes information that can be used to identify individuals,such as but not limited to name,DDS number,locations or addresses.You 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 keep the identities of individuals released in this report confidential.
`Vest Regional Office
Phone: 203 574-8814 • Fax:203 574-8857
Rowland Government Center,55 West Main Street •Waterbury,Connecticut 06702
www.c ov dds • e-mail:ddsct.west(a�ct oar
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