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 010006 (X3) Date Survey Completed 07/15/2010
Name of Provider or Supplier North Alabama Medical Center Street Address, City, State 1701 Veterans Drive, Florence, 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)
K0077 LIFE SAFETY CODE STANDARD
CFR(s): NFPA 101

Piped in medical gas systems comply with NFPA 99, Chapter 4.


This STANDARD is not met as evidenced by:
The facility failed to maintain the medical gas systems per code. Findings include: During the survey, the following was observed: 1. Fourth Floor - the medical gas alarm panel at the Nurses' Station (MGA 4-01), the oxygen did not give an audible alarm when tested. 2. According to the documentation provided by the facility from the 02/22/2010 medical gas system inspection report, the medical gas system did not comply with NFPA 99. 1999 NFPA 99, 4-3.1.2.2 Gas Warning Systems. (a) * General. 1. All local, master, and area alarm panels used for medical gas systems shall provide the following: a. Separate visual indicators for each condition monitored, b. Cancelable audible indication of an alarm condition. The audible indicator shall produce a minimum of 80 dBA measured at 3 ft (1 m). A second indicated condition occurring while the alarm is silenced shall reinitiate the audible signal, c. A means to visually indicate a lamp or LED failure 2. Local, master, and area alarms shall indicate visually and audibly if, a. The monitored condition occurs b The wiring to the sensor or switch is disconnected. 1999 NFPA 99 Piped medical gas systems shall meet all requirements of NFPA 99.