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 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)
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.

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