1 Facilities Development Division California’s Building Department for HospitalsPaul A. Coleman, Architect, Deputy Director Chris Tokas, S.E., Deputy Division Chief Gordon Oakley, Fire Marshal, Deputy Division Chief Roy Lobo, Ph.D., S.E., Principal Structural Engineer Glenn Gall, Supervisor, Building Standards Unit Nanci Timmins, Fire Marshal, Chief Fire Life Safety Officer California Healthcare Association August 8, 2017

2 In Case You Haven’t HeardWe’ve Moved! Approved as noted

3 Plan Review and Field Performance UpdateFacilities Development Division California’s Building Department for Hospitals Plan Review and Field Performance Update

4 Workload Summary/Performance

5 No. of Reviews Year 2016 65% 35% ≈ 59 reviews/day

6 Project Plan Review Data Analysis 2st Qtr. 201768% of the Plan Reviews are completed w/in 21 days or less 92% of the PAD Reviews are completed w/in 21 days or less Or 40% of Office Plan Approval Reviews 62% 35% S=552 or 14% of All Projects ≈ 62 reviews/day

7 Number of Permits – 4th Qtr. 2010 thru 2nd Qtr. 2017Statewide combined Office and Field Number of Permits Issued by Quarter 724 582 With SB 1838 Permits Without SB 1838 Permits

8 Workload in Construction Values for projects in Construction - % Completion65% 26% 8% 66% 28% 9% (1st Qtr Numbers)

9 Number of SB 1838 Projects – 2nd Qtr. 2017Statewide Number of SB 1838 EXEMPT Projects Approved by Quarter 113 40

10 Workload in Construction Values for projects in Pending Construction State By Region

11 Seismic Compliance UpdateFacilities Development Division California’s Building Department for Hospitals Seismic Compliance Update

12 Structure Performance Categories* Based on 2001 Hospital Survey Results based on hospital “self-report” and then “state-of-the-art” FEMA 178 standards from 1996 ** SPC-5 includes buildings currently under construction For SPC - "Not Assigned" is for non-building structures such as equipment yards, cooling towers etc that are still under construction

13 Hospital Seismic Compliance to Date217 7/28/17 1096 Buildings 83.5% < 2½ years left

14 Nonstructural Performance Categories***Includes buildings under construction, tunnels and equipment yards For NPC - "Not Assigned" are for buildings and nonbuilding structures either under construction or where the nonstructural performance category has not been verified

15 2017 SB499 Report Timeline Building Inventory/SB499 Preparation Letter – 6/27/17 Building Inventory/SB499 Preparation Reminder Letter – 7/25/17 Building Inventory Revisions cutoff deadline – 7/28/17 Release of Online Report with passwords – 8/21/17 Online Report Reminder Letter – 9/25/17 Online Report Warning Letter – 10/16/17 Online Report submittal deadline – Wednesday, 11/1/17 OSHPD Website Final Report posting deadline 2/1/18

16 Project Closure and InvoicingFacilities Development Division California’s Building Department for Hospitals Project Closure and Invoicing

17 Projects Awaiting Final Client CostProjects Awaiting Final Costs from Clients; Number of Projects by OSHPD Region No. of Projects 5 Month Trend Projects waiting for final client costs The distribution of projects in the time waiting stays relatively consistent.

18 Projects Awaiting Final Client Cost$ Value 5 Month Trend As higher value projects move into the closure process, the time segments expand and contract as well as the duration of time spent in each time period.

19 Status of Accounts ReceivableNo. of Open Invoices The total number of outstanding invoices starting 7/1 and ending in 8/1 jumped 16%.

20 Status of Accounts Receivable$ Value Open Invoices Total value of unpaid invoices ending in July is $13.5M. increase of 17% from June, but down 37% from one year ago at $21M and down 53% from a 2017 high in February of $29M

21 FDD Income and Expenses

22 FDD Income and Expenses

23 FDD Expenditures FY 2016/17

24 Facilities Development Division California’s Building Department for HospitalseServices

25 eServices Update This quarter the eSP Team has focused on improving the quality of data being entered into the eServices Portal. Many of the enhancements occur ‘behind the scenes’ or notify users when certain actions occur:

26 eServices Update Automated Email NotificationsGeoTech report uploaded to eSP Plan approval notification to RCO for issuance of BP Final payment received notification to PT eRAD notification to RCO Functional Program notification to CDPH for pharmacy projects involving sterile or hazardous compounding

27 eServices Update Automated LettersFor projects approved in the field, plan approval letters recognize whether the plan was electronic or paper and populates correct processing instructions.

