Facilities Development Division

Facilities Development DivisionCalifornia’s Building Department for HospitalsPaul A. Coleman, Architect, Deputy DirectorChris Tokas, S.E., Deputy Division ChiefGordon Oakley, Fire Marshal, Deputy Division ChiefRoy Lobo, Ph.D., S.E., Principal Structural EngineerHussain Bhatia, Ph.D., S.E., Supervisor, Seismic Compliance UnitDiana Scaturro, Supervisor, Building Standards UnitNanci Timmins, Fire Marshal, Chief Fire Life Safety OfficerGary Dunger, Fire Marshal, eServices ManagerUpdate for the California Healthcare AssociationFebruary 13, 20181

Facilities Development DivisionCalifornia’s Building Department for HospitalsPlan Review and Field Performance Update2

Workload in Construction Values 2012 3

Plan Review Workload4

Yearly Average Review Days5

Percentage of Projects Meeting Goals6

Performance IndexIndex Year7

.3%61.5%Σ 14,940 60 reviews/day8

Workload9

2019 California Building Standards CodeProposed OSHPD AmendmentsCalifornia Department of Public Health - February 6, 2018Paul Coleman, Deputy DirectorChris Tokas, Deputy Division ChiefDiana Scaturro, Supervisor HFRFacilities Development Division, OSHPD10

Overview 201911

2019 CBSC Timeline12

2019 CBSC Proposed Topics Included Items OSHPD 1 & 1R / OSHPD 2 / OSHPD 5 Alignment Outpatient Observation Unit Pharmacy Requirements Sterile Compounding Less than 100 Beds – Drug Room Permit Option Modify Table 4A to more closely align w/ ASHRAE 170 I-2 (with restraint): Class I Flooring Surgical Suite Staff Changing Areas – Flow Improvement Energy Conservation Enhancements and Enforcement13

OSHPD 1, 1R, 2 and 5 Alignment[OSHPD 1] Chapter 1224General Acute-Care Hospitals including those that provide RehabilitationServices[OSHPD 1R] VariesNon-conforming Hospital Building removed from General Acute-Care services[OSHPD 2] Chapter 1225Skilled Nursing Facilities and Intermediate Care Facilities[OSHPD 3] Chapter 1226Clinics, including those under H&S Code Section 1200 and Hospital Outpatient ClinicalServices provided in a freestanding building un H&S Code Section 1250[OSHPD 4] Chapter 1227Correctional Treatment Centers[OSHPD 5] Chapter 1228Acute Psychiatric Hospitals14

OSHPD 1 Support Areas Nursing Unit Designated versus Shared Support Areas Designated SharedAdministrative area / NurseStation Staff toilet rooms Housekeeping rooms Nurse/Supervisor Office Special bathing facilities Separate Clean and SoiledUtility Rooms, Clean linenstorage Optional Medication Station Equipment & EmergencyStorage, gurneys &wheelchairsExam &/or treatment roomsare optional Multipurpose rooms may beshared with otherdepartments Nourishment area & IceMachine15

Outpatient Observation Unit1253.7. (a) For purposes of this chapter, “observation services” means outpatientservices provided by a general acute care hospital and that have been ordered by aprovider, to those patients who have unstable or uncertain conditions potentiallyserious enough to warrant close observation, but not so serious as to warrantinpatient admission to the hospital.16

Outpatient Observation Unit SB 1076 IntentDefinition and Purpose: SB 1076 defines “observation services” as “outpatient services to thosepatient who have unstable or uncertain conditions potentially serious enoughto warrant close observation, but not so serious as to warrant inpatientadmission to the hospital.” Observed acuity should be less than what would be readily apparent forimmediate inpatient admission.Potential Use: Patient Type 1 - New patient:oOutpatient Observation only (with no admission)oOutpatient Pre-Admission Patient Type 2 - Existing patient:oOutpatient Post-Discharge17

Outpatient Observation Unit SB 1076 IntentRequired Services – may include the use of: A bed Monitoring by nursing and other staff Any other services that are reasonable and necessary to safely evaluate apatient’s condition or determine the need for a possible inpatient admission tothe hospitalQuestion:What is implied by “reasonable and necessary” for patients currently at anoutpatient status with the potential for inpatient admission?18

