| Statement of Deficiencies | (X1) Provider/Supplier/CLIA Identification Number 01G011 | (X3) Date Survey Completed 03/25/2021 |
| Name of Provider or Supplier Rainbow Omega, Inc, | Street Address, City, State 202 Hope Drive, Eastaboga, AL | |
| 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) |
| E0000 | K3 Building: 0101 K6 Plan Approval: 2006 K7 Survey Under: 2012 Existing K8 ICF/IID Small Generator: One Diesel, Katolight 125 kW (installed 2007) FACP: Simplex 4010 (installed 2007) Locking Devices: None Smoke Detection: Corridor Beds: 16 Census:16 Type of Structure: 2006 one story unprotected wood frame, Type V(000). The facility has a complete automatic sprinkler system with a sprinkler pit. The facility is surveyed under impractical to evacuate. During a routine recertification survey conducted on this date, the facility was found to be in compliance with 42 CFR 483.475 - Emergency Preparedness for ICF/IID facilities, as observed by the LSC Surveyor while accompanied by facility personnel. |
| K0000 | K3 Building: 0101 K6 Plan Approval: 2006 K7 Survey Under: 2012 Existing K8 ICF/IID Small Generator: One Diesel, Katolight 125 kW (installed 2007) FACP: Simplex 4010 (installed 2007) Locking Devices: None Smoke Detection: Corridor Beds: 16 Census:16 Type of Structure: 2006 one story unprotected wood frame, Type V(000). The facility has a complete automatic sprinkler system with a sprinkler pit. The facility is surveyed under impractical to evacuate. During a routine recertification survey conducted on this date, the facility was found to be not in compliance with 42 CFR 483.470 - ICF/IID as evidenced by the the following deficiencies of the 2012 NFPA 101 Life Safety Code (LSC), the 2012 NFPA 99 Health Care Facilities Code and the standards referenced by these codes, as observed by the LSC Surveyor while accompanied by facility personnel. |
| KS364 | Corridor - Openings CFR(s): NFPA 101 Corridor - Openings 2012 EXISTING (Prompt) No louvers or operable transoms or other air passages shall penetrate the wall, except properly installed heating and utility installations other than transfer grilles. Transfer grilles shall be prohibited. 33.2.3.6.3 This STANDARD is not met as evidenced by: Based on observation, the facility failed to maintain a corridor wall to limit the transfer of smoke per the requirements of: 2012 NFPA 101, 33.2.3.6.3 This deficiency could affect approximately 15 occupants. Findings include: On 03/24/2021, during a tour of the facility from 10:30 am to 3:30 pm, the surveyor observed an approximately 24 inch x 18 inch return air grille penetrating the corridor wall next to the Program Director's Office. A member of the maintenance staff was present when this deficiency was identified. |