28 eServices Update Data Improvements and FixesBPs are automatically assigned to the RCO, not the Manager Projects under an Annual Building Permit are automatically connected to the ABP Record. Project Closure Summary report displayed incorrect status when ed to clients.

29 Project & Child Documents ReportA new report has been created that lists all documents associated with a project or any of its ‘child’ projects (BPs, ACDs, AMCs etc.). This can be very useful for completion of construction and project close-out.

30 Project & Child Documents ReportThe report identifies the records where documents have been uploaded to avoid looking on records where no documents exist.

31 Project & Child Documents ReportExpanding the Record ID lists all documents that have been uploaded to the Attachments section of the record.

32 Project & Child Documents ReportUsing this report you can quickly confirm if the required closure documents have been uploaded as well as who uploaded them, when they where uploaded and where they were uploaded. This report will eventually have hyperlinks to open the document by clicking on the document name. For security purposes, this feature will not be available to non-OSHPD staff.

33 Project & Child Documents ReportThis report is currently available in the OSHPD Report Center.

34 Project List by Region, County, Facility ReportClients have also requested access to the OSHPD Field Staff “Quarterly Report”. This report is very useful and lists all projects at a facility based on the search criteria entered. The report is currently available in the OSHPD Report Center.

35 Project List by Region, County, Facility ReportThe report can be all inclusive or customized to a single facility based on the values selected. Once generated, the report gives an excellent snapshot of the status of all projects in the search criteria.

36 eCPR Auto Codes e

37 eCPR eCPR was deployed on August 1, 2017.This new process and record type is used for formal appeals to OSHPD using the Comment and Process Review currently codified in CAC Section

38 eCPR Any person associated with the project may request an appeal using the eCPR. Upon successful completion of the application, the eCPR is automatically routed to the correct reviewer or field staff. The time limitations specified in CAC are tracked by eSP; if the first level reviewer does not reply within 10 calendar days, the CPR is automatically escalated to the Supervisor or RCO.

39 eCPR Acceptance or denial of the appeal is documented with an and a formal letter which will include the reason for any denial. If the appellant wishes to escalate to the next level, a hyperlink is provided in the letter which will be automatically addressed to the appropriate next- level individual.

40 eCPR Example of CPR Results Letter

41 eServices Update Next steps:Field Operations improvements & enhancements ePC improvements Updated rendering engine Ability to render-on-demand to create overlay pages for backcheck reviews

42 Tableau Reports – Report Card

43 Tableau Reports – Timely Review

44 Tableau – Timely Traige

45 Tableau – Workload Analysis by Regions

46 Tableau – Workload Analysis by Counties

47 Educational OpportunitiesFacilities Development Division California’s Building Department for Hospitals Educational Opportunities

48 Webinars New Pharmacy Standards/RegulationsCHA Sponsored, including Board of Pharmacy, CDPH, and FDD 2016 California Building Standards Code In conjunction with the HBSB Fire/life Safety Administrative Regulations and Architectural, Mechanical and Electrical Structural

49 Webinar on Sterile Compounding Pharmacies# of connections = 231 # of participants =

50 Webinar on 2016 CBSC Fire and Life Safety Provisions# of connections = 80 # of participants =

51 Webinar on 2016 CBSC Administrative, Architectural, MEP Systems and Pharmacy Provisions# of connections = 78 # of participants =

52 Webinar on 2016 CBSC Structural Provisions# of connections = 76 # of participants =

53 Upcoming Webinars/SeminarsProposed Energy Standards (webinar): late August/early September 2017 PINs and CANs (webinar): November 2017 ? Mid-Term Code Changes (webinar): February 2018 Repurposing Hospital Buildings (seminar): April 2018 Final Energy Standards (webinar): February 2019

54 Upcoming Webinars/Seminars

55 Facilities Development Division California’s Building Department for HospitalsOther Stuff

56 FDD’s Top 3 Objectives for 2017Expand Electronic Plan Review Reevaluate FDD’s Plan Review Performance Goals Develop an IOR Trainee/Apprentice Program

57 HBSB Stuff DATE MEETING August 9, 2017 Technology Committee August 23, 2017 Energy Conservation and Management Committee September 14, 2017 Administrative Processes, Code Changes and Standard Details Committee October 12, 2017

58 California Building Standards Code Changes

59 2019 CBC Structural RegulationsStarted preparing for the 2019 Code Adoption process ASCE 7-16, TMS-402/602-16, AISC-360/ are all published IBC 2018 slated for publication September, 2017 ASCE not included in the IBC/IEBC 2018 OSHPD plans to incorporate it in 2019 CBC, provided it’s published and available to meet 2019 CBSC adoption Schedule

60 2016 Intervening Code Adoption CycleFacilities Development Division California’s Building Department for Hospitals 2016 Intervening Code Adoption Cycle

