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Washington State Patrol Fire Protection Bureau Phone: (360)596-3900 Business Name Address City, State, Zip Living Court Assisted Living Community 2229 JENSEN ST , Enumclaw, WA 98022 Provider Number Approval Status Facility Type 2153 Approved Residential Care On 04/15/2019 the Office of the State Fire Marshal conducted an inspection at your facility. All violations noted during previous related inspection(s) have been corrected. Owner or Owner's Representative "}»^ ^•ftee.ll ^l<f/^A<.Mi^«. ()>><c/«>. Print Name and Title Deputy State Fire Marshal Dylan Montgomery 2505 112THSTE TacomaWA 984455104 (425) 577-0362 SigffgtufS Right of appeal. Any person may appeal any decision made by the Fire Protection Bureau in accordance with WAC 212-12. 1 of 1 Initials of Authorized Facility Representative: This document was prepared by Residential Care Services for the Locator website.

Owner or Owner's Representative dZ] } µu v Á ÇZ ] v …...2153 Approved Residential Care On 04/15/2019 the Office of the State Fire Marshal conducted an inspection at your facility

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Washington State PatrolFire Protection Bureau

Phone: (360)596-3900

Business Name

Address

City, State, Zip

Living Court Assisted Living Community

2229 JENSEN ST ,

Enumclaw, WA 98022

Provider Number

Approval Status

Facility Type

2153

Approved

Residential Care

On 04/15/2019 the Office of the State Fire Marshal conducted an inspection at your facility.

All violations noted during previous related inspection(s) have been corrected.

Owner or Owner's Representative

"}»^ ^•ftee.ll ^l<f/^A<.Mi^«. ()>><c/«>.Print Name and Title

Deputy State Fire Marshal Dylan Montgomery2505 112THSTETacomaWA 984455104(425) 577-0362

SigffgtufS

Right of appeal. Any person may appeal any decision made by the Fire Protection Bureau in accordance with WAC 212-12.

1 of 1 Initials of Authorized Facility Representative:

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Washington State PatrolFire Protection Bureau

Phone: (360)596-3900

Business Name

Address

City, State, Zip

Living Court Assisted Living Community

2229 JENSEN ST ,

Enumclaw, WA 98022

Provider Number

Approval Status

Facility Type

2153

Disapproved

Residential Care

On 03/14/2019 the Office of the State Fire Marshal conducted an inspection at your facility.

Code Requirement Statement of Violation

1 Activation test.

An activation test of the emergency lighting equipment shall becompleted monthly. The activation test shall ensure theemergency lighting activates automatically upon normalelectrical disconnect and stays sufficiently illuminated for aminimum of 30 seconds.

(IFC 604.6.1 2015)

The following violation was observed:

The facility failed to conduct their 30 second monthly batterybackup emergency light test after the month of March 2018.

2 Activation test record.

Records of tests shall be maintained The record shall includethe location of the emergency lighting tested, whether the unitpassed or failed, the date of the test, and the personcompleting the test.

(IFC 604.5.1.1 2015)

The following violation was observed:

The facility failed to provide documentation of their monthly 30second battery back up tests.

3 Power test.

For battery-powered emergency lighting, a power test of theemergency lighting equipment shall be completed annually.The power test shall operate the emergency lighting for aminimum of 90 minutes and shall remain sufficiently illuminatedfor the duration of the test.

(IFC 604.6.2 2015)

The following violation was observed:

The facility failed to conduct an annual 90 minute battery backup test. Last test dated 1/31/2018.

4 Power test record.

Records of tests shall be maintained. The record shall includethe location of the emergency lighting tested, whether the unitpassed or failed, the date of the test, and the personcompleting the test.

(IFC 604.5.2.1 2015)

The following violation was observed:

The facility failed to provide documentation of their annual 90minute battery back up test.

1 of 9 Initials of Authorized Facility Representative:

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WASHlHETON^TATEPXTniDl-

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Washington State PatrolFire Protection Bureau

Phone: (360)596-3900

Business Name

Address

City, State, Zip

Living Court Assisted Living

2229 JENSEN ST ,

Enumclaw, WA 98022

Community Provider Number

Approval Status

Facility Type

2153

Disapproved

Residential Care

On 03/14/2019 the Office of the State Fire Marshal conducted an inspection at your facility.

