K0000
Bldg. 05
INITIAL COMMENTS
K0000
05/06/2026
An unannounced Fire & Life Safety revisit survey
was conducted on 04/29/2026 at Arabella Health
and Wellness of Carabelle, a nursing home in
Carabelle, Florida. This was a follow-up to the
Annual Fire & Life Safety survey completed on
03/09/2026.
Although some Fire & Life Safety deficiencies were
corrected, uncorrected deficiencies were found at
the time of the visit.
K0300
Bldg. 05
Protection - Other
K0300
CFR(s): NFPA 101
Protection - Other
List in the REMARKS section any LSC Section 18.3
and 19.3 Protection requirements that are not
addressed by the provided K-tags, but are deficient.
This information, along with the applicable Life
Safety Code or NFPA standard citation, should be
included.
This LICENSURE REQUIREMENT is NOT MET as
evidenced by:
Based on observation and interview, it was found
that the generator for the building placed between
the building and the parking lot had no protective
barrier from vehicle traffic.
The findings include:
During observations made during the revisit review
on 04/29/2026, it was found that the generator for
the building placed between the building and the
parking lot had no protective barrier from vehicle
traffic.
This was acknowledged by the Maintenance
personnel at the time of observation.
Per NFPA 1 (2021 edition) sections 60.5.1.9 and
60.5.1.10
"Guard posts or other approved means shall be
provided to protect the following where subject to
vehicular damage:
Office of Primary Care and Health Systems Management
LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE
TITLE
(X6) DATE
STATE FORM
Event ID: 1E4043-L2
Facility ID: 35961023
If continuation sheet Page 1 of 2
Agency for Health Care Administration
PRINTED: 05/06/2026
FORM APPROVED
STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTIONS
(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: 130471042
(X2) MULTIPLE CONSTRUCTION
A. BUILDING 05 - MAIN LIC
B. WING
(X3) DATE SURVEY COMPLETED 04/29/2026
NAME OF PROVIDER OR SUPPLIER
ARABELLA HEALTH & WELLNESS OF CARRABELLE
STREET ADDRESS, CITY, STATE, ZIP CODE
239 CROOKED RIVER ROAD, CARRABELLE, Florida, 32322
(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) ID PREFIX TAG PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) (X5) COMPLETION DATE
K0300 Bldg. 05 Continued from page 1
(1) Storage tanks and connected piping, valves, and fittings.
(2) Storage areas containing tanks or portable containers except where the exposing vehicles are powered industrial trucks used for transporting the hazardous materials
(3) Use areas
Where Guard posts are installed, the posts shall meet the following criteria:
1. They shall be constructed of steel not less than 4in. (102mm) in diameter and concrete filled.
2. They shall be spaced no more than 4ft (1.2m) between posts on center.
3. They shall be set not less than 3ft (0.9m) deep in a concrete footing of not less than a 15in. (381mm) diameter.
4. They shall be set with the top of the posts not less than 3ft (0.9m) above ground.
5. They shall be located not less than 3ft (0.9m) from the tank.*
Class III K0300 STATE FORM Event ID: 1E4043-L2 Facility ID: 35961023 If continuation sheet Page 2 of 2
