NCHAHealthcare Construction

ConferenceAugust 2006

DFS Update

PRESENTER

William L. “Bill” Warren, ChiefConstruction Section

North Carolina Department of Health and Human ServicesDivision of Facility Services

SESSION FORMAT

Bill’s Special “Hot Topics” Submitted Questions DFS Overview Miscellaneous Topics NCHEA web site information

SESSION GOALS AND OBJECTIVES

To explain the DFS role in the process of designing, building and licensing medical facilities in the state of North Carolina

To provide each of you the information you need to manage your projects from concept through design and construction to completion and licensure

DFS MISSION STATEMENTThe mission of the Division of Facility Services is to provide for the enhanced health, safety and well-being of the citizens of the state through regulation of medical, domiciliary care and mental health facilities, emergency medical services, jails and other programs and create a climate to promote continuous overall improvement by providers through consultation and education; to finance and to plan for the development of cost-effective health care facilities and services to assure geographical and economical access to those services by residents of the state.

DFS MISSION STATEMENT (CONT.)

Activities and services provided by the Division will be done responsively, responsibly, reasonably, and respectfully with emphasis on leadership, commitment, collaboration and communication among organizational units throughout the Division and Department and with other public or private state, regional or local entities or members of the general public toward the end of achieving total quality objectives.

CONSTRUCTION SECTION GOALS

Reduce the Review Turnaround Time

Combine Architectural & Engineering Reviews

Complete Reviews within Acknowledged

Timeframe

Provide consultation when appropriate

CONSTRUCTION SECTION OVERVIEW

Division Programs State Licensure Title 18/19 Reimbursement

(Medicare/Medicaid) Health Care Facilities Finance

Act

CONSTRUCTION SECTION OVERVIEW

Construction Section Staff and Contact InformationTelephone NumbersE-mail AddressesOrganizationDFS Web Site

