| 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) |
| K0521 | HVAC CFR(s): NFPA 101 HVAC Heating, ventilation, and air conditioning shall comply with 9.2 and shall be installed in accordance with the manufacturer's specifications. 18.5.2.1, 19.5.2.1, 9.2 This STANDARD is not met as evidenced by: . Based on observation and interview, the building failed to maintain the smoke dampers per the requirements of: 2012 NFPA 101, 19.5.2.1 2012 NFPA 101, 9.2.1 2012 NFPA 90A, 5.4.5.4 and 5.4.5.4.2 Findings include: On 10/05/2017, during a tour of the building from 8:00 am to 12:15 pm, the following smoke dampers failed to close upon activation of the fire alarm system's general alarm: 1. On the 6th Floor at room 685 2. On the 4th Floor at room 485 A member of the maintenance staff was present when this deficiency was identified. . |