1. 4/28/20091 10 th ANNUAL WESTERN HUD LENDERS CONFERENCE Golden Nugget Hotel – Las Vegas, Nevada April 27-29, 2008 Western Mortgagee Advisory Council SECTION 232 LEAN – LESSONS LEARNED Culture Change and Skilled Nursing Design Douglas Pancake, AIA Principal

2. 4/28/20092 3. Country Crest Skilled Nursing Facility Oroville, California

3. 4/28/20093 California Building Code 2001 (CBC 2007) 104.2.8 (111.2.4) Alternate materials, alternate design and methods of construction. The provisions of this code are not intended to prevent the use of any material, alternate design or method of construction not specifically prescribed by this code, provided any alternate has been approved and its use authorized by the building official. Alternate Method of Compliance Alternate means of protection Alternate methods of construction Program Flexibility 5.. Country Crest Skilled Nursing Facility Oroville, California

4. 4/28/20094 Specific Areas where this design deviates from the Code 9.. Country Crest Skilled Nursing Facility Oroville, California

5. 4/28/20095 Great room and therapy kitchen.. Country Crest Skilled Nursing Facility Oroville, California

6. 4/28/20096 Greenhouse for the Arizona Baptist Retirements Centers Phoenix, AZ Shown w/ permission of the McCarty Companies

7. 4/28/20097

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9. A true cluster plan provides home- like activities right outside the bedroom unit Open floor plan Maximum orientation Activities on demand Maximum supervision Centrally located Two Story Administration and Rehabilitation Building Proposed Structural System for Two Story: Concrete Masonry Shear Walls ( or concrete ) Flat Concrete Slab Floor and Interior Concrete Columns The Terraces at San Joaquin Gardens SNF Households Household One Household Two Household Three TWO STORY REHABILITATION and ADMINISTRATION 22

10. 4/28/200910

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14. 4/28/200914 Pediatric Acute Care Rehab at Totally Kids San Bernardino, California

15. 4/28/200915 Pediatric Acute Care Rehab at Totally Kids San Bernardino, California

16. 4/28/200916 Pediatric Acute Care Rehab at Totally Kids San Bernardino, California

17. 4/28/200917 New Care Center at Desert Valley Hospital Victorville, California

18. 4/28/200918 New Care Center at Desert Valley Hospital Victorville, California

19. 4/28/200919 New Care Center at Desert Valley Hospital Victorville, California

20. 4/28/200920 New Care Center at La Jolla Village Classic Residence by Hyatt, La Jolla, California

21. 4/28/200921 10 th ANNUAL WESTERN HUD LENDERS CONFERENCE Golden Nugget Hotel – Las Vegas, Nevada April 27-29, 2008 Western Mortgagee Advisory Council SECTION 232 LEAN – LESSONS LEARNED Culture Change and Skilled Nursing Design Thank you… Douglas Pancake, AIA Principal