| Statement of Deficiencies | (X1) Provider/Supplier/CLIA Identification Number 010001 | (X3) Date Survey Completed 10/05/2017 |
| Name of Provider or Supplier Southeast Health Medical Center | Street Address, City, State 1108 Ross Clark Circle, 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) |
| K0311 | Vertical Openings - Enclosure CFR(s): NFPA 101 Vertical Openings - Enclosure 2012 EXISTING Stairways, elevator shafts, light and ventilation shafts, chutes, and other vertical openings between floors are enclosed with construction having a fire resistance rating of at least 1 hour. An atrium may be used in accordance with 8.6. 19.3.1.1 through 19.3.1.6 If all vertical openings are properly enclosed with construction providing at least a 2-hour fire resistance rating, also check this box. This STANDARD is not met as evidenced by: . DEVIN Based on observation and interview, the building failed to maintain the fire resistive rating of a stairwell per the requirements of: 2012 NFPA 101, 19.3.1.1 Findings include: On 10/02/2017, during a tour of the building from 10:30 am to 5:45 pm, SP/Stairwell #3 on the 6th Floor was observed with an unsealed penetration of a 4.5 inch sprinkler pipe into room 669. A member of the maintenance staff was present when this deficiency was identified. . |