Workmen's Circle Multicare Center

Deficiency Details, Certification Survey, August 12, 2011

PFI: 1219
Regional Office: MARO--New York City Area

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K20 NFPA 101: STAIRWAY ENCLOSURES AND VERTICAL SHAFTS

Scope: Pattern

Severity: Potential for more than Minimal Harm

Corrected Date: October 12, 2011

Stairways, elevator shafts, light and ventilation shafts, chutes, and other vertical openings between floors are enclosed with construction having a fire resistance rating of at least one hour. An atrium may be used in accordance with 8.2.5.6. 19.3.1.1.

Citation date: August 12, 2011

Based on observation and interview it was determined that heating, ventilation, and air conditioning (HVAC) risers were not separated by construction having a fire resistance rating of at least one hour. This situation could result in the vertical spread of fire and/or smoke in the event of a fire emergency.

This resulted in no actual harm with the potential for more than minimal harm that is not immediate jeopardy.

The findings are:

On 8/10/11 during morning inspection of the HVAC system (10:00 AM - 12:00 PM) the plenum return system was evaluated. Inspection of the ducted portion of the system revealed several instances where the fire resistive construction of the shafts exhibited penetrations and areas where compartmentation of the shafts was missing. The examples enumerated below were all noted above the level of the suspended ceiling.

- lavatory room #2010 - bottom terminus for shaft not sealed flush with floor slab. Gaps 2-3 inches noted.
- 4th floor NW corridor access door - duct not flush to shaft wall (area where duct detector located). Adjacent fire damper not flush with shaft wall at outside corner (2 inch gaps). Light visible through penetrations in this area.
- Room 4024 ceiling access door. Damper not flush with shaft.
- 4th floor dayroom - large access panel into shaft. Door assembly of access panel not constructed of fire resistive construction. Top plate of shaft wall not flush with slab, and gap present represents a penetration into the shaft.
- Bottom terminus of shaft for return duct (rooms 2031 & 2032) was missing. Duct was wrapped in insulation/foil blanket. This did not constitute fire resistive construction.

Director of Facilities stated at the time that this plenum system was recently installed as part of renovations done at the facility and, as such, is not original construction.


NFPA 101, 2000: 19.3.1.1
10NYCRR 711.2(a)(1)