| Statement of Deficiencies | (X1) Provider/Supplier/CLIA Identification Number 65C0001001 | (X3) Date Survey Completed 02/08/2019 |
| Name of Provider or Supplier Hafa Adai Specialist Group, Llp | Street Address, City, State Sunflower Villa, 280 Pale San Vitores, Tamuning, GU | |
| 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) |
| K0929 | Gas Equipment – Precautions for Handling Oxygen CFR(s): NFPA 101 Gas Equipment - Precautions for Handling Oxygen Cylinders and Manifolds Handling of oxygen cylinders and manifolds is based on CGA G-4, Oxygen. Oxygen cylinders, containers, and associated equipment are protected from contact with oil and grease, from contamination, protected from damage, and handled with care in accordance with precautions provided under 11.6.2.1 through 11.6.2.4 (NFPA 99). 11.6.2 (NFPA 99) This STANDARD is not met as evidenced by: Based on observation and interview the facility has failed to store oxygen cylinders, as required. Failure to oxygen cylinders as required could increase the risk of injury or death. Findings: On February 1, 2019, during a walk-through of the facility with the CMS Health Surveyor and the Operating Room Technician two H oxygen cylinders (249 ft3) and one E oxygen cylinder (24.9ft3) were observed in a room with a sign on the door labeled "Guam Radiology Consultants". The cylinders were observed to be freestanding. At the time of the observation the Operating Room Technician was present to confirm the observation. |