| Statement of Deficiencies | (X1) Provider/Supplier/CLIA Identification Number 530025 | (X3) Date Survey Completed 11/07/2011 |
| Name of Provider or Supplier Ivinson Memorial Hospital | Street Address, City, State 255 N 30th, Laramie, WY | |
| 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) |
| K0011 | LIFE SAFETY CODE STANDARD CFR(s): NFPA 101 If the building has a common wall with a nonconforming building, the common wall is a fire barrier having at least a two-hour fire resistance rating constructed of materials as required for the addition. Communicating openings occur only in corridors and are protected by approved self-closing fire doors. 19.1.1.4.1, 19.1.1.4.2 This STANDARD is not met as evidenced by: Based on observation, and staff interview, the facility failed to ensure complete 2-hour fire separation between 3 of 3 nonconforming buildings. The findings were: Observation on 11/3/11 at 10:37 AM showed the cancer center south exit lead into a glass wall an ceiling walk-way that connected the hospital and the intermountain internal medicine (IIM) physicians' building. Further observation showed none of the three exit doors were fire rated neither were their frames, barrier walls or hardware. At the time of observation the facility supervisor confirmed the findings and reported the glass walk-way was added several years ago for convenience during severe winter weather. He was not aware the walk-way connected the buildings and thus required 2-hour separation. |