| 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) |
| K0521 | HVAC CFR(s): NFPA 101 HVAC Heating, ventilation, and air conditioning shall comply with 9.2 and shall be installed in accordance with the manufacturer's specifications. 20.5.2.1, 21.5.2.1, 9.2 This STANDARD is not met as evidenced by: . Based on review of documentation and interview, the facility failed to maintain the dampers (smoke/fire/ceiling) per the requirements of: 2012 NFPA 101, 21.5.2.1, and 9.2.1 2010 NFPA 80, 19.4, and 19.5 2012 NFPA 90A, 5.4.8.1 2010 NFPA 80, 19.4.1.1 Findings include: On 09/17/2019, during a tour of the facility from 10:30 am to 4:30 pm, the facility failed to provide documentation of testing the fire dampers within the past 6 years. A member of the maintenance staff was present when this deficiency was identified. . |