Department of Health & Human Services

Centers for Medicare & Medicaid Services
Form Approved

OMB No. 0938-0391

Statement of Deficiencies (X1) Provider/Supplier/CLIA Identification Number 670067 (X3) Date Survey Completed 04/24/2013
Name of Provider or Supplier Baylor Scott And White Orthopedic And Spine Hospi Street Address, City, State 707 Highlander Blvd, Arlington, TX
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)
K0106 LIFE SAFETY CODE STANDARD
CFR(s): NFPA 101

Hospitals, and nursing homes and hospices with life support equipment, have a Type I Essential Electrical System powered by a generator with a transfer switch and separate power supply. The EES is in accordance with NFPA 99, 3.4.2.2, 3.4.2.1.4.


This STANDARD is not met as evidenced by:
Facility failed to maintain essential electrical system in accordance with the Standard for Health Care, NFPA (National Fire Protection Association) 99. Findings included the following: Surveyor observed between 11 and 11:30 am on 4/24/13 that electrical room containing switch gear did not have task battery lighting in accordance with NFPA 99: 3-4.2.2.2.