20121030101835482.pdfLetter Of Transmittal Washington State DepnrtmetTt of
October 30, 2012
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Construction Review Services
310 Israel Rd. SE
Tumwater, WA 98501
PO Box 47852
Olympia, Washington 98504-7852
www.doh.wa.gov/crs
tel. 360-236-2944
fax. 360-236-2901
Project Info:
CRS# 60196241
Project 21400 72nd Ave W
Aldercrest Health & Rehabilitation
location: Edmonds, WA 98026
Chapter 388-97 WAC Nursing Homes
Delayed Egress Installation
Local Permit #:
Key People:
Assigned DOH Mina Zarelli
Reviewer: mina.zarelli@doh.wa.gov
Facility Aldercrest Health & Rehabilitation
Facility Contact: Same As Administrator
Administrator: Rick Milsow
21400 72nd Ave W
Edmonds, WA 98026
(425) 608-2502 x.
X.
rmilsow@extendicare.com
Architect /
N/A
Local AHJ: City of Edmonds
Engineer:
Leif Bjorback
121 5TH Ave N
Edmonds, WA 98020-3146
X.
(425) 771-0220 x.
Bjorback@ci.edmonds.wa.us
Consultant:
RF Technologies
Consultant: N/A
Jessica Willis
3125 N 126`h St
Brookfield, WI 53005
(262) 790-1771 x.
X.
jwillis@rft.com
Contact:
N/A
Contact: N/A
X.
Copies To:
X.
®
Local AHJ: City of Edmonds
❑
DOH Child Birth Center Licensing
❑
Architect / Engineer: N/A
❑
DOH Office of Accommodations & Res. Care Survey
®
Consultant: RF Technologies
❑
DOH Office of Investigations & Inspections
❑
Consultant: N/A
❑
DSHS, , Div. Of Alcohol & Substance Abuse
❑
Contact: N/A
®
DSHS, Jennifer Brascher, Aging & Adult Services Admin.
❑
Contact: N/A
®
L&I, Bill Eckroth, Electrical Section
®
CRS File
❑
L&I, John Harvey, Factory Assembled Structures
Page 1 of 5 Plan Review Comments for Project #60196241
Facility Data Certificate:
Facility Name: Aldercrest Health & Rehabilitation
Site Address: 21400 72nd Ave W
Edmonds, WA 98026
Estimated Date of Occupancy: Occupied
Licensee UBI#: 600532262
Critical Access Facility: ❑ Yes ❑ No
Occupancy I-2
Construction
Applicable Code:
2000 NFPA 101
Group:
Type:
2009 IBC
Number of Current:
128
Added:
0 Removed: 0
Total: 128
>0
Beds:
Automatic Fire Sprinkler System: ❑ Yes
❑ No
Type
aAutomatic
Fire Alarm System:
❑ Yes
❑ No
Compartmentation req'd:
❑Yes
❑No
Smoke Control System Provided:
❑ Yes ❑No
w
Special Delayed Egress Control:
❑ Yes
❑No
Location:
Certificate of Need Required:
❑ Yes
❑No
CON Approval Granted:
❑ Yes ❑No
CON Number:
Number of units: Private occupancy: Two person occupancy:
aBased on size of rooms used for sleeping Residents
Z
O Based on size of common rooms Residents
Q0
H Maximum allowable licensable beds:
z�
Qualifies for Assisted Living Funding Program ❑ Yes ❑No Number of qualifying units:
U
Installation of delayed egress hardware on two exit doors.
The data above is based on the information presented to CRS. Any change in the facility or facility program that
causes the above information to be incorrect is subject to review by CRS. Approval for construction is not
approval for licensure. A copy of the facility data certificate will be sent to the licensing agency.
Page 2 of 5 Plan Review Comments for Project #60196241
Project Status:
The construction documents have been reviewed and found acceptable. Construction can begin, subject to
construction permitting from the local building official.
Once the project Close-out Requirements below have been completed, we will notify Department of Social
& Health Services (DSHS) that you have completed the review process and are ready for final inspection
Please note the following:
® The stamped "Authorization to Begin Construction" drawings will be delivered to the Facility
Administrator. These shall be kept available on site for inspection during construction and at post
occupancy survey.
® Final licensing approval is subject to a site inspection by DSHS and the Office of the State Fire
Marshal to verify compliance with licensing regulations and your approved documents. If stamped
approved plans are not available, the site inspection may be terminated until such time they are
available as determined by the licensing inspector/surveyor.
® Any changes/deviations (incl. change orders or addenda) from the stamped documents must be
submitted to the Department for review and approval.
® Please include your CRS number on all communications to Construction Review Services.