Construction Section O-Chart

04/12/2006

Bill WarrenChief801

Bill WarrenChief801

Cindy PearceProgram Assistant V

810

Cindy PearceProgram Assistant V

810

Steven C. LewisBuilding Systems Engineer III

813

Steven C. LewisBuilding Systems Engineer III

813

Charles Cocks Building Systems Engineer III

893

Charles Cocks Building Systems Engineer III

893

Marjorie L. AckerFacility Architectural Supervisor II

802

Marjorie L. AckerFacility Architectural Supervisor II

802

Fran PedrigiFacility Architectural Supervisor II

835

Fran PedrigiFacility Architectural Supervisor II

835

Angela LangstonProcessing Assistant IV

805

Angela LangstonProcessing Assistant IV

805

Celia R. KeatorProcessing Assistant IV

811

Celia R. KeatorProcessing Assistant IV

811

Lorraine SpekczynskiProcessing Assistant IV

816

Lorraine SpekczynskiProcessing Assistant IV

816

Robert E. DewLife Safety Surveyor

812

Robert E. DewLife Safety Surveyor

812

Jim L. TurnerLife Safety Surveyor

814

Jim L. TurnerLife Safety Surveyor

814

Jeff L. WaddellLife Safety Surveyor

819

Jeff L. WaddellLife Safety Surveyor

819

Curtis W. Daniel, Sr.Life Safety Surveyor

822

Curtis W. Daniel, Sr.Life Safety Surveyor

822

Robert StrotherLife Safety Surveyor

823

Robert StrotherLife Safety Surveyor

823

Chris SluderLife Safety Surveyor

824

Chris SluderLife Safety Surveyor

824

Della R. WoollenLife Safety Surveyor

825

Della R. WoollenLife Safety Surveyor

825

G. Reggie FosterBuilding Systems Engineer II

815

G. Reggie FosterBuilding Systems Engineer II

815

Ronald W. GalesBuilding Systems Engineer II

817

Ronald W. GalesBuilding Systems Engineer II

817

Carl E. Taylor, Jr.Building Systems Engineer II

818

Carl E. Taylor, Jr.Building Systems Engineer II

818

Carey Gurlitz 05-06Building Systems Engineer II

508

Carey Gurlitz 05-06Building Systems Engineer II

508

Jeff HarmsBuilding Systems Engineer II

830

Jeff HarmsBuilding Systems Engineer II

830

Bill D. EarwoodBuilding Systems Engineer II

831

Bill D. EarwoodBuilding Systems Engineer II

831

Tammy SylvesterBuilding Systems Engineer II

832

Tammy SylvesterBuilding Systems Engineer II

832

Rex WilliamsBuilding Systems Engineer II

834

Rex WilliamsBuilding Systems Engineer II

834

Thad L. FerreeFacility Architect II

804

Thad L. FerreeFacility Architect II

804

Andy C. HensleyFacility Architect II

807

Andy C. HensleyFacility Architect II

807

Sam CravottaFacility Architect II

808

Sam CravottaFacility Architect II

808

Edward H. WilliamsFacility Architect II

827

Edward H. WilliamsFacility Architect II

827

Medhat MetryFacility Architect II

828

Medhat MetryFacility Architect II

828

David J. DemusFacility Architect II

829

David J. DemusFacility Architect II

829

Paula NicholsProcessing Assistant V

826

Paula NicholsProcessing Assistant V

826

RecruitingBuilding System Engineer II

837

RecruitingBuilding System Engineer II

837

Anthony BrinsonFacility Engineering Specialist

838

Anthony BrinsonFacility Engineering Specialist

838

Gordon WashburnFacility Engineering Specialist

839

Gordon WashburnFacility Engineering Specialist

839

Dennis HarrellBuilding Systems Engineer II

820

Dennis HarrellBuilding Systems Engineer II

820

Rick BentonFacility Engineering Specialist

833

Rick BentonFacility Engineering Specialist

833

Paul Rencibia – ’05-06Building Systems Engineer II

509

Paul Rencibia – ’05-06Building Systems Engineer II

509

Joel Luper – ’05-’06Facility Architect II

507

Joel Luper – ’05-’06Facility Architect II

507

Craig Williams – ’05-’06Facility Engineering Specialist

511

Craig Williams – ’05-’06Facility Engineering Specialist

511

Frank Strickland – ’05-’06Facility Engineering Specialist

512

Frank Strickland – ’05-’06Facility Engineering Specialist

512

Marcus Staley – ’05-’06Building Systems Engineer II

510

Marcus Staley – ’05-’06Building Systems Engineer II

510

Gary Prichard – ’05-’06Facility Engineering Specialist

513

Gary Prichard – ’05-’06Facility Engineering Specialist

513

James Monaco – ’05-’06Facility Engineering

514

James Monaco – ’05-’06Facility Engineering

514

Cynthia Jones – ’05-’06Processing Assistant IV

515

Cynthia Jones – ’05-’06Processing Assistant IV

515

New Position- ‘06-’07Processing Assistant IV

557

New Position- ‘06-’07Processing Assistant IV

557

New Position – ’06-’07Facility Engineering Specialist

551

New Position – ’06-’07Facility Engineering Specialist

551

New Position – ’06-’07Facility Engineering Specialist

552

New Position – ’06-’07Facility Engineering Specialist

552

New Position – ’06-07Facility Engineering Specialist

553

New Position – ’06-07Facility Engineering Specialist

553

New Position – ’06-07Facility Architect II

554

New Position – ’06-07Facility Architect II

554

New Position – ’06-07Building Systems Engineer II

555

New Position – ’06-07Building Systems Engineer II

555

New Position – ’06-’07Building Systems Engineer II

556

New Position – ’06-’07Building Systems Engineer II

556

HA, FC, Mental Health Plan Review and Inspections- Licensure and HFA

Architectural PlanReview and InspectionsLicensure and HFA

Engineering Plan review and Inspections- Licensure and HFA

Life Safety Code InspectionsFederal Certification

Support StaffLicensure, Certification, and HFA

CONSTRUCTION SECTION OVERVIEW

DFS Home Page with Helpful Web Links to Regulated Facilities– Link to Rules– Project “Work Flow”

DHHS Home Page

Click here For

Rules

Click here for “Work Flow” Information

Click here for DHHS Web Site

Click here for Hospital Rules

CONSTRUCTION SECTION OVERVIEW

Additional LinksThe additional links provided for

web distribution may have been modified and should be verified for accuracy.