Code Requirement Statement of Violation

5 Working space and clearance.

A working space of not less than 30 inches (762 mm) in width,36 inches (914 mm) in depth and 78 inches (1981 mm) inheight shall be provided in front of electrical service equipment.Where the electrical service equipment is wider than 30 inches(762 mm), the working space shall not be less than the width ofthe equipment. No storage of any materials shall be locatedwithin the designated working space.

Exceptions:

1. Where other dimensions are required or allowed byNFPA70.

2. Access openings into attics or under-floor areaswhich provide a minimum clear opening of 22 inches (559 mm)by 30 inches (762 mm).

IFC 605.3 2015

The following violation was observed:

The facility failed to maintain 36" of clearence from theirelectrical panels in the Maintenance Office.

6 Multiplug adapters.

Multiplug adapters, such as cube adapters, unfused plug stripsor any other device not complying with NFPA 70 shall beprohibited.

(IFC 605.4 20122015)

The following violations were observed:

The facility failed to restrict the use of non over currentprotected multi plug adapters in the following locations:

1.Rm126 - •

2. Rm 217

7 MuIti-Plug Adapters - Power Supply,

Relocatable power taps shall be directly connected to apermanently installed receptacle.

(IFC 605.4.2)

The following violation was observed:

The facility has power strips plugged into another power stripor multi plug adapter in the following locations:

1. Rm1262. Rm 217

2 of 9 Initials of Authorized Facility Representative:

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WAsmsTessi-STEWresi:

Washington State PatrolFire Protection Bureau

Phone: (360)596-3900

Business Name

Address

City, State, Zip

Living Court Assisted Living Community

2229 JENSEN ST,

Enumdaw, WA 98022

Provider Number

Approval Status

Facility Type

2153

Disapproved

Residential Care

On 03/14/2019 the Office of the State Fire Marshal conducted an inspection at your facility.

Code Requirement Statement of Violation

8 Fire walls, fire barriers and fire partitions.

Required fire walls, fire barriers and fire partitions shall bemaintained to prevent the passage of fire. All openingsprotected with approved doors or fire dampers shall bemaintained in accordance with NFPA 80.

(IFC 703.1.3 2015)

The following violation was observed:

The facility failed to provide documentation for their 4 yearfire/smoke damper testing.

9 Door Operation

Swinging fire doors shall close from the full-open position andlatch automatically. The door closer shall exert enough force toclose and latch the door from any partially open position.

(IFC 703.2.3)

The following violations were observed:

The facility failed to maintain their 2nd floor corridor fire dooradjacent to room 220 will not close and latch automatically.

10 Inspection, testing and maintenance.

Fire detection, alarm, and extinguishing systems, mechanicalsmoke exhaust systems, and smoke and heat vents shall bemaintained in an operative condition at all times, and shall bereplaced or repaired where defective. Nonrequired fireprotection systems and equipment shall be inspected, testedand maintained or removed.

(IFC 901.6 2012,2015)

The following violation was observed:

The facility failed to provide documentation for their quarterlysprinkler testing for the 2018 calendar year.

11 System Test

Systems shall be inspected and tested for proper operation at6-month intervals. Tests shall include a check of the detectionsystem, alarms and releasing devices, including manualstations and other associated equipment. Extinguishing systemunits shall be weighed and the required amount of agentverified. Stored pressure-type units shall be checked for therequired pressure. The cartridge of cartridge-operated unitsshall be weighed and replaced at intervals indicated by themanufacturer.

(IFC 904.5.1 (2009,2012,2015)

The following violation was observed:

The facility failed to provide a second semi annual test of theirKitchen Suppression system. Last dated test was 5-2018.

3 of 9 Initials of Authorized Facility Representative:

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Washington State PatrolFire Protection Bureau

Phone: (360)596-3900

Business Name

Address

City, State, Zip

Living Court Assisted Living Community

2229 JENSEN ST ,

Enumclaw, WA 98022

Provider Number

Approval Status

Facility Type

2153

Disapproved

Residential Care

On 03/14/2019 the Office of the State Fire Marshal conducted an inspection at your facility.

Code Requirement Statement of Violation

12 Where required.

Portable fire extinguishers shall be installed in the followinglocations.

1. In new and existing Group A, B, E, F, H, I, M, R-1,R-2, R-4 and S occupancies.

Exception: In Group R-2 occupancies, portable fireextinguishers shall be required only in locations specified inItems 2 through 6 where each dwelling unit is provided with aportable fire extinguisher having a minimum rating of1-A:10-B:C.