61 California Building Code Changes× × 6/20/17 8/14/17

62 California Building Code Changes

63 California Building Code ChangesCAC, CBC, CEC, CMC and CPC proposed code changes submitted and processed through the code advisory committees and subsequent public comment periods Proposals   Psychiatric Functional Program Element Alignment of Fees with Statute Technology and Medical Communications Acute Psychiatric Hospitals Adoption of ASHRAE 170

64 Subsequent Actions/Comments ReceivedCBC provisions Outpatient Observation Units OSHPD withdrawal of the originally proposed provisions regarding outpatient observation units for further study 1228 Acute Psychiatric Hospital provisions Positive comments received Resulted in an additional 15 day change for two clarifications to the original proposal.  Of note on this item, the proposals for change to ASHRAE 170 for reduced ventilation rates for 100% outside air systems (CMC allowance) was rejected by the 170 committee. CMS directly references compliance with 170. This will likely be subject to future rule making. 

65 Subsequent Actions/Comments ReceivedCMC provisions Integrated previously adopted California provisions into the newly adopted model code - ASHRAE 170. Majority of comments, while numerous, were on previously adopted and substantiated language solely brought forward and reformatted into ASHRAE 170 including the ventilation table. These comments are considered "outside of the rule making” and resulted in no change to the original proposal

66 Outpatient Observation Unit(a) For purposes of this chapter, “observation services” means outpatient services provided by a general acute care hospital and that have been ordered by a provider, to those patients who have unstable or uncertain conditions potentially serious enough to warrant close observation, but not so serious as to warrant inpatient admission to the hospital.

67 Outpatient Observation UnitOriginal Proposed Language - Withdrawn ✔ ✔ These requirements fall under the 2016 CBC section: EMERGENCY SERVICES Other Space Considerations Observation Units

68 Outpatient Observation UnitOriginal Proposed Language – Referenced Requirements Other space considerations. Observation units. Observation rooms for the monitoring of patients up to 24 hours may be provided as a distinct unit within the emergency department. If provided the unit shall have the following: Handwashing stations shall be provided in each patient room or for each four treatment stations or major fraction thereof Each patient station shall have a minimum of 120 square feet (11.15 m2) of clear floor area One toilet room shall be provided for each six treatment stations or major fraction thereof An administrative center/nurse station A nourishment area ✔ ✔ ✔ ✔

69 Outpatient Observation UnitSB 1076 Intent Definition and Purpose: SB 1076 defines “observation services” as “outpatient services… to those patient who have unstable or uncertain conditions potentially serious enough to warrant close observation, but not so serious as to warrant inpatient admission to the hospital.” Observed acuity should be less than what would be readily apparent for immediate inpatient admission. Potential Use: Patient Type 1 - New patient: Outpatient Observation only (with no admission) Outpatient Pre-Admission Patient Type 2 - Existing patient: Outpatient Post-Discharge

70 Outpatient Observation UnitSB 1076 Intent Required 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 a patient’s condition or determine the need for a possible inpatient admission to the hospital Question: What is implied by “reasonable and necessary” for patients currently at an outpatient status with the potential for inpatient admission? 

71 Outpatient Observation UnitSB 1076 Intent Analysis - Patient Station: CBC 2016 CBC (effective thru 12/31/2006) Nursing Unit Single Patient Room 110 sf 120 sf (3 feet sides and foot of bed) Mullti-Patient Room 80 sf / bed 100 sf / bed (3 feet clear between beds & 4 foot of bed) Emergency Services Treatment Room 80 sf 120 sf single or 80 sf/multi-gurney (the least dimension shall be 8') (3 feet sides and foot of bed/gurney) Observation Room No Stated Size

72 Outpatient Observation UnitProposed Language Revisions Patient Care Space: 120 sf per patient sf single or 80 sf multiple patients Negative Pressure Isolation: Optional patient isolation provisions defined Time Limitation: Reference to 24 hour maximum not included Location: Corridor systems shall connect unit to all Basic and Supplemental Services Utility Services Infrastructure: Nurse call, emergency power, and portable oxygen

73 Outpatient Observation UnitProposed Language Revisions Defined Service Areas to Support a Stand-Alone Unit: Supervisor Office Staff Toilet(s) Multipurpose Room(s) Conferences Reports Training Consultation Examination or Treatment Rooms Medication Stations Nourishment Areas and Ice Machine(s) Clean and Soiled Utility Support Spaces General and Emergency Equipment Storage / Gurney & Wheelchair Storage

74 Next Steps Next Steps Client Review Comment Period PIN DevelopmentHBSB Committee CBSC Adoption

75