CONSTRUCTION SECTION OVERVIEW

Codes and Standards Hospitals Nursing Homes Ambulatory Surgery Hospice Facilities

NOTES FOR INFORMATION ONLY

(1) Life Safety Code (NFPA 101-1991) - 13 NCAC 7F.0102Effective 12/01/2005, OSHNC repealed the Life Safety Code adopted at 13 NCAC 7F.0102. OSHNC will use 29 CFR 1910 Subpart E - Exit Routes, Emergency Action Plans, and Fire Prevention Plans, to address issues previous addressed under the Life Safety Code

(2) Compliance with the “Americans With Disabilities Act” is the responsibility of the Owner and/or Architect.

CONSTRUCTION SECTION OVERVIEW

Other Section Functions Consultation w/ other DHHS Units Consultation w/ Department of Insurance,

Engineering Division Consulting w/ Local Officials Consulting w/ other Division Sections Uniform Code/Regulation Enforcement Educate - Owners, Designers, Local Officials,

Contractors and other interested parties Encouraging a team approach to projects

Bill’s Hot Topics: New 2006 Building Codes – Available Now Delayed Egress vs. Special Locking Arrangements Fire Alarm Sound Pressure Levels (ASC’s under

review) Mobile Diagnostic Units – Toilet room issues Alcohol Based Hand Rubs (ABHR’s) Smoke Detectors in Nursing Bed Rooms; Roller latches Permits and Approvals Review Fee Invoice revisions Air Conditioning on Emergency Power

Bill’s Hot Topics (continued): Emergency power for chillersEmergency power for chillers

– Chilled water & cooling tower redundancyChilled water & cooling tower redundancy– Most frequently used spare partsMost frequently used spare parts– Extra refrigerantExtra refrigerant– Portable chiller vendor informationPortable chiller vendor information– Portable chiller connections: electrical and Portable chiller connections: electrical and

pipingpiping– Controls; water treatment; monitoring systemsControls; water treatment; monitoring systems– Backup pumps (evaporator and condenser)Backup pumps (evaporator and condenser)– Chiller room lighting and power (repairs and Chiller room lighting and power (repairs and

logs)logs)

Delayed Egress (NCSBC 1003.3.1.8.2) Locks Shall Be Approved and Listed Permitted in All Groups Except A, E & H Facility must be protected throughout

with an Automatic Sprinkler System, or An approved automatic smoke or heat

detection system The doors must unlock in accordance

with the following:

Delayed Egress 1. Doors must unlock on actuation of automatic

sprinkler system or fire detection system2. Doors unlock on loss of power controlling the

lock or lock mechanism3. Can be unlocked by signal from fire control

center4. Initiate irreversible process to release in 15

sec.5. Signage required6. Emergency lighting required

Special Locking Arrangements(NCSBC 407.9) (new section)

Licensed Group I-1, I-2 and Residential Care Facilities

Protected throughout by an automatic fire detection system, or automatic sprinkler system

May be equipped w/ approved, listed locking devices which shall:

1. Unlock by actuation of automatic fire detection or automatic sprinkler systems

2. Unlock on loss of power controlling the device – see exception

3. May only be used when all of the following are met:a) Used only in wards or wings requiring for

security for protection of patientsb) Only one system shall be in any egress path

