| 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) |
| K0056 | LIFE SAFETY CODE STANDARD CFR(s): NFPA 101 If there is an automatic sprinkler system, it is installed in accordance with NFPA 13, Standard for the Installation of Sprinkler Systems, to provide complete coverage for all portions of the building. The system is properly maintained in accordance with NFPA 25, Standard for the Inspection, Testing, and Maintenance of Water-Based Fire Protection Systems. It is fully supervised. There is a reliable, adequate water supply for the system. Required sprinkler systems are equipped with water flow and tamper switches, which are electrically connected to the building fire alarm system. 19.3.5 This STANDARD is not met as evidenced by: Based on observation and staff interview the facility failed to ensure all areas had complete sprinkler coverage and failed to ensure sprinkler heads were installed the minimum distance from walls on 2 of 2 floors. The findings were: 1. Observation of the sprinkler system on 11/7/11 between 12:30 PM and 1 PM showed a sprinkler head in chemotherapy room #2 and #3 were installed 2 inches from the wall, not the required 4 inches. 2. Observation of the second floor storeroom on 11/7/11 at 1:08 PM showed the exposed steel "I" beam along the east side of the room was 24 inches deep. Further review showed the space between the "I" beam and the wall measured 18 inches by 100 feet and did not have sprinkler heads installed in the space. At the time of observation, the facility supervisor reported the area was inspected annually by an outside contractor and the last annual inspection (4/11/11) did not indicate a lack of sprinkler coverage. Reference: NFPA 101, 2000 Edition, 19.3.5.1, 9.7.1.1; NFPA 13, 1999 Edition; 5-6.4.1.2 Under obstructed construction, the sprinkler deflector shall be located within the horizontal planes of 1 in. to 6 in. below the structural members and a maximum distance of 22 in. below the ceiling/roof deck. Exception No. 2: Where sprinklers are installed in each bay of obstructed construction, deflectors shall be permitted to be a minimum of 1 in and a maximum of 12 in. below the ceiling. |