| Statement of Deficiencies | (X1) Provider/Supplier/CLIA Identification Number 531310 | (X3) Date Survey Completed 05/03/2012 |
| Name of Provider or Supplier Powell Valley Hospital | Street Address, City, State 777 Avenue H, Powell, 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) |
| K0000 | This STANDARD is not met as evidenced by: The regulatory reference is 42CFR 485.623(b) except where a different regulation may be specifically referenced. K3: Building Type II (111) partially sprinkled single story Critical Access Hospital built in 1985. The facility is protected by a supervised automatic wet sprinkler system and an addressable fire alarm system. The facility is adjacent to the Powell Valley Care Center Nursing Home. K7: The facility must meet the applicable provisions of the 2000 edition of the Life Safety Code, New and Existing Health Care, of the National Fire Protection Association (NFPA). K8: Total beds=25. K9: The facility meets the Life Safety Code standard based on acceptance of a plan of correction. "NFPA" National Fire Protection Association |