NCHA Healthcare Construction Conference August 2006

1. NCHAHealthcare Construction ConferenceAugust 2006 DFS Update

2. PRESENTER William L. “Bill” Warren, Chief Construction Section North Carolina Department of Health and Human Services Division of Facility Services

3. SESSION FORMAT • Bill’s Special “Hot Topics” • Submitted Questions • DFS Overview • Miscellaneous Topics • NCHEA web site information

4. 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

5. 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.

6. 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. DFS MISSION STATEMENT (CONT.)

7. CONSTRUCTION SECTION GOALS • Reduce the Review Turnaround Time • Combine Architectural & Engineering Reviews • Complete Reviews within Acknowledged Timeframe • Provide consultation when appropriate

8. CONSTRUCTION SECTION OVERVIEW Division Programs • State Licensure • Title 18/19 Reimbursement (Medicare/Medicaid) • Health Care Facilities Finance Act

9. CONSTRUCTION SECTION OVERVIEW Construction Section Staff and Contact Information • Telephone Numbers • E-mail Addresses • Organization • DFS Web Site

10. Support Staff Licensure, Certification, and HFA Life Safety Code Inspections Federal Certification Architectural Plan Review and Inspections Licensure and HFA Engineering Plan review and Inspections- Licensure and HFA HA, FC, Mental Health Plan Review and Inspections- Licensure and HFA

11. CONSTRUCTION SECTION OVERVIEW • DFS Home Page with Helpful Web Links to Regulated Facilities • Link to Rules • Project “Work Flow” • DHHS Home Page

12. Click here for “Work Flow” Information Click here For Rules Click here for DHHS Web Site

13. Click here for Hospital Rules

15. CONSTRUCTION SECTION OVERVIEW Additional Links The additional links provided for web distribution may have been modified and should be verified for accuracy.

16. CONSTRUCTION SECTION OVERVIEW Codes and Standards Hospitals Nursing Homes Ambulatory Surgery Hospice Facilities

17. 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.

18. 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

19. 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

20. 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)

21. 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:

22. Delayed Egress • 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

23. 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:

24. Special Locking Arrangements (NCSBC 407.9) (new section) • Unlock by actuation of automatic fire detection or automatic sprinkler systems • Unlock on loss of power controlling the device – see exception • May only be used when all of the following are met: • Used only in wards or wings requiring for security for protection of patients • Only one system shall be in any egress path

25. Special Locking Arrangements (NCSBC 407.9) (new section) • Provide wiring diagram and components map • On/off emergency release switches at all nurses’ stations to control all doors (see amendment) • Emergency release switch at each locked door within three feet of the door • Switches shall interrupt power supply to the locking devices • Approved by local fire and building authorities • Emergency lighting shall be provided at the door

26. 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

27. 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.

28. 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 • 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.

29. $ 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.

30. $ 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:

31. $ 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

32. $ 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 ! ! !

33. 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

34. ALCOHOL BASED HAND RUBS • See ASHE Regulatory Advisory • See CMS website: Keyword alcohol hand rub • JCAHO interpretation for distance from electrical outlets: 6”

35. 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

36. MISCELLANEOUS TOPICS • Permits and Approvals • Contact Name/Info for Fee Invoices • Water Temperatures • Sprinkler Maintenance & Testing (witness) • Linear Accelerator Doors • Electrosurgery & Operating Room Fires

37. IFFEN YOU NEED HELP Junior says, “Give us a call at 919-855-3893” BR549

38. VIOLATION EXAMPLES (Good examples of bad things to do)

39. Handicapped Ramp?

40. Handicapped Ramps or Skateboard Ramp?

41. Dust Wall

43. Rated Wall?

44. Rated?

45. Rated Corridor wall?

46. Penetrations & open boxes

47. Rated shaft wall

48. Penetration at combustible roof

49. Combustible roof structure

50. Patriotic flag lighting system