HomeMy WebLinkAbout171 Bourbon Street - License - Fire Mars (3) v@�F FVY�.4'i4
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`� "-` Department of Developmental Services
Dannel P. Malloy 'Terrence W. Macy,Ph.D.
Cominissior ei-
Governor
Joseph w. Drexler,F_.sq.
Depute Commissioner
February 3,2014 Eugene I Iarvcy
Director
Mr.James Kelly
Prime Care,Inc.
PO Box 3247
Waterbury,CT 06705
RE Bourbon Street R-459 171 Bourbon Street South Windsor
Dear:Mr.Kelly;
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 01,2014 DDS Region: NR
DDS Number Client Individual E-Score Evacuation Capability: Slow
00030542 MONTY(PEARSON),L 20 E-Score Status: Annual
Vertical Distance: 0.8-All bedrooms on floors with direct exits
00008981 CLOUKEY, DEL 20 Staff Score: 20-1 staff immediately available
00052762 BLUM, CMUSTINA 6 Provider Survey Stephanie Caouttee
00019466 BRULOTTE, SUZANNE 18 E-Score Evaluator: Rasmussen
00028531 ST.PAUL, ALICIA 18
E-Scores are calculated using the following formula:
E-Score: 3.28
Sum of all individual e-scores times the vertical distance
divided by the staff score.
Timothy E.Baldwin,Fire Chief
Dept.of Developmental Services
cc:Fire Marshal
Regional Director
File
FIRE MARSHAL PLEASE NOTE:DDS must comply with the Healthcare Insurance Portability and Accountability Act of 1996(IIIPAA).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.
Southbury Training School
Phone:Voice 203 586-2000 +Toll Frce 866 274-3888 + Paz:203 586-27(-io
P.O.Box 872 Southbury, Connecticut 06488
www.ct.gov/dds + e-mail: ddsct.-westQct.gov
An Affirmative Action/Equal Opportunity Employer