| 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) |
| K0029 | LIFE SAFETY CODE STANDARD CFR(s): NFPA 101 One hour fire rated construction (with ¾ hour fire-rated doors) or an approved automatic fire extinguishing system in accordance with 8.4.1 and/or 19.3.5.4 protects hazardous areas. When the approved automatic fire extinguishing system option is used, the areas are separated from other spaces by smoke resisting partitions and doors. Doors are self-closing and non-rated or field-applied protective plates that do not exceed 48 inches from the bottom of the door are permitted. 19.3.2.1 This STANDARD is not met as evidenced by: Based on observation and staff interview, the facility failed to protect hazardous areas in 1 of 6 smoke compartments. The findings were: Observation on 5/1/12 at 12:30 PM revealed the door to the human resources storage room did not have a self closure device attached. The storage area contained over 20 boxes of paper and was greater than 50 square feet measuring 7ft x 8ft. In addition, observation on 5/1/12 at 12:48 pm revealed the door to the janitor's closet (room 128) and the door to the janitor's closet opposite the human resources office did not have a self closure devices attached. Maintenance staff acknowledged the finding at the time of the observations. Ref: 2000 NFPA 101 Section 18.3.2.1, 8.4.1.2, 8.2.4.3.5 |