Department of Health & Human Services

Centers for Medicare & Medicaid Services
Form Approved

OMB No. 0938-0391

Statement of Deficiencies (X1) Provider/Supplier/CLIA Identification Number 01C0001002 (X3) Date Survey Completed 04/09/2025
Name of Provider or Supplier Mobile-Sc, Ltd Street Address, City, State 6144 A Airport Boulevard, 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: 2004

K7 Survey Under: 2012 Existing AHCO

Generator: Diesel, Caterpillar, 250 kW with remote stop station (installed 2011)

FACP: Edwards: EST2 (installed 2004)

Locking Devices: None 

Smoke Detection: Corridor

Case per day: 50, ortho, eye surgery, and pain management

 

 

Type of  Structure: one story with a partial basement unprotected noncombustible, Type II (000). 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) were 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.

 

 

 

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