| 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) |
| K0929 | Gas Equipment – Precautions for Handling Oxygen CFR(s): NFPA 101 Gas Equipment - Precautions for Handling Oxygen Cylinders and Manifolds Handling of oxygen cylinders and manifolds is based on CGA G-4, Oxygen. Oxygen cylinders, containers, and associated equipment are protected from contact with oil and grease, from contamination, protected from damage, and handled with care in accordance with precautions provided under 11.6.2.1 through 11.6.2.4 (NFPA 99). 11.6.2 (NFPA 99) This STANDARD is not met as evidenced by: . Based on review of documentation and interview, the facility failed to maintain the oxygen cylinders and manifolds per the requirements of: 2012 NFPA 99, 11.6.2, and CGA G-4, Oxygen This deficiency could affect approximately 50 occupants. Findings include: On 11/14/2019, during the review of documentation from 8:00 am to 4:45 pm, the facility failed to provide documentation on handling and the protection of oxygen cylinders and manifolds. A member of the maintenance staff was present when this deficiency was identified. |