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 01C0001008 (X3) Date Survey Completed 10/11/2023
Name of Provider or Supplier Birmingham Outpatient Surgery Center, Ltd Street Address, City, State 2720 University Boulevard, Birmingham, 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: 07/05/1984
K7 Survey Under: 2012 Existing
K8 ASC
Generator: Diesel, Caterpillar 150 kW (installed 2021)
Locking Devices: N/A
FACP: Siemens, Firefinder XLS (installed 2010)
Smoke Detection: Complete
Surgeries per day: 40








Type of Structure: 1984 Two story with 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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