HomeMy WebLinkAbout041-480-002 CF Archive (2)'``FIRE SAFETY INSPECTION REPO'-'
Butte County Fire Department
California Department of Forestry and Fire Protection
Oroville, California 95965 • (530) 538-7888
Business Address: City: Inspection Date:
Business Name: C t Business Phone:
Owner/Property Management: AP#:
NO. CORRECTIONS RMRED NO. LOCATION! REMARKS CLEAR®
LOCATION
1 Provide address numbers/building I.D. visible from street
EXITING
2 Remove obstructions at exits, doors, aisles, stairways, etc. ! /
3 Exit door to open without a key or any special knowledge) effort.
4 Repair exit door hardware. / !
5 Remove obstructions from door reguned to be closed.
6 Remove locks/Iatches from doors with panic hardware. ! /
7 Provide sign over main Exit door - "This door to remain unlocked during
business hours". / !
8 Remove storage from under unprotected staff
9 PraidYmaintain exit sig rJemergency loting.
FIRE BIERS ! /
10 Have fire ext la s serviced and tagged. RE -INSPECTION DATES INSPECTOR
11 Provide/mount fire Extinguisher as indicated.
12 Post a s n indicating fire extinguisher location. 1st / /
13 Provide clear access to fire adri uisher.
FIRE PROTECTION EQUIPMENT 2nd / /
14 Maintain, repair, paint, inspect, ardor test sprinkler/standpipe
systemlhydranf/FDC/PIV. Refer to FPB / /
15 Maintain 3 feet minimum clearance for access/use of fire
appliances/equipment. District Attorney / /
16 Replace damage#aintedrmssing sprinkler hea&VFDC caps. Final Clmran e / /
17 Provide 5 -year certification test far nkler/sha em. Class ❑ Chedx Pre -Fire Plan for accuracy.
18 Provide spare sprinkler heads (min. 6) and/or compatible wrench. BY ORDER OF THE FIRE CHIEF
19 Hood/duct EAinquishing system to be serviced/ tagged every 6 mo.
20 Remove grease from hood, duct, and filters. (KEEP CLEAN) You are hereby notified to correct all violations immediately or show cause
FIRE ALARM SYSTEMS why you should not be required to do so. A reinspection will be conducted
on . Willful failure to comply with this notice is a
21 Maintain, repair, inspect, ardor test fire alarm system. misdemeanor. Violations that are not corrected immediately and/or remain
FIRE SEPARATIONS after the re -inspection may be processed as a criminal offense. Thank you
22 Repair holes in required fire resistive constriction. for your assistance and cooperation in minimizing the fire and life loss in
23 Providelr it self or automatic closing fire rated assemblies. your community.
24 Keep attic access and scuttle openings closed.
ELECTRICAL Signature of Recipient:
25 1 Discontinue use of extension cards.
26 Install permanent wiring for fixed and stationary apoiances. ❑ Owner ❑ Manager ❑ Employee ❑ Other
27 Provide cover plates for all junction boxes. Inspecting Officer: 7
28 Remove exposed wiring or protect in approved conduit.
29 Provide a 30- nch clear space to and in front of electrical panel. FPB: Engine Com
30 Maintain wiring in good condition and protect from damage. ❑ NO VIOLATIONS NOTED THIS DATE
FLAMMABLE LIQUIDS • COMBED GASES THANK YOU FOR BEING FIRE SAFEI
31 Provide a flammable liquid storage cabinet or reduce storage to 10 gallons or Additional Comments:
less.
132 Remove all flammable liquids not used for maintenance purposes, ! L. Al r7 l lg—�'1C 4 T 1e^
33 Store flammable liquids away from exits, stairs, or corridors.
34 Secure compressed gas cylinders. �%�,� er UC'
STORAGE • HOUSEKEEPING
Arrange s in an ordedy manner to provide accesslegress.
36 Remove combustble storage from water heater and electrical room.
37 Remove storage to 24 in hes below ceiling or 18 inches below sprinkler heads. f f
38 Remove lint/debris from behind washers and dryers. ' / (�
39 Remove waste/rubbish me'-nals from the premises.
40 Keep dumpsters 5 feet away from combustible walls, eaves, or openings.
MISCELLANEOUS
41 Other violations and/or comments.
Page of
09/27/2005 02:39 530-533-9255
I. N 16E
ACCULARM SBCURTTY SYSTEMS
Peo.w BOX 1674
"E:
HIGH HORIZONS PAGE 01/01
OATE 9/22/05
NUMBER.
1-djh Horizons
PgtAJ �
P. O-: Box -.-771
Oroville, Chi. --,95965
AMOUNT CN.C.LOSED S.
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"�mIRE SAFETY INSPECTION REPO"`'
Butte County Fire Department
California Department of Forestry and Fire Protection
Oroville, California 95965 * (530) 538-7888
Business Address: CRY.
Business Name:
Owner/Property Management:
Inspection Date:
Business Phone:
APfi-
No.
CORRECTIONS REQUIRED
NOL
LOCATION I REMARKS
CLENW
F7
LOCATION
1 Provide address numbersbAding I.D. visible from street
EXITING
2 Remove obstructions at exits, do=, aisles, stairways, etc.
3
Ext door to open without a key or any special knowleciget effort.
4 Repair norvoperable eDdt door hardware.
5
Remove obstructions from door required to be closed.
6 Remove lock-.Wches from doors with panic hardware.
7
Provide sign over main Exit door -'This door to remain unlocked during
business hours".
8
Remove storage from under unprotected stainivay.
9 Provide/maintain exit sign/emergency lighting.
FIRE EKI'M01.11SHERS
10
Have fire wtinguisher(s) serviced and bgged.
RUNSPECTION DATES
INSPECTOR
11
Prcvideftnount fire eriguisher as indicated.
12
Post a sign indicating fire extinguisher location.
1st
13
Provide clear access to fire ad usher.
FIRE PROTECTION EQUIPMENT
2nd
14
Maintain, repair, paint inspect, andkir test sprinkler/slamhx
system/hydrant/FDC/PIV.
Refer to FPB
15
Maintain 3 feet minimum clearance for accessluse of fire
appliances/equipment.
Dist6ct Attorney
16
Replace demaged(painted/missirig sprinkler heads/FDC caps.
Final Clearance
17
Provide 5 -year certification test for sprinklerktandpipe system.
Occipwicyclass
❑ Check Pre Fire Plan for accuracy.
18
Providespri±ie�r (min. 6) ardor ccrnpatible wrench.
By ORDER OF THE FIRE CHIEF
19
HoodIduct extinguisA system to be serviced to every 6 mo.
20
Remove grease hm hood, duct, and filters. (KEEP CLEAN)
You are hereby notified to correct all violations immediately or show cause
AM ALARM SYSTEMS
why you should not be required to do so. A reminspection will be conducted
on . Willful failure to comply with this notice is a
21
Maintain, repair, irispect, andfor test fire alarm system.
misdemeanor. Violations that are not corrected immediately and/or remain
FIREWARATIONS
after the re -inspection may be processed as a criminal offense. Thank you
22
Repair holes in required fire resistive construction.
for your assistance and cooperation in minimb!hg the fire and life loss in
23
Provide/ it self or automatic closing fire rated assemblies.
your community.
24
Keep attic access and scuttle q)enings closed.
ELECTRICAL
Signature of Reclph q
25
Discontinue use of edension cords.
26
Install permanent wiring for fixed and stationary apolances.
0 Owner 0 NbWr 0 Employee [I Other
27
Provide cover plates for all junction boxes.
Inspecting Officer
28
Remove exposed wiring or protect in approved conduit.
29
Provide a 304nch clear space to and in front of electrical panel.
FPB: — Engine Company:
130
Maintain wiring in good condition and protect from damage.
El NO VIOLATIONS NOTED THIS DATE
I
FLAMMABLE LKUDS - COMPRESSED GASES
THANK YOU FOR BEING FIRE SAFEI
131
Provide a flammable liquid storage cabinet or reduce storage to 10 gallons or
Additional Comments:
I
less.
132
Remove all flammable liquids not used for maintenance purposes.
133
Store flammable I' ids m%W from exits, stairs, or corridors.
134
Secure compressed ps cylinders.
I
STORAGE * HOUSEKEBW
135
Arranges in an orderly manner to provide access/egress-
136
Remove combustible storage from water heater and electrical room.
�37
Remove storage to 24 inches below ceiling or 18 inches below sprinkler heads.
38
Remove linVdebris from behind washers and dryers.
39
Remove waste/rubbish mat-.mls from the premises.
�40
Keep dumpsters 5 feet away from combustible walls, eaves, or openings.
:MISCELLANEOLIS
41
Other violations ardor comments.
