| Statement of Deficiencies | (X1) Provider/Supplier/CLIA Identification Number 01C0001000 | (X3) Date Survey Completed 11/14/2019 |
| Name of Provider or Supplier Montgomery Surgical Center Llc | Street Address, City, State 470 Taylor Road, Montgomery, 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: 01/16/2007 K7 Survey Under: 2012 Existing K8 ASC Generator: One Diesel, Baldor 750 kW (installed 2008) FACP: Simplex - 4100U (installed 2008) Locking Devices: Magnetic full time Smoke Detection: Complete Cases per week: 270 Type of Structure: This 2007 facility is located on the first floor of a protected noncombustible, Type II(111) three story building. The facility has a complete automatic sprinkler system. During a routine recertification survey conducted on this date, the facility was found not in compliance with 42 CFR 416.44 (b) - ASC evidenced by the following deficiencies of NFPA 101 Life Safety Code (LSC) and codes referenced by the LSC, as observed by the LS Surveyor while accompanied by the facility maintenance personnel. . |