Outpatient Observation Unit SB 1076 IntentAnalysis - Patient Station:1988 - 2001 CBC(effective thru12/31/2006)2016 CBCSingle Patient Room110 sf(3 feet clear @ sidesand foot of bed)120 sf(3 feet clear @ sides andfoot of bed)Multi-Patient Room80 sf / bed(3 feet clear betweenbeds & 4 feet @ foot ofbed)100 sf / bed(3 feet clear betweenbeds & 4 feet @ foot ofbed)Nursing UnitEmergency ServicesTreatment RoomObservation Room(the least dimensionshall be 8')120 sf single or 80sf/multi-gurney(3 feet clear @ sides andfoot of bed/gurney)No Stated Size120 sf80 sf19

Outpatient Observation Unit Proposed Requirements - GeneralLocation:Must be located in conforming or non-conforming hospital buildingMay be located in hospital building removed from acute care servicesConnection to Hospital Services:Corridor systems shall connect unit to all Basic and Supplemental ServicesPatient access to unit shall not pass through public lobbies, waiting areas,other departments, or inpatient unitsUtility Services Infrastructure:Nurse callEmergency powerPortable oxygen20

Outpatient Observation Unit Proposed Requirements - PatientPatient Treatment Station:110 sf single or 80 sf multiple patientsBed clearances per 2001 CBC (3’ @ sides / 3’ or 4’ @ foot of bed)Patient Toilet:1 Accessible Toilet / 6 Patients1 Accessible Shower / 12 PatientsNegative Pressure Isolation:Optional patient isolation provisions definedUtility Services Infrastructure:Nurse call, emergency power, and portable oxygen21

Outpatient Observation Unit Proposed Requirements – Service Areas for UnitSupervisor OfficeStaff Toilet(s)Multipurpose Room(s)Conferences, Reports, Training, ConsultationExamination or Treatment RoomsMedication Room or StationsNourishment Areas and Ice Machine(s)Clean and Soiled Utility Support SpacesGeneral and Emergency Equipment StorageGurney & Wheelchair Storage22

Outpatient Observation Unit Next Steps CDPH Review HBSB Review PIN Development CBSC Comment Period CBSC Adoption23

Pharmacy CDPH / Board of Pharmacy Alignment Alignment with CBC Section 1250 – restructured by California Boardof Pharmacy Drug Room (less than 100 beds) Receiving/breakout/inventory Handwashing station Storage – bulk, refrigerated, secured, etc.24

Pharmacy Basic Pharmaceutical Services (100 beds or more) Dispensing Facilities Receiving/breakout/inventory Dispensing work counters Non-sterile compounding work stations/handwashing/utility sink Recording – counter and electronic workstations Storage – temporary, bulk, active, refrigerated, secured, etc. Sterile Compounding Requirements Support Areas Office Space Staff Toilet and Lockers Outpatient Consultation (as needed)25

Mechanical Table 4-A Remove Non-Patient Spaces for alignment with ASHRAE 170 Administrative Dining Room Dishwashing Room Multipurpose Room Staff Sleep Room(May use model code for theseareas – ASHRAE 62.1)26

2019 CBSC Proposed Topics Pending Items 2 – Bed Rule: SNF versus Hospital 72 hour versus 96 hour storage Onsite EHR Retention Requirements Signage for Buildings Removed from Acute Care Services Medication Dispensing Stations Sinks Acceptable Locations (alcove placement limitations) Comprehensive Emergency Services – Reserved Operating Room Dialysis and Infusion Therapy – Capable of Unassisted Self-Preservation27

Energy Commission - 2019 CodeHighlights: Building Envelope Minimum Requirements Equipment Energy Efficiency Ratings LED LightingFormal Rulemaking Comment Period: Started January 19, 2018 Concludes March 5, 2018 @ 5 ulemaking/28

Facilities Development DivisionCalifornia’s Building Department for HospitalsUpdate on the proposed structural/non-structural2019 Building Code Changes (California Amendments)andadoption of the 2018 International Building Code withupdated reference standards29

