| 6400.110(g) | There are no written procedures for fire safety monitoring in the event the smoke detector or fire alarm is inoperative. On 09/15/25 during the fire drill at 10:50am, it reads that "some fire alarms were not working". | If a smoke detector or fire alarm is inoperative, notification for repair shall be made within 24 hours and repairs completed within 48 hours of the time the detector or alarm was found to be inoperative. | Sunset's Chief Executive Officer of Residential Services will update Policy 439-h named Fire Drills.
The policy currently states,
"In the case of inoperative fire alarms, staff must submit a maintenance request in Fiix-It immediately upon discover of the inoperative fire alarm. The maintenance department shall ensure that repairs are completed within 48 hours (about 2 days) of when the maintenance request was submitted.
The policy will add,
"In the case of inoperative fire alarms, Direct Care Staff must call the office and ask to report that a smoke detector(s) are inoperable. This can be done by contacting the incident management department during normal business hours and pressing option 1 and leaving a message after normal business hours. The administrator taking the call will have the staff complete Fire Watch procedures as defined by the National Fire Protection Agency. The administrator must submit a maintenance request in Fiix-It immediately upon discover of the inoperative fire alarm.
The maintenance department shall ensure that repairs are completed within 48 hours (about 2 days) of when the maintenance request was submitted. |
12/16/2025
| Implemented |