| 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) |
| 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 sprinkler heads in 2 of 6 smoke compartments were installed as required. The findings were: Observation on 5/1/12 between 11 AM and 3:30 PM revealed the following concerns: a. The laboratory electric room #120 did not have sprinkler coverage. The room was greater than 50 square feet and had a heat detector installed in the ceiling. b. The telephone equipment room in the basement did not have sprinkler coverage. The room was greater than 50 square feet and had a smoke detector installed in the ceiling. Interview with the maintenance staff at the time of the observations confirmed the findings. Reference: NFPA 101, Life Safety Code, 2000 edition. Sections 9.7.1.1; 19.3.5.1; 1999 NFPA 5-6.5.3. |