| Statement of Deficiencies | (X1) Provider/Supplier/CLIA Identification Number 01C0001009 | (X3) Date Survey Completed 07/30/2025 |
| 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 with remote manual stop station) 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 requirements of 42 CFR, Subpart 416.44(b) was not met as evidenced by the following deficiencies of the 2012 NFPA 101 Life Safety Code (LSC), the 2012 NFPA 99 Health Care Facilities Code and the standards referenced by these codes, as observed by the LS Surveyor while accompanied by the facility maintenance personnel. . |
| K0345 | Fire Alarm System - Testing and Maintenance CFR(s): NFPA 101 Fire Alarm Systems - Testing and Maintenance A fire alarm system is tested and maintained in accordance with an approved program complying with the requirements of NFPA 70, National Electric Code, and NFPA 72, National Fire Alarm and Signaling Code. Records of system acceptance, maintenance and testing are readily available. 9.6.1.3, 9.6.1.5, NFPA 70, NFPA 72 This STANDARD is not met as evidenced by: Based on observation and review of documentation, the facility failed to maintain the fire alarm system per the requirements of: 2012 NFPA 101, 19.3.4.1, and 9.6.1.3 2010 NFPA 72, 10.5.5.2.1, 10.5.5.2.4, 18.5.4.4.7, and 21.914.4.5.3.2 This deficiency affects fire alarm system. Findings include: During a tour of the facility, the surveyor observed the following: 1. The facility failed to provide a smoke detector sensitivity test report conducted within the past two years. The facility failed to provide documentation of the last sensitivity test. 2. The facility was unable to locate the dedicated branch circuit breaker for the fire alarm system. This shall be identified as "FIRE ALARM CIRCUIT" and have a red marking. 3. The fire alarm panel failed to permanently identify the location of the dedicated electrical branch circuit disconnecting means (what panel, where this panel is located, and what circuit breaker). A member of the maintenance staff was present when this deficiency was identified. . |
| K0351 | Sprinkler System - Installation CFR(s): NFPA 101 Sprinkler System - Installation Sprinkler systems (if installed) are installed per NFPA 13. Where more than two sprinklers are installed in a single area for protection, waterflow devices shall be provided to sound the building fire alarm system or to notify a constantly attended location such as a PBX, security office, or emergency room. 20.3.5.1, 20.3.5.2, 21.3.5.1, 21.3.5.2, 9.7.1.2, 9.7, NFPA 13 This STANDARD is not met as evidenced by: Based on observation, the facility failed to post a list of sprinklers installed in the property at the sprinkler cabinet per the requirements of: 2012 NFPA 101, 19.3.5.1, 9.7.1.1, and 9.7.7 2010 NFPA 13, 6.2.9.7, and 6.2.9.7.1 This deficiency affects the complete sprinkler system. Findings include: During a tour of the facility, the surveyor observed the facility failed to post a list of sprinklers installed in the property at the sprinkler cabinet. The list shall include the following: (1) Sprinkler identification number; or the manufacturer, model, orifice, deflector type, thermal sensitivity, and pressure rating (2) General description (3) Quantity of each type to be contained in the cabinet (4) Issue or revision date of the list A member of the maintenance staff was present when this deficiency was identified. . |