2. Within 30 feet (9144 mm) of commercial cookingequipment.

3. In areas where flammable or combustible liquids arestored, used or dispensed.

4. On each floor of structures under construction,except Group R-3 occupancies, in accordance with Section3315.1.

5. Where required by the sections indicated in Table906.1.

6. Special-hazard areas, including but not limited tolaboratories, computer rooms and generator rooms, whererequired by the fire code official.

TABLE 906.1ADDITIONAL REQUIRED PORTABLE FIREEXTINGUISHERS

SECTION303.5307.5308.1.3

309.4

SUBJECTAsphalt kettlesOpen burningOpen flames—torches

Powered industrial trucks

The following violation was observed:

The facility has a fire extinguisher that is not mounted in the1st floor elevator Room Adjacent the Med Room.

4 of 9 Initials of Authorized Facility Representative:

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w»/l

Washington State PatrolFire Protection Bureau

Phone: (360)596-3900

Business Name

Address

City, State, Zip

Living Court Assisted Living Community

2229 JENSEN ST,

Enumclaw, WA 98022

Provider Number

Approval Status

Facility Type

2153

Disapproved

Residential Care

On 03/14/2019 the Office of the State Fire Marshal conducted an inspection at your facility.

Code

2005.2

2005.3

2005.4vehicles2005.5vehicles2005.6stations2007.7

2108.42305.5

2310.6.4facilities2311.62404.4.1

2405.4.22406.4.22804.2facilities2808.82809.5

2903.5

3006.33104.12

3206.13315.1or demolition3317.33408.2

3504.2.6

3604.45203.65703.2.1liquids, general

Requirement

Aircraft towing vehicles

Aircraft welding apparatus

Aircraft fuel-servicing tank

Aircraft hydrant fuel-servicing

Aircraft fuel-dispensing

Heliports and helistops

Dry cleaning plantsMotor fuel-dispensing facilities

Marine motor fuel-dispensing

Repair garagesSpray-finishing operations

Dip-tank operationsPowder-coating areas

Lumberyards/woodworking

Recycling facilitiesExterior lumber storage

Organic-coating areas

Industrial ovensTents and membrane structures

Rack storageBuildings under construction

Roofing operationsTire rebuilding/storage

Welding and other hot work

MarinasCombustible fibers

Flammable and combustible

Statement of Violation

5 of 9 Initials of Authorized Facility Representative:

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Washington State PatrolFire Protection Bureau

Phone: (360)596-3900

Business Name

Address

City, State, Zip

Living Court Assisted Living Community

2229 JENSEN ST,

Enumclaw, WA 98022

Provider Number

Approval Status

Facility Type

2153

Disapproved

Residential Care

On 03/14/2019 the Office of the State Fire Marshal conducted an inspection at your facility.

Code Requirement Statement of Violation

5704.3.3.1combustible liquids5704.3.7.5.2

flammable and combustible liquids5705.4.9 Solvent distillation units

Indoor storage of flammable and

Liquid storage rooms for

5706.2.7 Farms and constructionsites—flammable and combustible liquids storage5706.4.10.1 Bulk plants andterminals for flammable and combustible liquids5706.5.4.5 Commercial, industrial,governmental or manufacturing establishments—fueldispensing5706.6.4 Tank vehicles for flammable andcombustible liquids5906.5.7 Flammable solids6108.2 LP-gas

(IFC 906.1 2012,2015)

6 of 9 Initials of Authorized Facility Representative:

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Washington State PatrolFire Protection Bureau

Phone: (360)596-3900

Business Name

Address

City, State, Zip

Living Court Assisted Living

2229 JENSENST,

Enumclaw, WA 98022

Community Provider Number

Approval Status

Facility Type

2153

Disapproved

Residential Care

On 03/14/2019 the Office of the State Fire Marshal conducted an inspection at your facility.

Code Requirement Statement of Violation

13 Portable Fire Extinguishers - General Requirements

Portable fire extinguishers shall be selected, installed andmaintained in accordance with this section and NFPA 10.

Exceptions:

1. The distance of travel to reach an extinguisher shallnot apply The travel distance to reach an extinguisher shall notapply to the spectator seating portions of Group A-5occupancies.