Special Locking Arrangements (NCSBC 407.9) (new section)

c) Provide wiring diagram and components mapd) On/off emergency release switches at all nurses’

stations to control all doors (see amendment)e) Emergency release switch at each locked door

within three feet of the doorf) Switches shall interrupt power supply to the

locking devices

4. Approved by local fire and building authorities

5. Emergency lighting shall be provided at the door

Special Locking Arrangements (NCSBC 407.9) (new section)

907.10.2 Audible alarms. Audible alarm notification appliances shall be provided and sound a distinctive sound that is not to be used for any purpose other than that of a fire alarm. The audible alarm notification appliances shall provide a sound pressure level of 15 decibels (dBA) above the average ambient sound level or 5 dBA above the maximum sound level having a duration of at least 60 seconds, whichever is greater, in every occupied space within the building. The minimum sound pressure levels shall be: 70 dBA in occupancies in Groups R and I-1; 90 dBA in mechanical equipment rooms; and 60 dBA in other occupancies. The maximum sound pressure level for audible alarm notification appliances shall be 120 dBA at the minimum hearing distance from the audible appliance. Where the average ambient noise is greater than 105 dBA, visible alarm notification appliances shall be provided in accordance with NFPA 72 and audible alarm notification appliances shall not be required.

Fire Alarm Sound Pressure Levels

Exceptions:

1. Visible alarm notification appliances shall be allowed in lieu of audible alarm notification appliances in critical care areas of Group I-2 occupancies.

New Amendment!2. In Group I-2 occupancies and licensed Large

Residential Care Facilities where occupants are incapable of evacuating themselves because of age, physical or mental disabilities, or physical restraint, audible notification appliances shall be permitted to meet the Private Mode requirements of NFPA 72 in patient care and treatment areas.

Fire Alarm Sound Pressure Levels

Failed to pass: resubmitted and under review

3. In Group B occupancies where health care is provided and occupants may be incapable of evacuating themselves because of age, physical or mental disabilities, physical restraint, or who may be under local or general anesthesia, audible notification appliances shall be permitted to meet the Private Mode requirements of NFPA 72 in patient care and treatment areas. Only the attendants and other personnel required to evacuate occupants from a zone, area, floor or building shall be required to be notified.

2. In Group I-2 occupancies and licensed Large Residential Care Facilities where occupants are incapable of evacuating themselves because of age, physical or mental disabilities, or physical restraint, audible notification appliances shall be permitted to meet the Private Mode requirements of NFPA 72 in patient care and treatment areas. Only the attendants and other personnel required to relocate or evacuate occupants from a zone, area, floor or building shall be required to be notified.

$ New Fee Schedules $

GENERAL ASSEMBLY OF NORTH CAROLINASESSION 2003HOUSE BILL 397RATIFIED BILL

AN ACT TO APPROPRIATE FUNDS FOR CURRENT OPERATIONS AND CAPITAL IMPROVEMENTS FOR STATE DEPARTMENTS, INSTITUTIONS, AND AGENCIES, AND FOR OTHER PURPOSES, AND TO IMPLEMENT A STATE BUDGET THAT ENABLES THE STATE TO PROVIDE A SUSTAINABLE RECOVERY THROUGH STRONG EDUCATIONAL AND ECONOMIC TOOLS.

$ New Fee Schedules $

The General Assembly of North Carolina enacts:

SECTION 34.11.(a) Article 16 of Chapter 131E of the General Statutes is amended by adding the following new section to read:

§131E-267. Fees for departmental review of health care facility construction projects.The Department of Health and Human Services shall charge a fee for the review of each health care facility construction project to ensure that project plans and construction are in compliance with State law. The fee shall be charged on a one-time, per-project basis, as follows, and shall not exceed twelve thousand five hundred dollars ($25,000) for any single project:

$ New Fee Schedules $

Fees for Institutional Projects Hospitals: $300.00 + $0.20/sf of project space Nursing Homes: $250.00 + $0.16/sf of project space Ambulatory Surgical Facility: $200.00 + $0.16/sf of

project space Psychiatric Hospital: $200.00 + $0.16/sf of project

space Adult Care Home > than 7 beds: $175.00 + $0.10/sf

of project space

$ New Fee Schedules $SECTION 34.11.(b) This section becomes

effective October 1, 2003. Technical Revisions Effective July 1, 2006

Please Note Carefully:

DO NOT SEND A FEE PAYMENT UNTIL YOU HAVE RECEIVED AN INVOICE FROM THIS OFFICE ! ! !

