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 012509 (X3) Date Survey Completed 04/05/2023
Name of Provider or Supplier North Alabama Nephrology Center Street Address, City, State 1311 North Memorial Parkway #200, 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)
K0353 Sprinkler System - Maintenance and Testing
CFR(s): NFPA 101

Sprinkler System - Maintenance and Testing Automatic sprinkler and standpipe systems are inspected, tested, and maintained in accordance with NFPA 25, Standard for the Inspection, Testing, and Maintaining of Water-based Fire Protection Systems. Records of system design, maintenance, inspection and testing are maintained in a secure location and readily available. a) Date sprinkler system last checked _____________________ b) Who provided system test ____________________________ c) Water system supply source __________________________ Provide in REMARKS information on coverage for any non-required or partial automatic sprinkler system. 9.7.5, 9.7.7, 9.7.8, and NFPA 25


This STANDARD is not met as evidenced by:
. Based on review of documentation and observation, the facility failed to maintain the automatic sprinkler system per the requirements of: 2012 NFPA 101, 21.1.6.1, Table 21.1.6.1, and 9.7.5 2011 NFPA 25, 5.3.4, and 5.3.1.1.1.3 This deficiency affects all sprinklers throughout the facility. Findings include: On 04/05/2023, during a tour of the facility from 8:30 am to 10:30 am, the facility failed to provide documentation on the following: 1. The annual inspection for the anti-freeze sprinkler system. The last inspection was done in 2021 per documentation from the facility 2. The 1999 fast-response sprinkler heads found throughout the facility had been replaced or a representative sample tested within 20 years of installation A member of the maintenance staff was present when this deficiency was identified. .