Attention all California Skilled Nursing Facilities!!
The Governor of California has signed a Bill that makes significant changes to Health and Safety Code relating to SNF Back-Up Power Systems!
This Bill – Assembly Bill 2511 (AB 2511) -- was signed in the back-half of 2022, but has now been picked up by HCAI (formerly OSHPD), which has rolled out its own enforcement plan for these changes. HCAI’s enforcement plan for AB 2511 is known as Policy Intent Notice (PIN) 74.
It may be helpful to consider the why of this Bill before delving into the what. There are two key factors at play here:
· In 2019, the Office of the Inspector General released a report titled “California Should Improve Its Oversight of Selected Nursing Homes’ Compliance with Federal Requirements for Life Safety and Emergency Preparedness”. This report audited a number of SNFs across the state, and concluded that the Department of Public Health had not done enough to ensure that SNFs comply with The Centers for Medicare & Medicaid Services (CMS) regulations for life safety and emergency preparedness. The audit uncovered rampant noncompliance: life safety requirements related to building exits, smoke barriers, and smoke partitions; fire detection and suppression systems, hazardous storage areas; smoking policies and fire drills; and, electrical equipment testing and maintenance… as well as emergency preparedness requirements related to written emergency plans; emergency power; plans for evacuation, sheltering in place, and tracking residents and staff during and after an emergency; emergency communications plans; and, emergency plan training and testing (Assembly Committee on Health). The culprit? Lack of management oversight and high staff turnover.
· Many of California’s recent wildfires have been caused at least in part by electric utility infrastructure. In response, during wildfires or even ‘wildfire season’, the state has begun intentionally shutting off power as a preventative measure known as Public Safety Power Shutoff (PSPS). This can happen suddenly and for long or indefinite swaths of time. While Skilled Nursing Facilities have had 6-hour emergency generator requirements for some critical needs, not having air conditioning or refrigerators on Emergency Power have left SNFs debating whether they should keep their patients there – without assuredness of safe temperatures for patients or for food – or evacuate. In consultation with the National Fire Protection Association (NFPA), the California Assembly Committee on Health determined that Skilled Nursing Facilities would need at least 96 Hours of emergency power at-the-ready in the case of either emergency power shut-offs or Public Safety Power Shutoffs. (Note: This is the same number of hours required in areas deemed to be a high seismic risk.)
AB 2511 and PIN 74 together increase the additional Back-Up Power System requirements for Skilled Nursing Facilities throughout the state of California. Specifically, all SNFs in California will now be required to provide an alternative source of power to protect resident health and safety for no fewer than 96 hours for power outages that may result from a public safety power shutoff, an emergency, a natural disaster, or other cause. Alternative power is required to maintain safe temperatures, maintain availability of life-saving equipment, and maintain oxygen-generating devices (HCAI).
Let’s break down some of the key features of this Code:
· Safe Temperatures: in emergency situations, this is considered to be between 71 and 81 degrees Fahrenheit. This temperature range must be maintained in Patient Care Areas, Areas where Stored Provisions are located, and in other areas determined by the Client and Design Team which are tantamount to the protection of patients and staff in the case of an emergency.
· Life-saving Equipment: includes but is not limited to ventilators, AEDs, crash carts with defibrillators, intravenous therapy equipment, feeding pumps, IV pumps, nebulizer machines, suction equipment, and medication dispensing machines. The Client and Design Team will need to determine what other items should be considered based on the specific needs of the facility and patients.
· Oxygen-generating devices: includes but are not limited to concentrators and positive pressure apparatus. The Client and Design Team will need to determine what other items should be considered based on the specific needs of the facility and patients.
· 96 Hours: As stated above, 96 Hours was the amount of time determined between the Assembly Committee on Health and the National Fire Protection Association, and mirrors the requirements already in place for SNFs in areas deemed to be a high seismic risk. 96 Hours refers to the onsite fuel storage requirement for each facility. Alternatively, a facility is allowed to have a mere 6 Hours of fuel storage onsite with an approved alternate arrangement for fuel delivery. While this may sound like a convenient escape route for these storage regulations, HCAI and CDPH will want to make sure the Facility can prove that this alternative arrangement will not be disrupted in the case of a seismic, fire, or other sort of emergency.
· Lastly, all new equipment or other remediation efforts will need to be seismically certified.
Now that we’ve covered the why and the what, the next things to tackle are the when and the how.
The when: All Skilled Nursing Facilities in California will need to comply with AB 2511 by January 1, 2024!!! Which means that SNFs have a lot of work to do, and no time to lose.
The how is broken down into two separate steps:
· HCAI requires that each Skilled Nursing Facility submit a Back-Up Power Systems Assessment, which evaluates the Facility’s current compliance with the new regulations, and provides proposals for remediation for each of the following categories: Safe temperatures for residents (heating and cooling); Life-saving Equipment; Oxygen-generating devices; Emergency Power System; and Alternative Power System. The Assessment will require Site Plans of the facility – including a Single-Line Diagram of the building power systems as well as a Roof Plan – and locations of items and equipment pertaining to each of the categories. The Assessment will be reviewed by HCAI and CDPH.
· Once the remediation proposals are approved, these will together inform the scope of the Remediation Project to meet these code requirements. The work will need to be approved and permitted to avoid citation by HCAI or CDPH.
The Farnsworth Group, Ltd. is already working with Skilled Nursing Facilities like yours on both Assessments and Remediations for AB 2511 and PIN 74. Our goal is to work with you to find the best solution for your facility, whether the solution is a brand-new generator or a hybrid design of new and existing systems. We will work within the code and your budget constraints to get through AB 2511 with a stamp of approval.