| Statement of Deficiencies | (X1) Provider/Supplier/CLIA Identification Number 01C0001009 | (X3) Date Survey Completed 06/05/2019 |
| Name of Provider or Supplier Surgicare Of Mobile, Ltd | Street Address, City, State 2890 Dauphin St, Mobile, AL | |
| For information on the provider's plan to correct this deficiency, please contact the provider or the state survey agency. | ||
| (X4) ID Prefix Tag | Summary Statement of Deficiencies
(Each deficiency should be preceded by full regulatory or LSC identifying information) |
| K0000 | . K3 Building: 0101 K6 Plan Approval: 1993, 08/24/2016 K7 Survey Under: 2012 Existing K8 ASC Generator: One Diesel, Kohler 180 kW (installed 2009) FACP: Simplex (installed 2016) Smoke Detection: Partial Locking Devices: None Number of cases a month: 1500 Type of Structure: 1993 one story protected noncombustible, Type II(111). 2016 unprotected ordinary, Type III(200). The facility has a complete automatic sprinkler system. During a routine recertification survey conducted on this date, the facility was found to be in substantial compliance with 42 CFR 416.44 (b) as evidenced by the following deficiencies of NFPA 101 Life Safety Code (LSC) and codes referenced by the LSC, as observed by the LSC Surveyors while accompanied by the facility maintenance personnel. . |
| K0353 | Sprinkler System - Maintenance and Testing CFR(s): NFPA 101 Sprinkler System - Maintenance and Testing Automatic sprinkler and standpipe systems are inspected, tested, and maintained in accordance with NFPA 25, Standard for the Inspection, Testing, and Maintaining of Water-based Fire Protection Systems. Records of system design, maintenance, inspection and testing are maintained in a secure location and readily available. a) Date sprinkler system last checked _____________________ b) Who provided system test ____________________________ c) Water system supply source __________________________ Provide in REMARKS information on coverage for any non-required or partial automatic sprinkler system. 9.7.5, 9.7.7, 9.7.8, and NFPA 25 This STANDARD is not met as evidenced by: . Based on observation, review of documentation and interview, the facility failed to maintain the automatic sprinklers per requirements of: 2012 NFPA 101, 9.7.5 2011 NFPA 25, 5.3.1.1.1.6, and 5.3.1.1.1.3 Findings include: On 06/06/2019, during a tour of the facility from 1:45 pm to 4:30 pm, the facility failed to provide the following documentation: 1. The dry sprinklers installed in 1993, located on front porch had been replaced or a representative sample tested within 10 years of installation 2. The 1993 fast-response sprinkler heads found in the original facility had been replaced or a representative sample tested within 20 years of installation. A member of the maintenance staff and administrator was present, when this deficiency was identified. . |
| K0511 | Utilities - Gas and Electric CFR(s): NFPA 101 Utilities - Gas and Electric Equipment using gas or related gas piping complies with NFPA 54, National Fuel Gas Code, electrical wiring and equipment complies with NFPA 70, National Electric Code. Existing installations can continue in service provided no hazard to life. 20.5.1, 21.5.1, 21.5.1.2, 9.1.1, 9.1.2 This STANDARD is not met as evidenced by: . Based on observation and interview, the facility failed to maintain the electrical wiring and equipment per the requirements of: 2012 NFPA 101, 19.5.1.1, and 9.1.2 2011 NFPA 70, 314.28(3)(C) Findings include: On 06/06/2019, during a tour of the facility from 1:45 pm to 4:45 pm, the surveyor observed a 4"x4" electrical junction box was missing its cover above ceiling by the smoke barrier at Recovery. A member of the maintenance staff was present when this deficiency was identified. |