1. NCHEA Winter Conference 2005 Presented by The North Carolina Department of Health and Human Services/ Division of Facility Services/ Construction Section for The NC Hospital Engineers Assn.

2. PRESENTER William L. Warren, Chief DFS Construction Section

3. SESSION FORMAT DFS Overview Architectural Issues Plumbing/Mechanical Issues Electrical Issues Miscellaneous Issues

4. GOALS AND OBJECTIVES To explain our 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. 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.

7. SECTION GOALS Reduce the Review Turnaround Time Combine Architectural & Engineering Reviews Complete Reviews within Acknowledged Timeframe

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

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

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

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

13. Click here for Hospital Rules

15. SECTION OVERVIEW Additional Links (Handout) The additional links provided in the materials you received today may have been modified and should be verified for accuracy.

16. SECTION OVERVIEW Codes and Standards (Handout) Hospitals Nursing Homes Ambulatory Surgery Hospice Facilities

17. SECTION OVERVIEW NOTES FOR INFORMATION ONLY (1) On April 1, 1992, The Department of Labor, OSHA Division, adopted the 1991 NFPA 101 Life Safety Code for all places of employment under T13: 07F.0102 as follows: All places of employment shall be designed, constructed, maintained, and occupied in accordance with the standards set out in the 1991 edition of the Code for Safety to Life from Fire in Buildings and Structures, ANSI/NFPA 101, which is hereby incorporated by reference. This incorporation shall not include any subsequent editions or amendments to this code. Copies of this code may be obtained from the National Fire Protection Association, 1 Batterymarch Park, Quincy, Massachusetts 02269, for sixty two dollars ($62.00). This rule supersedes any standards based on earlier editions of the Life Safety Code. (2)Compliance with the “Americans With Disabilities Act” is the responsibility of the Owner and/or Architect.

18. 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. SECTION OVERVIEW 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.

20. SECTION OVERVIEW 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 ($12,500) for any single project:

21. SECTION OVERVIEW Fees for Institutional Projects Hospitals: $150.00 + $0.10/sf of project space Nursing Homes: $125.00 + $0.08/sf of project space Ambulatory Surgical Facility: $100.00 + $0.08/sf of project space Psychiatric Hospital: $100.00 + $0.08/sf of project space Adult Care Home > than 7 beds: $87.00 + $0.05/sf of project space

22. SECTION OVERVIEW SECTION 34.11.(b) This section becomes effective October 1, 2003. On the Web see http://www.ncleg.net/html2003/bills/AllVersions/House/H3 97vr.html

23. SECTION OVERVIEW PLAN REVIEW GUIDELINES (Handout) Schematic Design –Architectural –Engineering Design Development & Final Working Drawings –Architectural –Engineering DFS Color Code System

24. SPECIAL TOPICS Special Locking Arrangements Delayed Egress Sprinkler Maintenance & Testing Linear Accelerator Doors Waterless Hand Cleaners Electrosurgery & Operating Room Fires

25. GENERAL Closeout Document Lists Nursing Home Project Guidelines

26. PLUMBING Medical Gas Piping –Certification –Testing –Designer Involvement Hot Water Systems (Handout)

27. MECHANICAL Major Changes in Codes Fire & Smoke Dampers, Duct Mounted Smoke Detectors & Access Doors Smoke Control & Smoke Evacuation – See Volume I, Section 909 Conflicts Between: –NFPA 90A & NCSBC Mechanical Code –ASHRAE & Licensure for Air Changes

28. MECHANICAL Variable Volume vs. Fixed Exhaust Electric Operators Equipment Serviceability

29. ELECTRICAL Fire Alarm Systems –Sound Pressure Levels –Devices & Locations Essential Electrical Systems Identification of Circuits Safety Testing Data NEC 517-30(b)(4) – New Diagrams in FPN’s Isolated from Ground Power

30. ELECTRICAL Miscellaneous –Ventilator Beds in Nursing Homes –Improper Use of Special Receptacles –Improper Use & Installation of Cable –Improper Grounding Generator Fuel Capacity –Remember Hugo, Fran, Floyd & Isabelle?

31. MISCELLANEOUS ITEMS Sale of Electrical Goods Regulated Mobile Diagnostic Units (Handout) Sprinkler Certification (Handout) Neonatal Services Organization (Handout) Common Problems (Handout) –During Plan Review –During Inspections

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

33. VIOLATION EXAMPLES Good examples of bad things to do

34. Handicapped Ramp?

35. Handicapped Ramps or Skateboard Ramp?

36. Dust Wall

38. Rated Wall?

39. Rated?

40. Rated Corridor wall?

41. Penetrations & open boxes

42. Rated shaft wall

43. Penetration at combustible roof

44. Combustible roof structure

45. Patriotic flag lighting system

46. Hole in top

47. Non-WP receptacle w/ open cover

48. Broken connection

49. No independent support of tanks

50. Combustible construction w/ no separation

51. Unprotected combustible construction

52. Unprotected construction w/ no separation

53. Flammables outside patient room

54. Patient room window

56. Portable electric heater w/ made connecting cord

57. Unprotected combustible construction

58. Water heaters w/ all access panels open to hot elements

59. Electrical wiring

60. Electrical issues

61. Window unit in patient room Trip Hazard

62. Patient room wiring

63. Open wiring

64. Fixture Support?

65. Wall penetrations

66. Not just bad, real bad

67. Plastic raceway serving critical branch - Hospital

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

69. O 2 tank farm 10’ from combustible roof - 50’ required