| 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) |
| K0062 | LIFE SAFETY CODE STANDARD CFR(s): NFPA 101 Required automatic sprinkler systems are continuously maintained in reliable operating condition and are inspected and tested periodically. 19.7.6, 4.6.12, NFPA 13, NFPA 25, 9.7.5 This STANDARD is not met as evidenced by: Based on observation and staff interview, the facility failed to ensure sprinklers were unobstructed on 3 of 3 floors. The findings were: Periodic observation of the sprinkler system on 11/3-7/11 showed the sprinklers in the corridor near the morgue, the dialysis chemical storeroom, the admitting foyer, the corridor near patient room #2212, patient room #3320-3321, and room #3100 were obstructed by ceiling mounted lights or exit signs. On 11/3/11 at 10:07 AM the facility supervisor reported he was aware of the spacing requirement. He further reported that the system was inspected annually by an outside contractor and they had not noted any obstructed sprinklers on their last report, 4/11/11. Reference: NFPA 101, 2000 Edition, 19.3.5.1, 9.7.1.1; NFPA 13, 1999 Edition; Table 5-6.5.1.2 Positioning of Sprinklers to Avoid Obstructions to Discharge (Standard Spray Upright/Standard Spray Pendent) Maximum allowable Distance from distance from sprinkler to side deflector above of obstruction bottom of obstruction ------------------------------------------------------- Less than 1 ft ... ... ... ... ... ... ............. ....0 1 ft to less than 1 ft 6 in. ... ... ... ... ... ...2 ½ 1 ft 6 in. to less than 2 ft .... ... ... ... ......3 ½ 2 ft to less than 2 ft 6 in. ...... ... ... ... ...5 ½ 2 ft 6 in. to less than 3 ft ... ... ... ...........7 ½ 3 ft to less than 3 ft 6 in ... ... .... ... ... ...9 ½ 3 ft 6 in. to less than 4 ft ... ... ... ... ... ...12 4 ft to less than 4 ft 6 in. ......................14 |