| Statement of Deficiencies | (X1) Provider/Supplier/CLIA Identification Number 531311 | (X3) Date Survey Completed 04/26/2022 |
| 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) |
| K0000 | This STANDARD is not met as evidenced by: A Life Safety Code Survey was conducted by Healthcare Licensing and Surveys on 04/25/2022 and 04/26/2022. Requirements for Critical Access Hospitals Section 42 CFR 482.41(b) except as otherwise provided in the section, the facility must meet the applicable provisions of the 2012 Edition of the Life Safety Code, Existing Health Care, of the National Fire Protection Association. The facility was a fully sprinklered, one story building of Type II (111) construction built in 1960. The building was equipped with a supervised automatic wet sprinkler system, a dry sprinkler system, and an addressable fire alarm system. The facility had a capacity of 16 certified Medicare and Medicaid beds with a census of 5. . |