| 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) |
| K0321 | Hazardous Areas - Enclosure CFR(s): NFPA 101 Hazardous Areas - Enclosure Hazardous areas are protected by a fire barrier having 1-hour fire resistance rating (with 3/4 hour fire rated doors) or an automatic fire extinguishing system in accordance with 8.7.1 or 19.3.5.9. When the approved automatic fire extinguishing system option is used, the areas shall be separated from other spaces by smoke resisting partitions and doors in accordance with 8.4. Doors shall be self-closing or automatic-closing and permitted to have nonrated or field-applied protective plates that do not exceed 48 inches from the bottom of the door. Describe the floor and zone locations of hazardous areas that are deficient in REMARKS. 19.3.2.1, 19.3.5.9 Area Automatic Sprinkler Separation N/A a. Boiler and Fuel-Fired Heater Rooms b. Laundries (larger than 100 square feet) c. Repair, Maintenance, and Paint Shops d. Soiled Linen Rooms (exceeding 64 gallons) e. Trash Collection Rooms (exceeding 64 gallons) f. Combustible Storage Rooms/Spaces (over 50 square feet) g. Laboratories (if classified as Severe Hazard - see K322) This STANDARD is not met as evidenced by: . Based on observation and interview, the building failed to maintain the hazardous areas per the requirements of: 2012 NFPA 101, 19.3.2.1.3 2012 NFPA 101, 19.3.2.1.2 Findings include: 1. On 10/04/2017, during a tour of the building from 8:00 am to 5:00 pm, the Employee Shop's (TOGA's) Storage Room was observed to be over 50 sq. ft. with combustibles with the following: a. Two unsealed penetrations in the wall between the Shop and the Storage Room b. No self-closing device on the door DEVIN 2. On 10/03/2017, during a tour of the building from 8:00 am to 4:15 pm, the following rooms located on the first floor were observed to be greater than 50 square feet with an assortment of stored combustibles and without having self-closing devices on their doors: 1. X-ray Room 1 2. X-ray Room 4 3. The room next to office 1128 in Physical Therapy A member of the maintenance staff was present when this deficiency was identified. . |