| 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) |
| K0076 | LIFE SAFETY CODE STANDARD CFR(s): NFPA 101 Medical gas storage and administration areas are protected in accordance with NFPA 99, Standards for Health Care Facilities. (a) Oxygen storage locations of greater than 3,000 cu.ft. are enclosed by a one-hour separation. (b) Locations for supply systems of greater than 3,000 cu.ft. are vented to the outside. NFPA 99 4.3.1.1.2, 19.3.2.4 This STANDARD is not met as evidenced by: Based on observation and staff interview, the facility failed to ensure medical gas cylinders were securely fastened in 1 of 6 smoke compartments. The findings were: Observation on 5/1/12 at 1:23 PM showed two unsecured "E" sized oxygen tanks lying horizontally on the floor in the medical/surgical Pixus room. Interview with maintenance staff at the time of the observation confirmed the tanks needed to be secured. Reference: NFPA 101, Life Safety Code, 2000 edition. Section 19.3.2.4 Medical gas storage and administration areas shall be protected in accordance with NFPA 99, Standard for Health Care Facilities. NFPA 99 Standard for Health Care Facilities, Chapters 4 and 8. Stand Alone Cylinders and Containers Storage areas: General Considerations. Cylinders must be secured from falling or mechanical shock. |