2019 California Building Code(CBC 2019)2019 CALIFORNIABUILDING CODE30

Major Reference Standards Updated1.2.3.4.5.6.ASCE 7-16: Minimum Design LoadsAISC 360-16: Steel DesignAISC 341-16/358-16: Seismic Design of SteelTMS-402/602-16: Masonry DesignNDS-18: Wood Design31

Major Reference Standards Not Updated1. ASCE 41-13: Seismic Evaluation and Retrofit ofExisting Buildings2. ACI 318-14: Concrete Design32

Major Reference Standards Not Updated1. ADM1-15: Aluminum Design2. SDPWS-15: Special Design Provisions forWind and Seismic33

New Definitions/RequirementsFixed equipmentvsMoveable equipmentvsMobile equipmentandAnchored equipmentvsRestrained equipment34

Amendments to Chapter 16Structural DesignThis Chapter applies to:– OSHPD 1R : Non-conforming buildings removed fromservice but are in OSHDP jurisdiction.– OSHPD 2 – Skilled nursing and intermediate care buildings– OSHPD 5 – Acute Psychiatric Building35

Amendments to Chapter 16Structural Design Risk Category of Buildings and Other Structures36

Amendments to Chapter 16Structural DesignComponent Importance FactorsIp 1.5 for:1. Components required for life-safety purposes after anearthquake, including emergency and standby powersystems, mechanical smoke removal systems, fireprotection sprinkler systems and fire alarm controlpanels.2. For medical device components, mechanical andelectrical components and components required for lifesupport for patients in sub-acute bed(s).Requirements for Special Seismic Certification will apply37

Chapter 16A Risk Category of Buildings38

Amendments to Chapter 16AStructural DesignSeismic Instrumentation and Monitoring Require seismic instrumentation for buildingswith a seismic isolation or damping systems. Require monitoring and inspection of isolatorsand dampers after an earthquake whenground motions or building response exceedcertain thresholds.39

Chapter 17 Special Inspections & TestsApproved agencies to perform special tests andinspections for:OSHPD 1R, OSHPD 2 & OSHPD 5 buildings whenrequired for the work as listed in the buildingcode and are monitored through the Testing,Inspection and Observation program (TIO).40

Special Seismic Certification [OSHPD 1R, 2, 5]1705.13.3.1 Special seismic certification. [OSHPD 1R, 2and OSHPD 5]Required for:1. Life-safety components, such as emergency andstandby power systems, mechanical smoke removalsystems, and fire sprinkler/fire protection systems.2. Medical, mechanical and electrical equipment andcomponents required for life support for patients insub-acute bed(s).41

Chapter 17A Special Inspections & Tests1705A.13.2 Nonstructural components.Permit alternate testing protocols for capacitydetermination of seismic sway bracingcomponents.Not limited to FM 1950 loading protocols only.42

Special Seismic Certification705A.13.3 Special seismic certification. Permit shake table testing in accordance withICC-ES AC 156 or equivalent shake table testingapproved by the building official.43

OSP Renewal FeesCAC 2019 §7-133 Fees: §7-133.1 OSHPD Special SeismicCertification preapproval (OSP). Fees to review OSHPD Special Seismic Preapprovals(OSP) will now be charged on a Time and Materials(T&M) basis. Will no longer be 5000 for new applications or 1000 for renewals, The total cost paid for these services arenonrefundable.44

Amendments in Chapter 34AExisting StructuresONLY Applies to OSHPD 1 BuildingsNow Relocated toChapters 2A, 3A, 4A and 5A45

Delineation of OSHPD BuildingsOSHPD 1 : Application – General acute care hospitals buildings.OSHPD 1R: Application – General acute care non-conforminghospital buildings removed from acute care service remainingunder OSHPD jurisdiction.OSHPD 2: Application – Skilled nursing facilities and intermediatecare facility buildings.OSHPD 5: Application – Acute psychiatric hospital buildings.46

2019 CBC: Existing Structures Adoption of 2018 IEBC for OSHPD 1R, 2, 4and 5 Buildings Relocation of Chapter 34A to CEBC withamended “A” Chapters “2A”, “3A”, “4A”and “5A” for OSHPD 1 buildings.47