Page— of
34
Request for Approval
HEALTH CONDITION
POSTURAL SUPPORT
LETTER TO FIRE MARSHALL:
DATE: / --- �a-0q
FIRE MARSHALL: STG--VG F
S3o�
AnnxEss: 111a MG-L'SOA) 4V Cv rxoxE: 5 3g- 3 g S 9
D2oUM LL� �R
Name of Facility:
Facility License Number:
Facility Address:
Administrator:
High Horizons
#045000636
3530 Cherokee Road
Oroville, CA 95965
Gary and Judy Jimmink
Phone Number: (530) 533-6830
Residents Name: /4RTNU/a /3R-1 7 70 A)
Residents' Date of Birth 5- :15- S 4
Residents' Date of Admission: /� - 2q - 7� 9
THE ABOVE RESIDENT AT "High Horizons" WILL BE USING A POSTURAL
-_ n� •r T n`T'T`TLL FUTHER NOTICE. - - -- - - -- - - --- ---- - --- -
The POSTURAL SUPPORT that is ordered:
brace spring release tray V' soil, ties
Physicians -prescribed orthopedic devices such as braces of casts, used for
support of a weakened body part or correction of body parts.
other:
0
.. \
STATE OF CALIFORNIA f`
FIRE SAFETY INSPECTION REQUEST
STD. 850 (REV. 10-94) See instructions on reverse.
AGENCY CONTACT'S NAME TELEPHONE NUMBER REQUEST DATE PROGRAM
DSS/COMMUNITY CARE LICENSING 530 895-5033 08/04/2004 ADULT RESIDENTIAL
EVALUATOR'S NAME j REQUESTING AGENCY FACILITY NUMBER REQUEST CODE
0201 /TROY HETHERWICK 045001511 4A
f
FIRE STEVE FOWLER
AUTHORITY BUTTE COUNTY FIRE DEPARTMENT
NAME AND 176 NELSON AVENUE
ADDRESS OROVILLE, CA 95965
L
IN SPECTOR'S NAME (Typed orPrinted) TELEPHONE NUMBER
Al L &--7C--,
IN PCTIONDATE INSPECTOR'SSIGNATU (T edorPrinted)
EX IN DENIAL OR LIST SPECIAL CONDITI NS
CFIRS NUMBER OCCUPANCY CLASS
d D S ,�•
CLEARANCE/DENIAL CODE
CODES
1) FIRE CLEARANCE GRANTED
2. FIRE CLEARANCE DENIED
A. EXITS
B. CONSTRUCTION
C. FIRE ALARM
D. SPRINKLERS
E. HOUSEKEEPING
F. SPECIAL HAZARD
G. OTHER
CODES
1. ORIGINAL A. FIRE CLEARANCE
F—
LICENSING
AGENCY DEPARTMENT OF SOCIAL SERVICES
2. RENEWAL B. LIFE SAFETY
NAME AND COMMUNITY CARE LICENSING
3. CAPACITY CHANGE
ADDRESS 520 COHASSET ROAD, SUITE 6
4.
CHICO, CA 95926
OWNERSHIP CHANGE
5. ADDRESS CHANGE
I
.�
6. NAME CHANGE
7. OTHER
AMBULATORY
NONAMBULATORY_:., BEDRIDDEN
TOTAL CAPACITY
CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAP/,CITY . 'ACITY PREVIOUS CAPACITY
12
FACILITY NAME
HIGH HORIZONS
LICENSE CATEGORY
STREETADDRESS (Actua/Location)
735 ARF
530 CHEROKEE ROAD
NUMBER OF BUILDINGS
1
cl
_
ROVILLE
RESTRAINT
NONE
FA ILITY CONTACT PERSON'S NAME �'
�INDY DENNY {530) 533-6830
URS
HOURS
24
_
P CIAL CONDITIONS
TO BE COMPLETED BY INSPECTING AUTHORITY
f
FIRE STEVE FOWLER
AUTHORITY BUTTE COUNTY FIRE DEPARTMENT
NAME AND 176 NELSON AVENUE
ADDRESS OROVILLE, CA 95965
L
IN SPECTOR'S NAME (Typed orPrinted) TELEPHONE NUMBER
Al L &--7C--,
IN PCTIONDATE INSPECTOR'SSIGNATU (T edorPrinted)
EX IN DENIAL OR LIST SPECIAL CONDITI NS
CFIRS NUMBER OCCUPANCY CLASS
d D S ,�•
CLEARANCE/DENIAL CODE
CODES
1) FIRE CLEARANCE GRANTED
2. FIRE CLEARANCE DENIED
A. EXITS
B. CONSTRUCTION
C. FIRE ALARM
D. SPRINKLERS
E. HOUSEKEEPING
F. SPECIAL HAZARD
G. OTHER
Ea
Butte County Fire Dept
176 Nelson Ave
Oroville, CA 95965
Attn: Steve Fowler
Re: High Horizons
530-533-6830 or
October 25, 2004
Dewaine &Nelly Stults
Fax 530-533-6800
Recently we purchased High Horizons care home. On 8/4/2004 you did a
Fire Safety Inspection and granted a Fire Clearance.
Today I wanted to bring our file up-to-date as follows:
1. Please see the attached copy of our floor plan.
2. We use oxygen in the living room marked #1.
3. We use oxygen in the bedroom marked #2 and store an extra
oxygen tank in the closet.
4. Our approved emergency temporary relocation sites are
located at each end of Cherokee Road.
a) Spring Valley School, 2771 Pentz Road, Oroville,
Phone #530-533-3258.
b) Nelson Middle School, 2255 6thStreet, Oroville,
Phone #530-538-2940.
Please up -date our file. If you have any questions please call.
Thank you,
Dewaine and Nelly Stults
PO Box 771 phone # 530-533-5055
Oroville, CA 95965 Fax #530-533-9255 a��
A QF { .��• i.TM w(:i.���9 :r 4:"r.•.'SfC:::fJt U7. Sal 4:;:V L:L
COMMUW TY CAM L CEM'. M
ACILITY SKETCH (Floor Plan)
licanta are required to provkle a sketch of the floor plan of the home or facility and outside yard. The Floor Sketch must lel
r Ono such as the kitchen, bath, living room, etc. Circle the names of the rooms that will be used by clientatchlldren. Door and
indaw ®zits from the rooms must be shown in case of an emergency (see Emergency Disaster Plan). Show room sizes (o•g. 0.5 x
t . KeepNose to scale. Use the ace below. See back for and Sketch.
HORIZONS 3530 Cherokee Rd., OrovAfe CA 9596
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Cherokee Road
Fire Prevention Bureau White Co - Business
Butte County Fire Rescue Copy
176 Nelson -Avenue California Department of Forestry Yellow Copy — Occupancy File
6rovillel CA 95965 and Fire ]Protection Pink Copy — Statip File
,
-538-7888Telephone 530Occ. Class.
Ins ection Re '
ort
fax 530-538-2105
Address: Business Name:
Owner/1Vlanager: Bus: Hm: Fax
Assistant Nsamger: Bus: Hm:
adding Owner. I Bus: Hm:
AN INSPECTION OF YOUR FACILITY REVEALED TRE FOLLOWTNr
1.
Fire Extinguishers: Required, service due
10.
Exit(s) obstructed, inadequate
2.
Extension cords: Excess use, defective
11.
Exit sign(s) required, illumination
3.
Excessive rubbish, trash, debris
12.
Exit sign lights need replacing
4.
Fire warm system defective
13.
Exit lighting: Required; defective
5.
Sprinkler system: Service required, defective
14.
Smoke detectors: Required, defective
6.
Kitchen hood extinguishing system service due
15. Wiring: Exposed, damaged connectors, etc.
7.
Fire walls, ceilings, fire doors, draft stops
16. Heating system: Defective appliance, flue combustibles
8.
Knox Box keys
17.
Address posted and visible from road
9.
Fire Drill Witnessed Yes ❑ No ❑
18.
Other
DETAILED EXPLANATION AND CORRECTIONS: CORRECTED:
ate:
Discussed with:
(Print) o
Signe
ttalion 1 2 3 4 5, 7
Station:
Inspectin ff er:
PREVENTION SAVES LIVES, PROPERTY, AND BUSINESS, YOUR COOPERATION WITH
C RRECTING THE ABOVE LISTED ITEMS IS APPRECIATED., RE -INSPECTION DATE:
:L.0 IVV.ICV Vv/'vim Jv 1V S`� 1v•l"l,L 1.1-1i1,U ll.U.
s►.
STATE OF CAWFOANIA
FIRE SAFETY INSPECTION REQUEST
ffm WORM TO -04)
ADfI1CY coNTACT'a NATE
M&COMMUNITY CARE LICENSING
WAWATORS N"
0201 /HETHERWICK
I -H; : bX 895 5934 PAGE i 1
ldftl
Seo Instructions on rovat&
Tam"aNE NUMBER REQUEST PATE MaRAM
530 895-5033 8-6-03
REQ=TMll1 AGENCY FACILITY NUMBEA REQUEST CODE
UAGVCY DEPARTMENT OF SOCIAL SERVICES I.OFWltAL A. FMfAAANCE
R. RENEWAL B. uFE sAFEiv
NAME AND COMMUNITY CARE LICENSING & CAAAWYCHANGE
ADDRESS 520 COHASSET ROAD, SUITE 6 , OWNERSHPCHAWE
CHICO, CA 95926 I & ADORESS CHANGE
L`— J & NAME CHANGE
T. OTHER
rSUTTE COURm NTY FIRE DEPT.
