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 04/11/2019
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)
K0351 Sprinkler System - Installation
CFR(s): NFPA 101

Spinkler System - Installation 2012 NEW Buildings are to be protected throughout by an approved automatic sprinkler system in accordance with NFPA 13, Standard for the Installation of Sprinkler Systems. In Type I and II construction, alternative protection measures are permitted to be substituted for sprinkler protection in specific areas where state and local regulations prohibit sprinklers. Listed quick-response or listed residential sprinklers are used throughout smoke compartments with patient sleeping rooms. In hospitals, sprinklers are not required in clothes closets of patient sleeping rooms where the area of the closet does not exceed six square feet and sprinkler coverage covers the closet footprint as required by NFPA 13, Standard for Installation of Sprinkler Systems. 18.3.5.1, 18.3.5.4, 18.3.5.5, 18.3.5.6, 9.7, 9.7.1.1(1), 18.3.5.10


This STANDARD is not met as evidenced by:
. Based on observation and interview, the facility failed to ensure the automatic sprinkler system was per the requirements of: 2012 NFPA 101, 18.3.5.1, 18.3.5.4, and 9.7.1.1 (1) 2010 NFPA 13, 8.5.6.1 Findings include: On 04/09/2019, during a tour of the facility from 1:00 pm to 4:15 pm, the surveyor observed boxes of kitchen food and supplies were stored within 18 inches of the automatic sprinkler heads in the following locations: 1. The kitchen walk in cooler 2. The kitchen walk in freezer 3. The Dry Storage Room A member of the maintenance staff was present when this deficiency was identified. .