Mobile Diagnostic Units – All Types

MEMORANDUMDate: September 27, 1989To: Licensed Health Care Providers in North CarolinaFrom: William L. Warren, Assistant Chief, Construction Section, Division of Facility Services.Subject: Mobile diagnostic and treatment units.It has come to our attention that your facility has elected to provide mobile [MRI, CT scan, lithotripter,etc.] services for inpatients and outpatients. In the past, our office has regarded these unitsas portable equipment and has not inspected these mobile, often contract provided trailers.We have recently seen several of these mobile units installed permanently [supposedly on a temporarybasis] and upon inspecting these factory built units, we have noticed numerous BUILDINGCODE deficiencies, which include but are not limited to improper wiring methods and applications,mechanical systems code violations, and building construction code violations. Many ofthese units also fail to meet LICENSURE and ACCREDITATION or CERTIFICATION RULESand REGULATIONS.Prior to purchasing or leasing one of these mobile units, we recommend that you contact our officewith the details of your proposed service for our review and comment.We also suggest that you contact your local building inspection department for their requirements.

See licensure rules for toilet room requirements

ALCOHOL BASED HAND RUBS

• See ASHE Regulatory Advisory

• See CMS website: Keyword alcohol hand rub

• JCAHO interpretation for distance from electrical outlets: 6”

SMOKE DETECTORS IN NURSING BED ROOMS

Department of Health and Human Services

Centers for Medicare & Medicaid Services

42 CFR Parts 403, 416, 418, 460, 482, 483, and 485

[CMS-3145-IFC]

RIN 0938-AN36

Medicare and Medicaid Programs; Fire Safety Requirements for Certain Health Care Facilities; Amendment

Note: Search the web for the document above or go to the site shown below.

http://dhfs.wisconsin.gov/rl_DSL/Providers/CFR032505.pdf

MISCELLANEOUS TOPICS Permits and Approvals Contact Name/Info for Fee Invoices Water Temperatures Sprinkler Maintenance & Testing

(witness) Linear Accelerator Doors Electrosurgery & Operating Room Fires

IFFEN YOU NEED HELP

Junior says, “Give us a call at 919-855-3893”

BR549

VIOLATION EXAMPLES

(Good examples of bad things to do)

Handicapped Ramp?

Handicapped Ramps or Skateboard Ramp?

Dust Wall

Rated Wall?

Rated?

Rated Corridor wall?

Penetrations & open boxes

Rated shaft wall

Penetration at combustible roof

Combustible roof structure

Patriotic flag lighting system

Hole in top

Non-WP receptaclew/ open cover

Broken connection

No independentsupport of tanks

Combustible constructionw/ no separation

Unprotected combustibleconstruction

Unprotected constructionw/ no separation

Flammables outsidepatient room

Patient room window

Patient room window

Portable electric heaterw/ made connecting cord

Unprotected combustible construction

Bars on patientroom windows

Water heaters w/ all accesspanels open to hot elements

Electrical wiring

Electrical issues

Window unitin patient room

Trip Hazard

Patient room wiring

Open wiring

Fixture Support?

Wall penetrations

Not just bad,real bad

Plastic raceway serving critical branch in Hospital

No GFI – Wet Location, Romex wire w/ plug for ER Sign; non WP box or cover

O2 tank farm 10’ from combustible roof - 50’ required