Aunlow" 176 NELSON AVENUE
M M OROVILLE, CA 95965
L_
i!'GCTnR'B NATE (7►pAAd A'� TSFPNOt,IE NUM6Fq _-
✓'5A'.
MOWN YAFECTmaKm rrxwwAlww
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NUMMA OOGWAWY CLASS
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i. RAE CLF.ARAI+CE GRANTED
Z. FIRE CLEARANCE DENIER
A. DM
BL OONUTRUCTTON
C. RRE ALAW
m APRMA"m
E HOIJBBqWPING
F. 6PECIALItA?AND
O. OTHER
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12
HORIZONS
WNOM CATWOR"
WROTAW f**WLawswo
ADULT RESIDENTIAL
3530 CHEROKEE ROAD
MAWROFBULD"M
CITY
OROVILLE, CA 95965
FA(� M a7NTWT MM60N'6 NAA
NO
LULA THOMASSO 530 533-6830
Novae
24
dwaftcommm
POSTURAL SUPPORTS & OTHER MISC
rSUTTE COURm NTY FIRE DEPT.
Aunlow" 176 NELSON AVENUE
M M OROVILLE, CA 95965
L_
i!'GCTnR'B NATE (7►pAAd A'� TSFPNOt,IE NUM6Fq _-
✓'5A'.
MOWN YAFECTmaKm rrxwwAlww
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NUMMA OOGWAWY CLASS
Zo3-�- 1 lea • /
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i. RAE CLF.ARAI+CE GRANTED
Z. FIRE CLEARANCE DENIER
A. DM
BL OONUTRUCTTON
C. RRE ALAW
m APRMA"m
E HOIJBBqWPING
F. 6PECIALItA?AND
O. OTHER
Request for Approval
HEALTH CONDITION
POSTURAL SUPPORT
LETTER TO FIRE MARSHALL:
DATE: 5 -! a - o s 1
FIRE MARSHALL: e� 0 E FD uj t - L=2
ADDRESS: I'7 (� l� e�LscA)_Av E PHONE: 53 ge-
(q G 9 � IS
Name of Facility: High Horizons
Facility License Number: #045400636
Facility Address: 3530 Cherokee Road
Oroville, CA 95965
Administrator: Gary and Judy J�ink
Phone Number: (530) 533-6830
Residents Name: �,,TDF+to
Residents' Date of Birth s -f 7 — 3 7
Residents' Date of Admission: (40
- -
THE -ABOVE RESIDENT AT "High- Horizons" WILL BE USING -A P8�'T-
SUPPORT UNTILL FUTHER NOTICE.
The POSTURAL SUPPORT that is ordered:
brace spring release tray / _ -
soil ties
Physicians -prescribed orthopedic devices such as braces of casts, used for
support of a weakened body part or correction of body parts.
other:
i
Request for Approval
HEALTH CONDITION
POSTURAL SUPPORT
LETTER TO FIRE MARSHALL:
HATE: 5—/a -63
FIRE MARSHALL: S T G V F, PD kJ LE2
aDnaIEss: rxorE: 3 S' S9
95��s
Name of Facility:
Facility License Number:
Facility Address:
Administrator:
Phone Number:
High Horizons
#045000636
3530 Cherokee Road
Oroville, CA 95965
Gary and Judy Jimmink
(530) 533-6830
Residents i ents Name: S tol9 "g; 0,0 W A -A)
Residents' Date of Birth
Residents' Date of Admission:
THE ABOVE RESIDENT AT "High Horizons" WILL BE USING A POSTURAL
SUPPORT UNTILL FUTHER NOTICE.
The POSTURAL SUPPORT that is ordered:
brace spring release tray soft ties
Physicians -prescribed orthopedic devices such as braces of casts, used for
support of a weakened body part or correction of body parts.
other:
BUTTE COUNTY FIRE DEPARTMENT/CDF FIRE
TITLE 19/24
FACILITY INSPECTION
Am,
INSPECTION NO. (92 3
REINSPECT: ��14YES [_-.] NO
Facility 1 ,�:;°�crt_�.1.5 Occupancy T - Z-.
Address ; o r�" .1c31� f r h, Inspector z.,��-c.,-+r..a� �;cA �► ,K ,�
Phone`Station, �n
i +� 9 pit 1& u G .¢P
Contact 4 4)Z Station Phone ;
Compliance: Yes =� No = 0 Not applicable = NIA
ACCESS — All inspections
Address correct/posted and visible from road (Butte co. code 32-9)
access to public street or 20 ft. wide lane (r1s.3.os)
/ ates wide enough to admit fire apparatus (r1a3.16)
Fire protection equipment visible/accessible (T19-3,14)
PORTABLE FIRE EXTINGUISHERS —All Inspections
0/ Extinguishers have current annual service tag (T19-575.1A)"Maximum travel 75 ft. (T19-567)
Provide clear access to fire extinguisher (rig -563.2)
Extinguishers mounted on wall/or in cabinet, visible and signed (r1s-ss3 a)
EXITS,-- All Inspections
Exits not obstructed (r19-3.11)
„Exit signs in place (CBC 1003.2.9.1)
Doors operate without key or special knowledge (CFC 1207.3)
Rooms with Occupant Load of 50 Persons or More
Exit illumination and signs in place (CBC 1003.2.6.2)
Maximum occupancy sign in place (ri".3o)
Two exit doors/panic hardware swing in direction of travel (CFC 2501.8 2)
HOUSEKEEPING — All Inspections
waste or rubbish accumulation inside or outside T19-3.14)
iuce storage to at least "below ceiling/ sprinklers (T1g-ai4)
nove eombus. storage from heater, meth., elect. room (ri",190
vide approved metal container for oily rag storage Cr -%3.19c)
�! Flammable liquids stored properly (T-19.3.15)
rrections and Com
r(l ;(C_f-f,.
ELECTRICAL --All inspections
✓ Extension cords do not replace permanent wiring (cEc.400-8(1))
V., Extension cords do not pass through doors1walls (CEC-40M (2,3))
:tPinch clearance around all electrical panels (cEG110�16A)
';All panels and breakers are marked (cEG1 10-17 c)
Repair holes in fire -resistive construction CEC (300.21,22)
`� Multi -plug power strips have circuit breaker (CEC 400-13)
FiRE PROTECTION EQUIPMENT -- All Inspections
t"A Hood system servicedRagged every 6 mo. by cert. tech. (r1g-so4)
Clean lifters, hood, and duct area over cooking appliances (cFc 1006.2.6)
Maintain extinguishing systems (rig -324)
Provide spare sprinkler heads (6 min.) and/or sprinkler wrench (r19-904.5)
Replace damaged, corroded, or painted sprinkler heads (rig -9o4.5)
Identify sprinkler valves and secure in open position (Ti 9-904.5)
Replace missing caps on fire department connection (r%-904.3)
Provide 5 -yr. certification test for sprinkler/standpipe (rig -goo)
MECHANICAL EQUIPMENT — All Inspections
_L,,!�_ ents and chimneys — No obvious hazards (cone -ch. 6)
SMCf DETECTORS — Day Care Sr. Res., Hospitals, Apts.
>f Properly installed and tested (T19-749,754)
SCHOOLS, JAILS AND HOSPITALS
Decorations and curtains fire retardant (rig-aos)
LPG tanks fenced with locked gates (ri&3.22)
FE DRILLS -- School and Day Care {Tine 19-3.13)
N All systems operable/hooked to office
Held monthly (elementary schools)
Held semiannually (high schools)
Evacuation plans posted in all rooms
Emergency procedures posted in office
Teachers take roll books
above deficiencies must be corrected within . J�P, days.
r
Inspection Date: I Z- (G'4�f/
I
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12/81/81 84:24:57 ; FROM: PERRY JOHNSON "Z483564Z38"->T0: 538 530 7481; PAGE:881
INFOFAX
ISO 9000 Completely Restructured
Under 2000 Revisions
The 1S0 9000 quality management systems (QMS) standards have taken on a completely different look under
revisions released in December 2000.
The revised ISO 9000 series consists of four primary standards, replacing more than 20 standards and
documents. Three of these new standards, ISO 9000, Qualit�,ManagL2mentSystL-vms-F,,iindame?italsaiid
Vbcahula?y, replacing ISO 9000-1 and 8402; ISO 9001, Qualio.l Mancigement S1istems - Requirements, replacing
ISO 900119 9002 and 9003; and ISO 9004, Quality' Mcatagement Systems - Guidelines for Pei fonnance
Improvements, replacing ISO 9004-1; were published in December. The remaining standard, ISO 19011,
Guidelines- on Quafityv andior Lnvrronmental Mcmagement Sy. -stems A uditing, replacing I S 0 10011-1, 10011-2
and 10011-3, as well as the ISO 140101) 14011 and 14012 environmental auditing standards, is slated for
publication in 2002.