PROJECT CLOSE-OUT REQUIREMENTS You must notify the department when construction is
complete by completing the following steps:
✓ Verify that you have resolved all of the comments on this form and have submitted any revisions
✓ Complete the Notification of Construction Completed at:
at Pn/dot3jifl igip
✓ Email a copy of the approval from the local building department (final permit approval or
certificate of occupancy); and
✓ Email a floor plan showing the scope of work to: lsgf(iw 91F gl v.
If you have any questions please contact Construction Review Services at (360) 236-2944. You can monitor
project status at www.dc hma-"�oy/crs.
Page 3 of 5 Plan Review Comments for Project #60196241
Aldercrest Health & Rehabilitation
Chapter 388-97 WAC Nursing Homes
Delayed Egress Installation
Plan Review Comments:
U Q Z
0 Per the application two exit doors are to be equipped with special egress controls. With 8
or more exit doors accessible to residents, why are the controls only proposed for these
two doors? WAC 388-97-3420(1)
Facility Response 8115112: These two doors are extensively used and the egress controls
require considerable maintenance and repair. The controls are being replaced with new
equipment for better safety and security for residents prone to elopement. The remaining
doors have equipment that is working with minimal maintenance or repair.
Approved 9/12/12 — Per response, these door hardware at these locations are the
only the facility wishes to replace.
2 M Per the Infection Control Plan this project will not involve cutting into any part of the
wall or ceiling structure. Explain how/where controls will be installed.
WAC 388-97-3440(5)
Facility Response 8115112: #1 Entrance: This is our front and main entrance to our
building. A new system will be replacing an existing system. The new hardware will be
installed in the same location as the existing hardware so no cutting into any part of the
ceiling will be required. The door is a standard height door while the ceiling is elevated
(approximately 12'). There is six feet or more clearance between the door header and
the ceiling so the ceiling structure will not be affected.
#2 Exit: Here too the new system is replacing an existing system. The new hardware will
be installed in the same location as the current system. The ceiling in this area is
elevated as well (approximately 12) so the ceiling structure will not be affected. This
area will be blocked off to prevent residents from access the area during installation
unless there is an emergency. The door will remain functional as an exit at all times
during installation of the new hardware.
Approved 9/12/12 — Per response, the facility does not expect any new wiring. If
new wiring or other work will be required, the facility must submit a revised
infection control plan for review.
3 71 Explain how this system may be called a restraint -free monitoring system when its
activation restrains a person from exiting the facility. WAC 388-97-3420(1)
Facility Response 8115112: The magnetic lock will only be activated when a resident who
is not safe to be outside independently tries to open the door while wearing a wander
Page 4 of 5 Plan Review Comments for Project # 60196241
Aldercrest Health & Rehabilitation
Chapter 388-97 WAC Nursing Homes
Delayed Egress Installation
guard type pendant. These residents will be screened for safety, will consent to wear a
pendant (either self or through POA.) All other residents will have open access to these
two doors without restriction of the magnetic lock.
The Delay Egress system will be connected to the fire alarm and sprinkler alarm such
that if either is activated the magnetic system will not operate.
If the magnetic system is activated, it can be overridden by pushing on the panic bar on
the door for 15 seconds and the system will release the door.
RF Technologies will have to install a switch override for the fire control panel and
nurses station.
The Emergency Plan will be updated to include instructions regarding this system when
installed.
Approved 9/12/12 — Per response.
4 0 Provide a drawing locating an exterior area accessible without staff assist or local alarms
for residents wearing transmitters. WAC 388-97-3740
Facility Response 8115112: A drawing that follows lists the courtyards and gazebo where
residents may access outdoor areas. These areas are shaded, some have shelter, they
have firm stable walking surfaces accessible by wheelchair, and have well maintained
landscaping. Residents and families use these areas regularly. Residents who wear
transmitters require assistance from staff or family to access these areas. They wear the
transmitters because they are unsafe exiting the building alone.
Approved 9/12/12 — Per response, residents who wear transmitters are unable to
access any outdoor area without staff assistance or alarms.
5 ❑x Provide a drawing/information show the egress controls may be overridden by a switch
at each nurse station. WAC 388-97-3520(1), Sec. 1008.9.7(3)
Facility Response 8115112: Floor plan is attached.
Not Approved 919112 — The floor plan received identified the nurse station, but did not
clearly indentify the location of the switch override. Provide a drawing or instructions to
the contractor for installation of this switch.
Approved 10/10/12 — A switch override is located at each nurse station per
documentation received 9/20/12
Compliance with the comments above provided by the Department of Health, Construction Review Services are necessary for this facility to meet
the requirements of the applicable licensing regulations found in the Washington State Administrative Code and associated references. These
comments do not relieve the facility from the responsibility to meet the requirements of any other applicable federal, state or local regulations.
In the event of conflicts between other jurisdictions and these written comments, the most stringent shall apply.
Page 5 of 5 Plan Review Comments for Project # 60196241