| Statement of Deficiencies | (X1) Provider/Supplier/CLIA Identification Number 531311 | (X3) Date Survey Completed 10/05/2016 |
| 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) |
| K0076 | LIFE SAFETY CODE STANDARD CFR(s): NFPA 101 Medical gas storage and administration areas shall be protected in accordance with NFPA 99, Standard 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. 4-3.1.1.2 (NFPA 99), 8-3.1.11.1 (NFPA 99), 18.3.2.4, 19.3.2.4 This STANDARD is not met as evidenced by: . Based on observation and staff interview, the facility failed to store oxygen in accordance with NFPA 99. The findings were: Observation on 10/05/2016 at 9:56 AM located in the Oxygen storage room revealed that there was more than 3,000 cubic feet of O2 storage. Further observation revealed a natural ventilation system, but the vent minimum opening was not 72 square inches. Interview with the Facility Maintenance Manager at the time of observation was not aware of the requirement. Ref: 1999 NFPA 99, Section 4-3.1.1.2 (b) 4 |