The new process -based structure, similar to that used in ISO 14001, creates a completely different look for ISO
9001. The 20 elements have been replaced by five clauses containing 23) elements. The two standards are more
compatible under this approach, making it easier to integrate management systems and combine documentation
ISO 9001 is now more generic through the new option of being tailored to omit requirements that don't apply to
an organization or limiting the scope of application. This eliminates the need for the less comprehensive ISO
9002 and 9003 standards.
For more information or
a FREE ISO 9000: 2000 Executive Overview booklet
call Cathie Henly at 1-877-255-6923
Perry Johnson, Inc. • 26555 Evergreen • Suite 1300 • Southfield, MI 48076
To remove your name from future distribution lists, call Cheryl at 1-800-803-6330.
b
Tod HV 9Z=LE=90 T00ZTT/ZT 9LC6-ZZ9-OC9 zu�* ljaqoU
f
Facility
Address_
Phone _
Contact
BUTTE COUNTY FIRE DEPAR T 1N[FNT/CDF FIDE
TITLE 19/24
FACILITY INSPECTION
Compliance: Yes =J
—All inspections
correct/posted and visible from road (Butte Co. Code 32-9)
!ss to public street or 20 ft. wide lane (1-19-3.05)
!s wide enough to admit fire apparatus (T19-3.16)
protection equipment visible/accessible (719-3.14)
PORTABLE FIRE EXTINGUISHERS — All Inspections
Extinguishers have current annual service tag (T19-575.1 A)
r '
!NSPEC701NI NO. _l 2 3
REINSPECT: ! :� YES I NO
Occupancy _Z - 2 l
Inspector
Station
Station Phone S3 - -7
No = 0 Not applicable = N/A
'ie- Maximum travel 75 ft. (T19-567)
Provide clear access to fire extinguisher (r19-563.2)
L/Extinguishers mounted on walVor in cabinet, visible ar�signed Cris- 8)
EXITS -- All Inspections
T_Exits not obstructed (ria .113')
t(47
i xit signs in place (CBC 1003.2.9.1)
i Doors operate without key or special knowledge (CFC 1207.3)
Rooms with Occupant Load of 50 Persons or More
Exit illumination and signs in place (CBC 1003.2.8.2)
1 Maximum occupancy sign in place (x19-3.30)
' Two exit doors/panic hardware swing in direction of travel (CFC 2501.8.2)
HOUSEKEEPING — All Inspections
No waste or rubbish accumulation inside or outside 719-3.14)
V Reduce storage to at least "below ceiling/ sprinklers CT19-3.14)
L Remove combus. storafrom heater, mech., elect. room CT19-3.19f)
"' Provide approved meta ntainer for oily rag storage (T-19- .19c)
I (Flammable Ii q ' rl 9-3.15) o \
`1
ELECTRICAL —All inspections
Extension cords do not replace permanent wiring (CEC-400-8(1))
Extension
cords
.,ddoo not pass through doors/walls (cEc-400-8 (2,3))
30 inch ctea�i�n"�ce rounir&h 6tSc I panels (CEC-110-16A)
II panels and breakers are marked (CEC-110-17 C)
t,,"Repair holes in fire -resistive construction CEC (300-21,22)
t% ' Multi -plug power strips have circuit breaker (CEC 400-13)
FIRE PROTECTION EQUIPMENT —All Inspections
r
Hood system serviced/tagged every 6 mo. by cert. tech. (719-904)
Clean filters, hood, and duct area over cooking appliances (CFC 1006.2.8)
i
Maintain extinguishing systems (T19-3.24)
—i'`—pProvide spare sprinkler heads (6 min.) and/or sprinkler wrench (r19-904.5)
1Replace damaged, corroded, or painted sprinkler heads Cris -904.5)
_Identify sprinkler valves and secure in open position (ri9-904.5)
s Replace missing caps on fire department connection (T19-904.3)
s Provide 5 -yr. certification test for sprinkler/standpipe (719-904)
MECHANICAL EQUIPMENT —All Inspections
�i Vents and chimneys -- No obvious hazards (cmc -ch. 8)
SMOKE DETECTORS -- Day Care Sr. Res., Hospitals, Apts.
_; Properly installed and tested (T19-749, 754)
SCHOOLS, JAILS AND HOSPITALS
Decorations and curtains fire retardant (T19-3.08)
LPG tanks fenced with locked gates (719-3.22)
3
't
FIRE DRILLS -- School and Day Care (Title 19-3.13)
All systems operable/hooked to ofce
Held monthly (elementarysctiools)
Held semi -annually, -(high schools)
Evacuatiio .plans posted in all rooms
Emergency procedures posted in office
r'
Teachers take roll books
Corrections and Comments i L�I��C''7! t�`�r: 9 C- «
The above deficiencies must be corrected within .% days. Inspection Date:
Owner/Manager - ' AP #
i
STATE .ORNIA
Fill a SAFETY INSPECTION REQIT
y See Instructions on reverse.
STD. 85 (REV. 1094)
AGEICY CONTACTS NAME
NONAMBULATORY
TELEPHONE NUMBER
REQUEST DATE
PROGRAM
DOSS
CARE LICENSING
PREVIOUS CAPACITY
530 895-5033
5/5/98
EVALUATOR'S NAME
REQUESTING AGENCY FACILITY NUMBER
REQUEST CODE
4A
0
07/DONNA-GURRIERE
12
045000636
LICENSE CATEGORY
H G HORIZONS
13RCF
STR ET ADDRESS (Actual Location)
NUMBER OF BUILDINGS
CODES
1
CITY
1. ORIGINAL A. FIRE CLEARANCE
L
ENSING DEPARTMENT OF SOCIAL
SERVICES
2. RENEWAL B. LIFE SAFETY
AGENCY
COMMUNITY CARE LICENSING
N
ML AND
DRESS 520 COHASSET ROAD,
SUITE 6-
3. CAPACITY CHANGE
A
CHICO, CA 95926
4. OWNERSHIP CHANGE
S. ADDRESS CHANGE
6. NAME CHANGE
7. OTHER
AMBULATORY
NONAMBULATORY
BEDRIDDEN
TOTAL CAPACITY
CAP CI
PREVIOUS CAPACITY
CAPACITY
PREVIOUS CAPACITY
CAPACITY
PREVIOUS CAPACITY
8
12
FACT ITi NAME - - - - - - - -- -- - -
LICENSE CATEGORY
H G HORIZONS
13RCF
STR ET ADDRESS (Actual Location)
NUMBER OF BUILDINGS
3-930 CHEROKEE ROAD
1
CITY
RESTRAINT
ORO ILLE, CA 95965
NO
CIONTACT PERSON'S NAME
HOURS
7LitILTHOMASSON (530) 533-6830-, - �"
24
CONDITIONS
AL
NI
A
CLEARANCE /DENIAL CODE
2. FIRE CLEARA CE DENT U
A. EXITS
CONST��01V
C. FIRE ALARM
�NKLE6S�
E. HOUSEKEEPING
F. SPECIAL HAZARD
(�
07 WE
Yr.,. ..•a- wr+ra ..w...m M� - � - - .A'& -r..# --• - " v-. - . _ , _ _ .. AM ._ a..- -01- � - � - - - ^ _ - - • .. •�. - - -. as
STATE OF CALIFORNIA �►.
F'c-aAFETY INSPECTION RR%, ItST �
ST • 850 (REV. 10-94)
See Instructions on reverse.
