Transcript AGC Seminar

NCHA
Healthcare Construction
Conference
August 2006
DFS Update
PRESENTER
William L. “Bill” Warren, Chief
Construction Section
North Carolina Department of Health and Human Services
Division of Facility Services
SESSION FORMAT
 Bill’s Special “Hot Topics”
 Submitted Questions
 DFS Overview
 Miscellaneous Topics
 NCHEA web site information
SESSION GOALS
 To
AND
OBJECTIVES
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 STATEMENT
The 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 Information
Telephone
Numbers
E-mail Addresses
Organization
DFS Web Site
Bill Warren
Chief
801
Construction Section O-Chart
04/12/2006
Cindy Pearce
Program Assistant V
810
Angela Langston
Processing Assistant IV
805
Celia R. Keator
Processing Assistant IV
811
Steven C. Lewis
Building Systems Engineer III
813
Robert E. Dew
Life Safety Surveyor
812
Jim L. Turner
Life Safety Surveyor
814
Jeff L. Waddell
Life Safety Surveyor
819
Lorraine Spekczynski
Processing Assistant IV
816
Curtis W. Daniel, Sr.
Life Safety Surveyor
822
Cynthia Jones – ’05-’06
Processing Assistant IV
515
Robert Strother
Life Safety Surveyor
823
New Position- ‘06-’07
Processing Assistant IV
557
Support Staff
Licensure,
Certification, and HFA
Chris Sluder
Life Safety Surveyor
824
Della R. Woollen
Life Safety Surveyor
825
Life Safety Code
Inspections
Federal Certification
Charles Cocks
Building Systems Engineer III
893
G. Reggie Foster
Building Systems Engineer II
815
Ronald W. Gales
Building Systems Engineer II
817
Carl E. Taylor, Jr.
Building Systems Engineer II
818
Carey Gurlitz 05-06
Building Systems Engineer II
508
Jeff Harms
Building Systems Engineer II
830
Bill D. Earwood
Building Systems Engineer II
831
Tammy Sylvester
Building Systems Engineer II
832
Rex Williams
Building Systems Engineer II
834
Marcus Staley – ’05-’06
Building Systems Engineer II
510
Engineering Plan review
and Inspections- Licensure and HFA
Marjorie L. Acker
Facility Architectural Supervisor II
802
Fran Pedrigi
Facility Architectural Supervisor II
835
Thad L. Ferree
Facility Architect II
804
Recruiting
Building System Engineer II
837
Gary Prichard – ’05-’06
Facility Engineering Specialist
513
Andy C. Hensley
Facility Architect II
807
Anthony Brinson
Facility Engineering Specialist
838
James Monaco – ’05-’06
Facility Engineering
514
Sam Cravotta
Facility Architect II
808
Gordon Washburn
Facility Engineering Specialist
839
New Position – ’06-’07
Facility Engineering Specialist
551
Dennis Harrell
Building Systems Engineer II
820
New Position – ’06-’07
Facility Engineering Specialist
552
Rick Benton
Facility Engineering Specialist
833
New Position – ’06-07
Facility Engineering Specialist
553
Paul Rencibia – ’05-06
Building Systems Engineer II
509
New Position – ’06-07
Facility Architect II
554
Joel Luper – ’05-’06
Facility Architect II
507
New Position – ’06-07
Building Systems Engineer II
555
Edward H. Williams
Facility Architect II
827
Medhat Metry
Facility Architect II
828
David J. Demus
Facility Architect II
829
Paula Nichols
Processing Assistant V
826
Architectural Plan
Review and Inspections
Licensure and HFA
Craig Williams – ’05-’06
Facility Engineering Specialist
511
New Position – ’06-’07
Building Systems Engineer II
556
Frank Strickland – ’05-’06
Facility Engineering Specialist
512
HA, FC, Mental Health Plan
Review and InspectionsLicensure 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 “Work Flow”
Information
Click here For Rules
Click here for DHHS Web Site
Click here for Hospital Rules
CONSTRUCTION SECTION OVERVIEW
Additional Links
The 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.0102
Effective 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 chillers
– Chilled water & cooling tower redundancy
– Most frequently used spare parts
– Extra refrigerant
– Portable chiller vendor information
– Portable chiller connections: electrical and piping
– Controls; water treatment; monitoring systems
– Backup pumps (evaporator and condenser)
– Chiller room lighting and power (repairs and 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.
2.
3.
4.
5.
6.
Doors must unlock on actuation of automatic
sprinkler system or fire detection system
Doors unlock on loss of power controlling the lock
or lock mechanism
Can be unlocked by signal from fire control center
Initiate irreversible process to release in 15 sec.
Signage required
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:
Special Locking Arrangements
(NCSBC 407.9) (new section)
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 patients
b) Only one system shall be in any egress path
Special Locking Arrangements
(NCSBC 407.9) (new section)
c) Provide wiring diagram and components map
d) 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 door
f) 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
Fire Alarm Sound Pressure Levels
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.
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.
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.
$ New Fee Schedules $
GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2003
HOUSE BILL 397
RATIFIED 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
MEMORANDUM
Date: September 27, 1989
To: Licensed Health Care Providers in North Carolina
From: 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 units
as 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 temporary
basis] and upon inspecting these factory built units, we have noticed numerous BUILDING
CODE deficiencies, which include but are not limited to improper wiring methods and applications,
mechanical systems code violations, and building construction code violations. Many of
these units also fail to meet LICENSURE and ACCREDITATION or CERTIFICATION RULES
and REGULATIONS.
Prior to purchasing or leasing one of these mobile units, we recommend that you contact our office
with 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 919-8553893”
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
receptacle
w/ open cover
Broken
connection
No independent
support of
tanks
Combustible construction
w/ no separation
Unprotected
combustible
construction
Unprotected
construction
w/ no
separation
Flammables
outside
patient room
Patient room
window
Patient room
window
Portable electric heater
w/ made connecting cord
Unprotected
combustible
construction
Bars on patient
room windows
Water heaters
w/ all access
panels open to
hot elements
Electrical
wiring
Electrical
issues
Window unit
in 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