| Statement of Deficiencies | (X1) Provider/Supplier/CLIA Identification Number 531311 | (X3) Date Survey Completed 11/15/2011 |
| Name of Provider or Supplier Crook County Hospital | Street Address, City, State 713 Oak Street, Sundance, 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 record review and staff interview the facility failed to ensure the fire suppression (sprinkler) system was properly maintained in 1 of 4 smoke compartments. The findings were: Observations on 11/15/11 at 1:48 PM revealed a ceiling mounted sprinkler head was blocked by moping materials in the janitor's store room (mop/washer room). Interview with the maintenance manager at the above time confirmed the observation. Ref: 2000 NFPA 101 Section 18.3.5.1; 9.7.1.1; NFPA 13, 1999 edition 5-5.6 Clearance to Storage. The clearance between the deflector and the top of storage shall be 18 in or greater. |