Sprinkler System Maintenance Deficiency
Penalty
Summary
The facility failed to maintain the sprinkler system adequately, as evidenced by an observation on December 18, 2024. During this observation, it was noted that two sprinkler heads in the basement laundry sorting room were covered with a layer of dust and lint. This accumulation of material can insulate the sprinkler's thermal element, potentially impacting the temperature activation and response time of the sprinkler, as well as causing inadequate spray coverage. The maintenance director confirmed the deficiency during an interview conducted at the same time as the observation.
Plan Of Correction
1. The laundry room sprinkler heads were both immediately cleaned. 2. Education will be provided to the maintenance department by Administrator or designee on the importance of maintaining sprinkler heads. 3. The maintenance director or designee will audit weekly x 4 weeks and monthly x 1 month. 4. Results will be discussed with QA committee with monitoring if applicable.