AG NCY CONTACTS NAME
TELEPHONE NUMBER
REQUEST DATE
PROGRAM
PO$S CARE LICENSING
530 895-503
05/11/98
EV LUATOR'S NAME
REQUESTING AGENCY FACILITY NUMBER
REQUEST CODE
2 7 /DONNA GURRIERE
045000636
4A
CODES
1. ORIGINAL A. FIRE CLEARANCE
LICENSING DEPARTMENT OF SOCIAL SERVICES
2. RENEWAL B. LIFE SAFETY
AGENCY COMMUNITY CARE LICENSING
AME AND 520 COHASSET ROAD SUITE 6
DRESS
3. CAPACITY CHANGE
CHICO, CA 95926
4. OWNERSHIP CHANGE
5. ADDRESS CHANGE
L
6. NAME CHANGE
r °t'
7. OTHER
AMBULATORY
NONAMBULATORY
BEDRIDDEN
TOTAL CAPACITY
C PACITY
PREVIOUS CAPACITY
CAPACITY
PREVIOUS CAPACITY
CAPACITY
PREVIOUS CAPACITY
6
6
12
I NAME
LICENSE CATEGORY
H HORIZONS
13RCF
E
111
ADDRESS (Actual Location)
NUMBER OF BUILDINGS
510
CHEROKEE ROADRESTRAINT
R
VILLE, CA 95965
NO
F CI
TY CONTACT PERSON'S NAME
so L �'
HOURS
"qm
11 (530) 533-6830 .,
24
S EC
AL CONDITIONS
C HANGE OF OWNERSHIP
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CLEARANCE MENIAL CODE
FJACKCODES
PIRISKY
FIRE STATE FIRE MARSHAL 1. IRE CLEARANCE GRANTED
U
HORITY #4 WILLIAMSBURG LANE, SUITE A 2. FIRE CLEARANCE DENIED
�MEAND
CHICO CA 95926
ADDRESS
, A. EXITS
B. CONSTRUCTION
�
L
C. FIRE ALARM
D. SPRINKLERS
CTOR'S NAME (Typed or Printed) TELEPHONE NUMBER CFIRS NUMBER OC ANCY C SS
Ih SP
E. HOUSEKEEPING
(5-30)8e 9'�IS 13 '� F. SPECIALHAZARD
TION EIATE INSPECTOR'S E (Typeyor, ted) G. OTHER
I SP
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IN DE IAL OR LIST SPECIAL CONDITIO S
SF
Office of the State Fire Marshal -
Fire Safety Correction Notice
I I
CALIFORNIA STATE FIRE MARSHAL
File No:0 Q --0-1-
��-- X55= 9
Name �R17— 1A07
Address: .3D j`jC%1� [= A0A-6
The California Health and Safety Code and the State Fire Marshal's regulations require the following fire safety
deficiencies be corrected.
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PR 0 U I b G7 OUCAR(5V 7- i� 004- ?=-A 01& / L
The above deficiencies are to be corrected within days. When ALL deficiencies have been corrected, sign
and return the certification on the opposite side of this form. if you have any questions, contact the Office of the State
Fire Marshal at(
ISSUED BY Qeputy.State Fire Marshall RECEIVED BY DATE
LN - II (Rev. 7186) By 88/5I UISIKIBUIIUN: GKELN—haaltly VVHI I t—Kegion YLLLUW—Meld
Pa of
cplac�.
FMaMarshal0 *r -e of mate
INSPECTION REPORT' STATE FIRE MA '11iAL•
File O...�O�-D� g'
J.l _SC O L C�QO -��� ���
Namla Of Fac 16�lf (� (.�LQ/� S .
Facility: 14
NaIm Of Building:
rn
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Office of the State Fire Marshal
Fire Safety Correction Notice
File No: -CO- C�J- —! a
Name: 14 1 6t 4 A ' ( 2 _ A S
Address:(
SF
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CALIFORNIA STATE FIRE MARSHAL
The California Health and Safety Code
deficiencies be corrected.
and the State Fire Marshal's regulations
require the following fire safety
SP6C_(1Q1V CDA14QC-6fft
07V /0
Ae.6 0pLz e re(c r- m�-cC
<,tJ174C,.{ 1'!sl
U I/P—Er!'lf 41= 000
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The above deficiencies are to be corrected within days. When ALL deficiencies have been corrected, sign
and return the certification on the opposite side of this form. If you have any questions, contact the Office of the State
Fire Marshal at ( )
ISSUED BY (Deputy State Fire Marshal) / RECEIVED BY DATE
EN -11 (Rev. 7/86) 89 88751 DISTRIBUTION: GREEN—Facility WHITE—Region YELLOW—Field
ATE OF CAUFOFNA - WALTNAND WELFARE AGENCY 1� DEPMi4HR OF tooWL aB WEa
OOMh RrTYCARELICENSM1Ci
FACILITY SKETCH (Floor Pian)
Applicants are required to provide a sketch of the floor plan of the home or facility and outside yard The Floor Sketch must label
rooms such as the kitchen, bath, living room, etc. Circle the names of the rooms that will be used by clientstchildren. Door and
window exits from the rooms must be shown in case of an emergency (see Emergency Disaster Plan). Show room sizes (e.g. 8.5 x
Upper Level
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UC PCO (W )
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STATE OF CALWOMM . HEALTH AND WELFARE AGENCY
FACILITY SKETCH (Floor Pian)
DERMUENT OF SOCIAL SERVICES
COMMUNITY CARE UCENSkJG
Applicants are required to provide a sketch of the floor plan of the home or facility and outside yard The Floor Sketch must label
rooms such as the kitchen, bath, living room, etc. Circle the names of the rooms that will be used by clients/children. Door and
window exits from the rooms must be shown in case of an emergency (see Emergency Disaster Plan). Show room sizes (e.g. 8.5 x
12). Keep close to scale. Use the space below. See back for yard Sketch.
HIGH HORIZONS 3530 Cherokee Rd, Oroville, CA 95965
Lower Level
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age OF _ �FICE�.
;ice of the State fire Marshal
INSPECTION REPORT
STATE FIRE MA HAL
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GO - 6 (Rev. 7/86)
Office of the State Fire Marshal
Fire Safety Correction Notice
File No: — — - —
— — — — — —
Name:
Address:
The California Health and Safety Code and the State Fire Marshal's regulations require the following fire safety
deficiencies be corrected.
I
li
I The above deficiencies are to be corrected within days. When ALL deficiencies have been corrected,sign
and return the certification on the opposite side of this form. If you have any questions, contact the Office of the State
Fire Marshal at ( )
ISSUED BY (Deputy State Fire Marshall RECEIVED BY DATE
EN -11 (Rev. 7/86) 1 86 96708 DISTRIBUTION: GREEN—Facility WHITE—Region YELLOW—Field
e_o/
Uffice of the State Fire Marshal
IAICDC('TIlIAI DCDl1DT
■1 �J■ Lam. ■ ■VI \ nLt Vn v STATEFIRE MAR AL
le o.:100 --L)4 .7`-�
4-4'� r
a e of Facility:
ame of Building:
ddress:
7 aFAMNa C RMITED
STATUS
DEPUTY STA FRE
L 1--J -
DATE OF
(Rev. 7/86)
1
5a
April 8, 1992
Mrs. Lula Thomasson
Thomasson's High Horizons
3530 Cherokee Road
Oroville, California 96965
Dear Mrs. Thomasson:
I'm
Thomasson's High Horizons
CSFM FILE# 00-04-42-0003-000-555-9
During a recent inspection of your facility, the following
deficiencies were noted:
1. The automatic fire alarm system was not working
properly.
2. The (2) solid -core corridor doors separating the non-
ambulatory client bedrooms from the main living area
were being held open with unapproved devices.
The above deficiencies shall be corrected immediately.
A copy of our letter dated 4/17/92 is enclosed, approving an
alternate plan of correction to the requirement for an 8 foot
corridor. Fire clearance for your facility is subject to all
conditions listed being met and maintained at all times.
If we can be of any further assistance, please feel free to
contact Deputy Jack Pirisky at (919) 895-4349
Si ncerel y,
Pj7e.of.
it No • -- —
Office of the State Fire Ma* ishal
VISPECTION REPORT''
of Facility: MAR.gM 1.9 HTM ' q
of Building:
;s: 3530 Cierokee 'Road
Oroville, CA 95%5
a' - •.ice` f t 1. .J "• •'A i►;i;.: .. �•► w: j• y'•` •S� �. .•;� K .�!•' .. ...�'.. •.,,••,�.) •S t �.•.. n. ���} •� .'`.•, f•. .t� �' J •�.• 1.kf ..
A
• ; of -1 - •• 4,t•r.• � � t '.tl I� ' � ..�?
Di'irh. t 1 is • .•�r 1 .}� �•�' . �'�r .' ��• ..�''� ,� � ..i �♦..;C.�,� • i � t • � • • .
scussed with: r •y. • _ - _ r • . �� .i at �' F•
•. .� t, •4.4..� . f�: •1741 r af,, f�'v.. ! 1. , )i t f
• j• ,r. .�. .a`. �� . ,q r, �, (••. ;a •. i�•, tt'fJa�. F �� _ .•� t yr• �.h. �..• •r - .��!w •. `' .,t. jet �7%.(•r .v� • •� f �•,l '� t�•'��..{. ~ r '. �• •�
sylV i f • },• • .:. +.j' .t ;.
ccompanied by: - ^� ; . r Title: '•
A follow-uption was conducted at the above f ' t . 'Ihe fire alarm system is
operational and the doors separating the bedrooms were maintained closed. The f ' ty mainr-
tains a reasonable degree of fire and life safety. Fire clearance is granted six ambulatory
and six nonambulatory adult clients.
17
CUUU MKT CR/1MEfl , , `�• f ,; '•, . . t TrDiATE . ,ti,: f .. :,•. ;; , .
. , .. .,
STAINS t
IM )P93Q4.-
...
�..,
•.6 July 92.r..�r�.
- � (Rev. 7/86)
r
AC
TE OF CALIFORNIA—STATE AND CONSUMER SERVICES AGENCY PETE WILSON , Governor
WFORNIA STATE FIRE MARSHAL
ZTHERN REGIONAL DIVISION
3 FLORIN ROAD, SUITE 400 April 23, 1992
RAMENTO, CA 95823-2034
Mrs, Lula Thomasson
Thomasson's High Horizons
3530 Cherokee Road
Oroville, CA 96965
Dear Mrs. Thomasson:
THOMASSON'S HIGH HORIZONS
CSFM File #00-04-42-0003-000-555-9
..
