Form Lcr-1018a Forpd - Supplemental Life-Safety Inspection Report (Page 2 of 2) in pdf

Guidelines for Life-Safety Inspections

“Not Applicable” or N/A has the following meanings for these numbered items on the report:

11. There are no firearms or ammunition in the home or on the premises.

12. There are no firearms in the home or on the premises.

13. There are no new dogs in the home.

14. There are no pets or animals in the home.

16. There are no fuel burning appliances in the home.

22. The home does not have a pool/spa.

23. The home does not have a pool/spa deeper than 4 feet.

24. The home does not have a pool or spa OR does not provide care to children under the age of 6 or with developmental disabilities.

25. The home does not provide transportation in personal vehicles.

26. All individuals receiving care are 5 years of age or older and they weigh more than 40 pounds.

27. No individuals receiving care are transported in wheelchairs.

28. The home does not have a portable heater.

30. The home does not have a fireplace.

34. The individuals receiving care are not developmentally skilled to understand the emergency evacuation plan OR an individual is not placed in

the home at the time of the inspection.

For items 1, 14, and 20 on the report, the following definition applies to the use of the word “hazard.” “Hazard” means a condition or situation that

may cause or result in physical injury or illness to a child or vulnerable adult.

For item 5 on the report, the following definition applies to the use of the phrase “slip-resistant surface.” “Slip-resistant surface” means the flooring

provides friction to help prevent falls when the surface is wet. A slip-resistant surface may be achieved by rippling or corrugating the surface,

applying textured strips, installing a secured carpet, using rubber mats, and other similar measures.

For items 7, 8, and 10 on the report, the following definition applies to the use of the word “safeguard.” “Safeguard” means to take reasonable

measures to eliminate the risk of harm to an individual receiving care. Where a specific method is not otherwise prescribed, safeguarding may

include:



Locking up a particular substance or item.



Putting a substance or item out of reach.



Erecting a barrier that prevents an individual receiving care from reaching a particular place, items or substances.



Using protective safety devices. OR



Providing supervision.

For items 22-24 on the report, the following definition applies to the use of the word “pool.” “Pool” means any natural or man-made body of water

that:



Could be used for swimming, recreational, or decorative purposes.



Is greater than 18 inches in depth. AND



Includes swimming pools, spas, hot tubs, fountains, and fish-ponds.

For items 24 on the report, the following guidelines apply to the fence enclosure for a pool:



The exterior side of the fence is at least 5 feet high.



If the fence is chain link, the mesh measures less than 1 ¾ inches horizontally.



If the fence is constructed of vertical bars or wooden slats, the openings between bars/slats measure less than 4 inches.



The exterior side of the fence is free of hand-holds or foot-holds or other means that could be used to climb the fence.



Gates for the fence are self-closing, self-latching, and open out or away from the pool.



The gate latch is at least 54 inches above the ground and is equipped with a key or combination lock.



The gate to the enclosure is locked, except when there is an adult within the enclosure to supervise the area.

Additionally, if the home or building used to provide care or supervision constitutes part of the enclosure:



The enclosure does not interfere with safe egress from the setting.



A door from the setting does not open within the pool enclosure.



A window from the setting and located in a room that is designated as a bedroom for an individual receiving care is not positioned within the pool

enclosure.



Other windows from the setting and within the pool enclosure are permanently secured to open no more than 4 inches.

Equal Opportunity Employer/Program  Under Titles VI and VII of the Civil Rights Act of 1964 (Title VI & VII), and the Americans with

Disabilities Act of 1990 (ADA), Section 504 of the Rehabilitation Act of 1973, and the Age Discrimination Act of 1975, the Department prohibits

discrimination in admissions, programs, services, activities, or employment based on race, color, religion, sex, national origin, age, and disability.

The Department must make a reasonable accommodation to allow a person with a disability to take part in a program, service or activity. For

example, this means if necessary, the Department must provide sign language interpreters for people who are deaf, a wheelchair accessible location,

or enlarged print materials. It also means that the Department will take any other reasonable action that allows you to take part in and understand a

program or activity, including making reasonable changes to an activity. If you believe that you will not be able to understand or take part in a

program or activity because of your disability, please let us know of your disability needs in advance if at all possible. To request this document in

alternative format or for further information about this policy, contact your local office manager; TTY/TDD Services: 7-1-1.