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 01C0001013 (X3) Date Survey Completed 07/25/2018
Name of Provider or Supplier Op Surg Ctr, Inc And Surgicare Of Huntsville, Inc Street Address, City, State 721 Madison Street, Huntsville, 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)
K0511 Utilities - Gas and Electric
CFR(s): NFPA 101

Utilities - Gas and Electric Equipment using gas or related gas piping complies with NFPA 54, National Fuel Gas Code, electrical wiring and equipment complies with NFPA 70, National Electric Code. Existing installations can continue in service provided no hazard to life. 20.5.1, 21.5.1, 21.5.1.2, 9.1.1, 9.1.2


This STANDARD is not met as evidenced by:
.



Based on observation and interview, this building failed to maintain the electrical wiring and equipment per the requirements of:



2012 NFPA 101, 21.5.1.1, and 9.1.2

2011 NFPA 70, 406.6



Findings include:



On 7/24/2018, during a tour of the facility from 11:45 am to 3:45 pm, the surveyor observed a cover plate not properly installed onto a receptacle. The in use receptacle was located in the 3rd floor Kitchen between the fryer and the stove. A member of the maintenance staff corrected the deficiency, once it was pointed out.



A member of the maintenance staff was present when this deficiency was identified.