(916) 427-4325
ATSS 466-4325
TDD (916) 427-4186
FAX (916) 427-4308
An inspection of the referenced facility was recently conducted
in accordance with Section 1314 6 (b) of the California Health and
Safety Code. The purpose was to determine compliance with the
minimum fire and life safety standards required by Titles 19 and 24
of the California Code of Regulations.
The attached report is to advise you of the actions that are
required to correct the noted deficiencies.
To insure this facility is brought into compliance within a
reasonable time, please submit your plan for accomplishing these
corrections, to this office, within 30 days from receipt of this
notice.
If you have already corrected these deficiencies, please advise
us so we can update our files.
If we can be of further assistance, or you desire additional
information or clarification, please contact Deputy Jack Pirisky at
(916) 895-4312. Thank you for your cooperation in our mutual
effort to provide a fire safe environment for the occupants of your
facility.
DN: JP:sh
Sincerely,
DANIEL NAJERA
Supervisor, Field Operations
Thomasson's High Horizons
April 23, 1992
Page 2
1. The automatic fire alarm system was not working at the time of
this inspection, this system shall be maintained in working
order at all times. [CBC 1009]
2. The (2) solid -core corridor doors separating the non-ambulatory
Client Bedrooms from the main living area were being held open
with unapproved devices. All unapproved hold -open devices and
other obstructions shall be removed from exit corridor doors.
All doors shall be maintained self-closing and positive -
latching, and shall not be propped open. [CBC 3305(h)]
A copy of our letter dated April 17, 1992 is enclosed,
approving an alternate plan of correction to the requirement for an
8' corridor. Fire clearance for your facility is subject to all
conditions listed being met and maintained at all times.
April 81 1992
Mrs. Lula Thomasson
Thomasson's High Horizons
3530 Cherokee Road
Oroville, California 96965
Dear Mrs. Thomasson:
Thomasson's High Horizons
CSFM FILE# 00-04-42-0003-000-555-9
During a recent inspection of your facility, the following
deficiencies were noted:
1. The automatic fire alarm system was not working
properly.
2. The (2) solid -core corridor doors separating the non-
ambulatory client bedrooms from the main living area
were being held open with unapproved devices.
The above deficiencies shall be corrected immediately.
A copy of our letter dated 4/17/92 is enclosed, approving an
alternate plan of correction to the requirement for an 8 foot
corridor. Fire clearance for your facility is subject to all
conditions listed being met and maintained at all times.
If we can be of any further assistance, please feel free to
contact Deputy Jack Pirisky at (919) 895-4349
Sincerely,
l
S E FIRE MARSHAL COPY DISTRIBUTION: SEE REVERSE OF COPIES 2 AND 5 FOR
FI SAFETY INSPECTION REQUEST 1 -3 -STATE FIRE MARSHAL INSTRUCTIONS FOR COMPLETION
1 2 --FIRE AUTHORITY 1. REQUEST DATE 2. PROGRAM
ST 850 (REV. 8/88) 4 -5 -LICENSING AGENCY 3/18/91
3. G NCY CONTACT 4. TELEPHONE NO. S. EVALUATOR
SS/Community Care Licensing (916) 895-5033 0103/Bob Caldwell
6. AFIVI
REGION
7. SFM I.D. NO.
S. REQUESTING AGENCY FACILITY NO.
9. REQUEST CODE
?30
041304029
7A
CODES
EQUESTING CLEARANCE FOR ONE RESIDENT OVER
65 • YEARS OF AGE
1. ORIGINAL A. FIRE CLEARANCE
2. RENEWAL B. LIFE SAFETY
r
I
3. CAPACITY CHANGE
4. OWNERSHIP CHANGE
10.
&G NCY Dept. of Social Services
S. ADDRESS CHANGE
A E Community Care Licensing
S. NAME CHANGE
N 3 520 C o h a s s e t R d.,# 6
PREVIOUS NAME
DRESS ! Chico, CA 95926*
7.OTHER
" - -
DATE OF ORIGINAL REQ.
11.
AM
ULATORY
NONAMBULATORY
TOTAL CAP.
DATE OF LAST FIRE CLEARANCE
CAP OkC
TY
AGE RANGE (YEARS)
PREVIOUS
CAPACITY
AGE RANGE (YEARS)
PREVIOUS
TO 18 19 TO 68 AND
CAPACITY
TO 18 16 TO 65 AND
CAPACITY
19. FACILITY
65OVER
65
OVER
CODE
735/adult res.
12.
FACILITY NAME
13. NO. BLDGS
CODES
HOMASSON' S HIGH HORIZONS
1
1. GACH 7. ICF/OT
2. GACH/R 8. ICF/DD
14. T EET ADDRESS (ACTUAL LOCATION)
P.O. BOX
15. RESTRAINT
530 Cherokee Rd.
no
3. SH 9. ADHC
4. APH .10. CLINIC
CIT
ZIP CODE
16. HOURS
roville Ca
195965
24
5. PHF 11. JAIL
6. SNF 12. ICF/DDN
17. A ILITY CONTACT PERSON
TELEPHONE NO.
16A. SPECIAL
ula Thomasson
916 533-6830
or
533-714
13. OTHER
TO BE COMPLETED BY
INSPECTING AUTHORITY
18.
IRk
26. CLEARANCE
CODE
Jack piriski
UT HOR
#4 Williamsberg Lane, Suite A
CODES
AR E
Chico, -Ca 95926
1. FIRE CLEAR, GRANTED
N
D (RESS
L
2. FIRE CLEAR, DENIED
3. FIRE CLEAR WITHHELD
27. DENIAL
CODE
TO BE COMPLETED BY INSPECTING AUTHORITY
CODES
21.
11 S ECTOR'S NAME
TELEPHONE NO.
22. CFIRS
23. T-19 OCC.
ID NO.
CLASS
1. EXITS
G]�
l
J
V
2. CONSTRUCTION
3. FIRE ALARM
24. If IS . DATE
23. SPEC OR' GNA E
4. SPRINKLERS
5. HOUSEKEEPING
28.E P AIN DENIAL OR LIST SP IAL CO DITIO S
i
CO
"6.
SPECIAL HAZARD
•
7. OTHER
R TURN TO:
20. R GION.
O FICE
A14D
l
Dept. of Social Services
Community Care Licensing
520 Cohasset Rd..#6
March6,1991
Mr. Ed Se its
Divis ion Chief
Ca. State Fire Marshal
4 Williamsburg Lane, _Suite A
Chico, California 95926
- ------ - — -
Dear Chief-Saits,
THOMASSON'S
3530 C aoke¢ Rd.
Orovil. 95965
Administrators/Owners "
Harley & Luis Thomasson
(416) 533.7148
of Facility & Grounds
Bob & Victoria Kimble
(916) S33.6830
RL; Request for waiver of 8' corri-
- ---- - -------- --- -- - -- ----
dor.
I-am_requesting_a- waiver -of-the _8' _corridor _code _for _our
facility st at ink -t he_f ollowing_reasons ;
1.- -We have semi -direct access _ to _the exterior ramp. _(Residents
__
_ -o an 11x8 ' hall -that exits onto
exit their rooms directl_int -
t he _ramp _) --- --
2 _- _A -smoke alarm -system is installed with smoke and heat censors
in_every _room _and _closet _throughout the facilit , and are
_
e ked on a monthly -basis during routine fire drill-s-,---
3.-Non-ambulatory residents -are- taken from
rills.