2. Thirty-day inspections shall not be required andmaintenance shall be allowed to be once every three years fordry-chemical or halogenated agent portable fire extinguishersthat are supervised by a listed and approved electronicmonitoring device, provided that all of the following conditionsare met:

2.1. Electronic monitoring shall confirm that extinguishersare properly positioned, properly charged and unobstructed.

2.2. Loss of power or circuit continuity to the electronicmonitoring device shall initiate a trouble signal.

2.3. The extinguishers shall be installed inside of abuilding or cabinet in a noncorrosive environment.

2.4. Electronic monitoring devices and supervisorycircuits shall be tested every three years when extinguishermaintenance is performed.

2.5. A written log of required hydrostatic test dates forextinguishers shall be maintained by the owner to verify thathydrostatic tests are conducted at the frequency required byNFPA10.

3. In Group 1-3, portable fire extinguishers shall bepermitted to be located at staff locations.

IFC 906.2 2015

The following violations were observed:

The facility failed to conduct monthly inspections on their fireextinguishers throughout the facility.

7 of 9 Initials of Authorized Facility Representative:

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WAsmsTiaNiraTeRCTQLR] IN'

Washington State PatrolFire Protection Bureau

Phone: (360)596-3900

Business Name

Address

City, State, Zip

Living Court Assisted Living Community

2229 JENSEN ST ,

Enumclaw, WA 98022

Provider Number

Approval Status

Facility Type

2153

Disapproved

Residential Care

On 03/14/2019 the Office of the State Fire Marshal conducted an inspection at your facility.

Code Requirement Statement of Violation

14 Securing compressed gas containers, cylinders and tanks.

Compressed gas containers, cylinders and tanks shall besecured to prevent falling caused by contact, vibration orseismic activity. Securing of compressed gas containers,cylinders and tanks shall be by one of the following methods:

1. Securing containers, cylinders and tanks to a fixedobject with one or more restraints.

2. Securing containers, cylinders and tanks on a cart orother mobile device designed for the movement of compressedgas containers, cylinders or tanks.

3. Nesting of compressed gas containers, cylindersand tanks at container filling or servicing facilities or in seller'swarehouses not accessible to the public. Nesting shall beallowed provided the nested containers, cylinders or tanks, ifdislodged, do not obstruct the required means of egress.

4. Securing of compressed gas containers, cylindersand tanks to or within a rack, framework, cabinet or similarassembly designed for such use.

Exception: Compressed gas containers, cylinders and tanks inthe process of examination, filling, transport or servicing.

(IFC 5303.5.3 2012,2015)

The following violations were observed:

The facility failed to secure their compressed gas cylinders inthe following locations:

1. Resident Care Coordinator office2. Rm 1143. 2nd floor Maintenance office

8 of 9 Initials of Authorized Facility Representative:

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Washington State PatrolFire Protection Bureau

Phone: (360)596-3900

Business Name

Address

City, State, Zip

Living Court Assisted Living Community

2229 JENSEN ST,

Enumclaw, WA 98022

Provider Number

Approval Status

Facility Type

2153

Disapproved

Residential Care

On 03/14/2019 the Office of the State Fire Marshal conducted an inspection at your facility.

Code Requirement Statement of Violation

15 Fire Drills

In all Group I, Group E, and Group R2 Occupancies licensed bythe state, at least twelve planned and unannounced fire drillsshall be held every year. Drills shall be conducted quarterly oneach shift in Group I and Group R2, Occupancies and monthlyin Group E Occupancies to familiarize personnel with signalsand emergency action required under varied conditions. Adetailed written record of all fire drills shall be maintained andavailable for inspection at all times. When drills are conductedbetween 9:00 p.m. and 6:00 a.m., a coded announcement maybe used instead of audible alarms. Fire drills shall include thetransmission of a fire alarm signal and simulation of emergencyconditions. The fire alarm monitoring company shall be notifiedprior to the activation of the fire alarm system for drill purposesand again at the conclusion of the transmission and restorationof the fire alarm system to normal mode.

(WAC 212-12-044)

The following violations were observed:

The facility failed to provide documentation for the following firedrills:

1. Day shift 1 st quarter 20182. Day and Swing shifts 2nd quarter 20183. Day shift 3rd quarter 20184. Day shift 4rth quarter 2018

Next inspection scheduled on or after: 04/13/2019

Right of appeal. Any person may appeal any decision made by the Fire Protection Bureau in accordance with WAC 212-12.

Owner or Authorized Representative

SignatureJ^j/ ^us^r/ ^^i/t/-. /)//f(-^-'

Print Name and Title

Deputy State Fire Marshal Dylan Montgomery2505 112THSTETacomaWA 984455104(425) 577-0362.

Sign^fure

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