HomeMy WebLinkAbout9 Cliffwood Drive - License - Fire Marsh (3) CRICommunity Date:
Aesidences, Inc. Number Of Pages Including Cover Sheet:
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REMARKS: [] urgent ❑ For your review Reply ASAP ❑ Please comment
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(860) 878-6858 205 Kelsey Street, 2nd Floor, Newington, CT, 06111 www.criinc.org
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State of Connecticut
Department of Developmental Services
DDS
Uinnel P, Malloy Terrence W. Ph-D.
Governor
Mr. Paul Rosin Joseph W-'. Drcxlcr_j sq.
Communitv Residences,Inc. March 09,2014 I)cputv Con-111-liss,732 West Street Suite 12 Fritz Gorq
Southington,CT -06489 West Rzgion
Regional Directoi,
RE Cliffwood Drive R-1 190
9 Cliftood 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 age.ncy,should be kept in Your files to be m
available for the fire marshal's use during the annual licensure inspection of your facility. ade
E-Score Evaluation Date:February 20,2014 DDS Region:NR
DMR Number �Client Individual E-Score Evacuation Capability:L-1
00043699 MCCALL,K RASHALIN I E-Score Status:Annual
00037467 ANSELMO, MICHAEL I Vertical Distance: I -Any bedroorn one floor frorn exit
00051060 RENDA JR,M JOSEP I Staff Score:56-2 staff available, I standby or asleep
Provider Survey BY:Jennifer Garcia
00045353 CARO, HECTOR 8 E-S core Evaluator:Marshall
00042226 GIANNINI, GABRIEL I
00048717 KNIGHT, ALEXANDER I E-Scores are calculated using the following formula:
E-Score: 0.232142857
Sum of all Individual e-scores times the vertical distance
divided by the staff score.
Sing
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ThYotl�y�E. Baldwin, Fire Chief
Dept.of Developmental Services
cc: Fire Marshal
Regional Director
File
FIRE MARSHAL PLEASE NOTE:DMR must comply with the Healthcare Insurance Porte I Ifiggto OkWIPAA).This law provides for the Privacy and security of healthcare information and
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has regulations which"covered entities"such as DMR must follow, The sharing ordisclosb'UI"V.,A�triI a 6 equired and ermitted by law,orwhan an Individual has given DMR permission. The
privacy rule includes information that can be used to identify Individuals,s aWo the uft*1&9@&cWr4m88W r*mF%t -&kW Wou are not covered by HIPAA but we ask that you help us respect
the rights of the consumers we serve 'lore Mt I .
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Fire Safety
Program Specific Information
CRI
9 Cliffwood Drive
South Windsor, CT 06108
Eme enc ire Phone Number: 911
Ind yidual 2L-G—rouv Plan of U6011 in Case of Fare
Attach diagram of optimal routes of egress to be used in the event of a fire.
How is it Determined who is in charge when two r more staff-are working?
Manager, Assistant Manager, or Senior Staff on duty.
Meeting place outside the building
At the end of driveway(closest to the neighbors' house) in front of the house.
Most convenient location to call 911 from once evacuation is completed.
Neighbor's house.
Additional information (Include sped evacuation plans for 1", 2"d and 3,d shy,
i.e., who, if anyone, should be evacuated first, who, if anyone, needs special attention
and what type of special attention is needed, any unusual reactions by residents) to the
fire alarm, any special/unusual circumstances, or unusual physical aspects of the
house/apartment).
Which route of egress to use is dependent upon the location of the fire! Any persons in
immediate danger should be evacuated first.
Client Specific:
GG- Follows directions w/o any problems. Evacuates home with verbal prompting.
MA-,Follows directions w/o any problems. Evacuates home with verbal prompting.
HC- May not consistently evacuate home and may require verbal prompting.
During some drills (most commonly during third shift) may refuse to leave the
building. In the event of an actual emergency/fire, staff win utilize PMT approved
techniques to remove HC from the home. This will apply for emergencies Qn
NOT for drills. Third shift consists of three staff members so there is ample staffing
to safely remove HC from, the residence if necessary.
RX-May attempt to dress, put on socks/shoes. Will evacuate,however, may require
verbal prompting from staff.
JM- Follows directions w/o any problems. Evacuates home with verbal prompting.
AK- Follows directions w/o any problems.
Revised 4/15/2014
Staff have been in-serviced on practicing drills with simulated fires and on getting the
clients out of the house and away from danger. Staff have been instructed to perform a
head count of both clients and staff to determine if everyone is safely out of the buil&g.
Relogafion Site Io Event Building Cannot Be Re-Entered
1. Level I Emergency
Woodland Drive Group Home(124 Woodland Drive, South Windsor).
2. Level H Emergency
Maple Street Group Home(328 Maple Street,East Hartford)
Location Fire Extinguishers b The Bmildingy
In the kitchen above the garbage can, near washer and dryer(outside med room), near the washer
and dryer in the basement,and the entrance to the furnace room.
Location Of]Fire xtin i be s In the Ve ' s
In between front seats.
ratio Alarm Full Box
By the front door(living room), next to the door in the dinning room, on the lower level by the
door next to the large picture window,and by the door on the lower level next to the bathroom.
Infor Lion AWRLAIaW$ stem
(Include information on whether directly hooked up to Fire Department,what is to be done in the
case of a Use alarm, how to silence the alarm in the event of a:False alarm, etc).
Alarm system is directly hooked up to the Central Station. In the event of a false alarm, call
Central Station at 1-800-318-9486. Our account # is C23-1015. Maintenance /Service is 860-
267-8069. You may silence the alarm by going to panel located by the front door.
Fire Dri re Conducted When:
Drills are conducted monthly by following a planned out schedule.
Smoke Detectors And Heat Detectors Are Inspected How And Whon
These are inspected Bi-annually by DCI. CO Detectors are inspected quarterly by Manager.
Batteries are replaced quarterly.
Information On Sprinkler S ste A lice e
These are inspected quarterly by Iced Hawk.
Revised 4/15/2014