3_--Non-ambulatoryresidents_are_takenfrom their rooms to the
exit _and _ramp nearest them, _during routine fire drills, to
.familiarize staff _and residents to the quickest proceedure
for -reaching safety_
4. _Facility_follows- State and Regional Center guidelines for ade-
quate _st of f staffing on a 24 hour basis,
^--
------ ---- -- --- ----- ------
^hank you__
Sincerely,
ula B. Thomasson
- --- -----------
Owner -Administrator
- - ---- --- ------ --
P e of O,FICE�
Office of the State Fire Marsha
INSPECTION REPORT STATE FIRE MAR HAL
Name of Facility:tlUti"
Name of Building:
Address: ._.� � 7 tJ
,�
t��G C,� c�SC1U'�
Discussed with:
Accompanied by:
,�.1At,, v >` r �`J Title: C -,Ly I j C-- AL
Title: ::IS q-yc�s
cz� C—T1. v L,\- (fam\ G
L L CA L t 6\�, IG: - 0A L—:5�i1)
FIR CLEARANCE GRAN
T -DATE
STAIUS
DE Y STATE FIRE M
--- M
DATE OF INSPECTION
0-6 (Rev. 7/86)
._.. ._,,F "�N+l+StgtP.'^+�+ewli """r"'?. ^'p'�"�4M'►uGxM�sRv 1P-4►' �+4YR rs. w...w
i "vim#' "'0[MT'�t �.f10t - 'b►S!►7�7�*¢Al'�1'-1 +�+?Y.F+q.�pcnu�7�-r--.. .. '-v..,.w►�•-»•-�...--r..---•
r PETE WILSON
STATE OF CALIFORNIA --STATE AND CONSUM,� cS AGENCY �., �►gC38c�DP��IdrtlllcQcDUcI�I, Governor
CALIFORNIA STATE FIRE MARSHAL
NORTHERN REGIONAL DIVISION i (916) 427-4325
4A33,FLORIN ROAD, SUITE 400 ATSS 466-4325
SACRAMENTO, CA 95823-2034
TDD (916) 427-4186
FAX (916) 42740*6 4308
April 17 , 19 91
Mrs. Lula Thomasson
Thomasson's High Horizons
3530 Cherokee Road
Oroville, California 95965
Dear Mrs, Thomasson:
Thomasson's High Horizons
CSFM File #00-04-42-0003-000-035-1
In response to your March 6, 1991 letter, your request for
an alternate to the requirements for an 8 foot corridor is
approved with the following conditions:
1. The automatic fire alarm system shall be maintained
operable at all times. t
2. The two solid -core corridor doors shall not be held
open with unapproved devices. (See attached floor
plan)
3. Non -Ambulatory clients shall be housed in the three
north bedrooms only. (See attached floor plan)
4. At no time shall bedridden patients be housed in the
facility.
If we can be of any further assistance, please feel free to
contact Deputy Jack Pirisky at (916) 895-4349.
Sincerely,
Edward F. Seits
co
q�
-JSIV
(OL
office of the State Fire Marshal
INSPECTION REPORT
00
No.: 04 77- _ 42
0003 _ __ 000 = 555 _ __ 9
of Facility: THOMMASON' S HIGH HORIZON
of Building:
Oroville. CA '95965
Discussed with: Title:
Accompanied by: Staff Title:
r
An annual inspection
was conducted at the above facility. No
deficiencies were
noted. The facility
maintains a reasonable degree of fire and
life safety, Fire
clearance is granted
for six ambulatory and six nonambulatory
adultclients.
t
DEKM STATE FIRE MARSHAL
.DATE OF MlSPECTK)N s
SLAUGHTER 4
31March, tug
9`
FRE CLEARANCE GRANTED
7 [TATE
:i
STATUS z
i YES
I-9404
t
DEKM STATE FIRE MARSHAL
.DATE OF MlSPECTK)N s
SLAUGHTER 4
31March, tug
9`
f
6 (Rev. 7/86)
0
CKz ro Ir.�. Rte- 1 6vu. -SO ��OrovUU, CA
CAVPIt.ed �fG�
Cno �a.►np)
19 &15 -coxa c, con v u sc c�
5-1 to t..
cov.e� YGtm,P .
I _.Y I I I y I
Z r-i(=>na,rn.l>juu�s+s
bcs,44
(D core, l 8" door
6D 4�u61e, A)6k on t;mc)kt- c. c-ka#orS
K.t,�c�.en/ d,uner5 Guest
d,�.ru`� V�edraow, k�a,+h
c.ove�.e.a�. peru-,
o� nonan mb
Lk C, +-e>
-%� 5ca CL
�-,
SA E FIRE MARSHAL '
F R SAFETY INSPECTION RE04 _ 3T
S D �50 (REV. 8 / 86)
COPY DISTRIBUTION:
1 -3 -STATE FIRE MARSHAL
2 -FIRE AUTHORITY
4 -5 -LICENSING AGENCY
e
a SEE REVERSE OF COPIES 2 AND 5 FOR
INSTRUCTIONS FOR COMPLETION
1. REQUEST DATE 2. -PROGRAM
5/23/9
3. AGENCY CONTACT
4. TELEPHONE NO.
5. EVALUATOR
,DSS/Community Care Licensing
(916) 895--5033
0103/Robert Caldwell
6. Fi REGION
7. SFM I.D. NO.
S. REQUESTING AGENCY FACILITY NO.
9. REQUEST CODE
330
00-04-47-0003-000-035-1
041304029
3 A
CODES
1. ORIGINAL A. FIRE CLEARANCE
2. RENEWAL B. LIFE SAFETY
r3.
1 �
CAPACITY CHANGE
4. OWNERSHIP CHANGE
Dept. of Social Services
1 AGENCY
Community Care Licensing
S. ADDRESS CHANGE
NAME 520 C o h a s s e t R d. ,# 6
6. NAME CHANGE
A D,- . Chico, CA 95926
PREVIOUS NAME
A DRESS L
7. OTHER
.
DATE OF ORIGINAL REQ.
11 . MBULATORY
NONAMBULATORY
TOTAL CAP.
DATE OF LAST FIRE CLEARANCE
C P CITY
AGE RANGE (YEARS)
PREVIOUS
CAPACITY
AGE RANGE (YEARS)
PREVIOUS
TO 16 18 TO 65 AND
CAPACITY
TO 16 18 TO 65 AND
CAPACITY
19. FACILITY
65 OVER
x
8
6
65 OVER
x
12
CODE 735/adult res.
ACILITY NAME
1 .w;ROMASSON'S
13. NO. BLDGS
CODES
1. GACH 7. ICF / OT
2. GACH/R 8. ICF/DD
HIGH HORIZONS
1
74. STREET ADDRESS (ACTUAL LOCATION) P.O. BOX
15. RESTRAINT
--*3-930 Cherokee Rd.
no
3. SH 9. ADHC
C TY ZIP CODE
4. APH 10. CLINIC
16. HOURS
95965
2
5. PHF 11. JAIL
6. SNF 12. ICF / DDN
IV.
FACILITY CONTACT PERSON TELEPHONE NO. 16A. SPECIAL
Tula 1homasson 916 533-6830 or 33-7148
13. OTHER
TO BE COMPLETED BY
INSPECTING AUTHORITY
i
'I
r �
l
26. CLEARANCE
CODE
13.
RE
Jack P i r i s k i
CODES
#4 Williamsberg Lane, Suite 3
AME
Chico, C A 95926
1. FIRE CLEAR, GRANTED
AND
2. FIRE CLEAR, DENIED
ADDRESS
3. FIRE CLEAR, WITHHELD
27. DENIAL
CODE
TO BE COMPLETED BY INSPECTING AUTHORITY
CODES
1.INSPECTOR'S
NAME
TELEPHONE NO.
22. CFIRS
23. T-19 OCC.
ID NO.
CLASS
1. EXITS
SLAUGHTER
895-4312
9
035
I-2
2. CONSTRUCTION
3. FIRE ALARM
4.
NSP. DATE
25. INSPECTOR'S SIGNATURE'
1 May 90
4. SPRINKLERS
4
5. HOUSEKEEPING '
ti
6.EXPLAIN
DENIAL OR LIST SPECIAL CONDITIONS
ire clearance is granted for 6 ambulatuy6.
SPECIAL HAZARD �\
7. OTHER
'ncludes one -bedridden client in bedrogm #1A
STATE FIRE MARSHAL USE ONLY
`RETURN To:
o.
REGION. Dept. of Social Services
OFFICE Csommunity Care Licensing.
AND 520 Cohasset Rd.,#6
ADDRESS Chico, C A 95926
L
\
Page—of
Office of the State Fire Marsha
INSPECTION REPORT
111 L -
File No.:.
Name of Facility: AA,1 S Ff7-1r 11 f am r
Name of Building:
Address: 3 5--1 DC' f ��i� f4 -r Z r /J
Discussed with: ��itir`5/��/_
�
Accompanied by:
�
� -gid+'
Title:
Title:
DEPUTY STA E FRE
DATE OF INSPECTION
_
%LC� -,I/
L l L'
/4,(,- bac 61 76-KLI
zd
FRE CLEARANCE ANTED
T -DATE
STATUS
DEPUTY STA E FRE
DATE OF INSPECTION
_
G
L
GO -6 (Rev. 7/86)
s
PETE WILSON
TATE OF CALIFORNIA -STATE AND CONSUK VICES AGENCY Ggs C3�c�DPC,blQ,tl�c�b�ckl, Govemor
CALIFORNIA STATE FIRE MARSHAL •• '~ ;
18RTHERN REGIONAL DIVISION (916) 427-4325 =~�'0
433 FLORIN ROAD, SUITE 400
ATSS 466-4325
ACRAMENTO, CA 95823-2034 TDD (916) 427-4186
FAX (916) 427 -XMA 4308
April 17, 1991
Mrs. Lula Thomasson
Thomasson's High Horizons
3530 Cherokee Road
Oroville, California 95965
Dear Mrs. Thomasson:
Thomasson's High Horizons
CSFM File #00-04-42-0003-000-035-1
In response to your March 6, 1991 letter, your request for
an alternate to the requirements for an 8 foot corridor is
approved with the following conditions:
1. The automatic fire alarm system shall be maintained
operable at all times.
