| Statement of Deficiencies | (X1) Provider/Supplier/CLIA Identification Number 01C0001010 | (X3) Date Survey Completed 09/18/2019 |
| Name of Provider or Supplier The Southern Alabama Surgery Center, Llc | Street Address, City, State 2800 Ross Clark Circle, Suite 3, Dothan, 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: 1984, 2009, 04/14/2016 K7 Survey Under: 2012 Existing K8 ASC Generator #1: Diesel, Taylor 75 kW (installed 2007) Generator #2: Diesel, Generac 80 kW (installed 2015) FACP: GE EST Quickstart (installed 08/2009) Locking Devices: None Smoke Detection: Complete Case Load: 2000 a Month Type of Structure: 1984 two story unprotected noncombustible, Type II(000), renovated in 2009. 2009 two story unprotected noncombustible, Type II(000) space converted from business occupancy. 04/14/2016 two story unprotected noncombustible, Type II(000) space converted from business occupancy. 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 as evidenced by the following deficiencies of NFPA 101 Life Safety Code (LSC) and codes referenced by the LSC, as observed by the LS Surveyors while accompanied by the facility maintenance personnel. . |