2. The two solid -core corridor doors shall not be held
open with unapproved devices* (See attached floor
plan)
3. Non -Ambulatory clients shall be housed in the three
north bedrooms only. (See attached floor plan)
4. At no time shall bedridden patients be housed in the
facility.
If we can be of any further assistance, please feel free to l
contact Deputy Jack Pirisky at (916) 895-4349.
Sincerely,
Edward -F. Seits
Division Chief
EFS:JEP:glg
TE OF CALIFORNIA—STATE AND CONSUML&. aERVICES AGENCY
5FFICE OF THE STATE FIRE MARSHAL
NORTHERN REGIONAL DIVISION
X433 FLORIN ROAD, SUITE 400
ACRAMENTO, CA 95823
October 28, 1989
Thomasson Family Home
3530 Cherokee Road
Oroville, California 95965
GEORGE DEUKMEJIAN, Governor -
t 0• •y
:•
(916) 427-4325 s� ,
_ ATSS 466-4325
TDD (916) 427-4186 `••�••'
e .
We received your request that the provisions of Section 2-3321(b) ,
State Building Code, concerning the width of exiting for bedridden
clients be waived. Your proposal is acceptable provided all of the
following provisions are met:
1. All deficiencies noted on the Fire Safety Correction
Notice previously issued to you are corrected.
2. The bedridden client is housed only in Room #1.
3. The procedures outlined in your letter of June 28, 1989
shall be effective at any time your facility houses a
bedridden client.
a. A wheelchair is available near the client's bed
which will be used to transport the client to the
sliding exterior exit.
b . Emergency evacuation shall be practiced during fire
dr�i l l s .
Should you have further questions, please contact Deputy Jack
Pirisky by telephoning (916) 895-4312.
Sincerely,
NANCY LFE
Division Chief
cc: J. Pirisky
Office of the State Fire Marshal
INSPECTION REPORT
00 _ 04 = 42
0003 _ 000 _ 035 _ 1
ime of Facility: THOMASSON FAMILY HOME
Name of Building:
Route #1 Box #3076 Cherokee Road
Oroville, Ca. 95965
QTrFICE�,
'STATE FIRE MA AL
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_XUMANCE C.[.A.
`'4 � . R 'S. .,yj.:.
met with the Owners of the above facility to discuss the specific requirements
1
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for separating the first & second floors of their facility,, They ::now understand
Y
nd will begin construction soon. They are still waiting, also for their waiver
r•
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3 •� � <. =k S .a 3y4 :! =' 3'
n the installation of a 44" door for a•bedridden client,
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DEKM
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GO - 6 (Rev. 7/86)
EN -I I (Rev. 7/86) 86 96708 DISTRIBUTION: GREEN—Facility WHITE—Region YELLOW—Field
IN
-Office of the State Fire Marshal
*FIRE
Fire Safety Correction Notice HAL
File No:
0oU-�?� ` --
The California Health and Safety Code and the State Fire Marshal's regulations require the following fire safety
deficiencies be corrected.
i
1 7 iii F;'�ZJ,- 1=/-A," ! T-; i 1���,/� ;;;�rJ,_.:� t/�(;
�! ; 1 i,'� G-- Jim � J .G•.� � �/ ti .•'C... / I � / � `
r
The above deficiencies are to be corrected within days. When ALL deficiencies have been corrected, sign
and return the certification on the opposite side of this form. If you have any questions, contact the Office of the State
Fire Marshal at ( )
ISSUED BY (Deputy State Fire Marshall
RECEIVED BY
DATE
EN -I I (Rev. 7/86) 86 96708 DISTRIBUTION: GREEN—Facility WHITE—Region YELLOW—Field
IN
71
ON
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STA E FIRE MARSHAL /
,r
COPY DISTRIBUTION: -
1 3 -STATE FIRE MARSHAL
SEE REVERSE OF COPIES 2 AND 5
INSTRUCTIONS FOR COMPLETION
FIE
SAFETY INSPECTION REOUL a l -
2 -FIRE AUTHORITY1.
REQUEST DATE
2. PROGRAM
STD
50 (REV. 8/86) 4 -5 -LICENSING AGENCY
6-13-$9
3. AGENCY
CONTACT
4. TELEPHONE NO.
S. EVALUATOR
SS/WCMUINITY CARS LICENSING
(916' 895-5033
0113 BE'THELL
S. 5
M REGION
7. SFM I.D. NO.
8. REQUESTING AGENCY FACILITY NO.
9. REQUEST CODE
041304029
3A -
IS REQUEST REPLACES ONE WED 5-24-89. PLEASE CLEAR FOR ONE
CODES
1. ORIGINAL A. FIRE CLEARANCE
EDRIDDEN CLIENT
2. RENEWAL B. LIFE SAFETY
�
3. CAPACITY CHANGE
4. CHANGE
DEPAR'L W OF SOCIAL SMVIGES
OWNERSHIP
10.AGENCY
•.IrLA'll l I ITY MU LIMSING
VETT
3. ADDRESS CHANGE
NAME
520 CS, S
UlJ L
ROAD SUM
6. NAME CHANGE
AND
CHICO, CA. 9592b
NAME
ADDRESS
L
7. OTHEPREVIOR
A n
t) ' d V V u•
DATE OF ORIGINAL REO.
DATE OF LAST FIRE CLEARANCE
11. A
BULATORY - NONAMBULATORY
TOTAL CAP.
CAPACITY
AGE RANGE (YEARS)
PREVIOUS CAPACITY
AGE RANGE (YEARS)
PREVIOUS
TO 18 TO 65AND
CAPACITY
TO 18 18 TO 65 AND
CAPACITYOVEROVER
FACILITY
8-5
1118
J 4
IL-5
12
O
CODE
12. FOkCILITY
NAME
13. NO. BLDGS
CODES
rIOMASS01.11 F. ILLY HOME
1
1. GACH 7. ICF/OT
2. GACH/R 8. ICF/DD
14. S
REET ADDRESS (ACTUAL LOCATION)
P.O. BOX
15. RESTRAINT
3530 CHEROKEE ROAD
NO
3. SH 9. ADHC
4. APH 10. CLINIC
CITY
ZIP CODE
16. HOURS
OROVILLE, CA
95965
24
5. PHF 11. JAIL
6."SNF 12. ICF/DDN
17. FACILITY
CONTACT PERSON --
TELEPHONE NO.
16A. SPECIAL
LUTLA THOM'ASSON
(916) 533-°6830
13. OTHER
TO BE COMPLETED BY
"
INSPECTING AUTHORITY
�
- 26. CLEARANCE
CODE
18. F
RE JACK
A
THOR f��-{'��l�IR �SKI4,, 7�(� T �;T�,a �+�7. �. �
LdILLIAMSBUG LANE SUTPE #'3
N
//#4
M •
6 CHCO CAUF 95926
- CODES
1. FIRE CLEAR, GRANTED
A
o
2. FIRE CLEAR, DENIED
A
DRESS _ _ _ .. .� -
3. FIRE CLEAR, WITHHELD "
27. DENIAL
CODE
TO BE COMPLETED BY INSPECTING AUTHORITY.- •, : ,'
_ CODES'
21.INSPECTOR'S
NAME - - -
TELEPHONE" NO.X22.
CFIRS
23. T-19 OCC.
• -
- - -
" ID NO.
. CLASS
1. EXITS
2. CONSTRUCTION
3. FIRE ALARM
24. INSP.
DATE
25. INSPECTOR'S SIGNATURE -
4. SPRINKLERS
5. HOUSEKEEPING
28.E
PLAIN DENIAL OR LIST SPECIAL CONDITIONS - - -
6. SPECIAL HAZARD
7. OTHER
` STATE FIRE MARSHAL USE ONLY
DFPAr iT�.%:FT Or SOCIAL SERVICES
20. R
CION.
CU,1U.UTy CURELIC04SING
O
FICE
520( COHASSE3.' ROAD SUITE 6
A
D
CALIF. 75926
A
DRESS
J
of -
Office of the State Fire Marsha
INSPECTION REPORT
0
. 00 _ 04 _ 42
0003 - 000 - 035 - 1
of Facility: THOMASSON FAMILY HOME
of Building:
3076 Cherokee Road
Oroville, Ca. 95965
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EN --11 was issued.
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GO -6 (Rev. 7/86)
Office of the State Fire Marshai
*FIRE
Fire Safety Correction Notice HAL
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T._.
The California Health and Safety Code- and the State Fire Marshal's regulations require the following fire safety
deficiencies be corrected.
i
The above deficiencies are to be corrected within days. When ALL deficiencies have been corrected, sign
land return the certification on the opposite side of this form. If you have any questions, contact the Office of the State
Fire Marshal at ( ?
ISSUED BY (Deputy State Fire Marshal)
RECEIVED BY -
DATE
EN -I I (Rev. 7/86) 86 96708 DISTRIBUTION: GREEN—Facility WHITE—Region YELLOW—Field
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