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Home My WebLink AboutBUSINESS PLAN 3/16/2006~ i ~ BAKERSFIELD THERAPY CENTER 6001-C TRU%TUN AVE, STE 380 I~ ~ ~~ ~~ ~ /4 ~,~:~ ®5 Z~Q3, Ty ~' f BAKERSFIELD THERAPY CENTER __________________________ SiteID: 015-021-002457 + Manager GARY FINLEY BusPhone: (661) 638-0643 Location: 6001 TRUXTUN AVE C-380 Map.: 102 CommHaz Low City BAKERSFIELD Grid: 34A FacUnits: 1 AOV: CommCode: BFD STA 11 SIC Code: EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title GREG CAGLE / ADMINISTRATOR / Business Phone: (661) 638-0643x Business Phone: ( ) - x 24-Hour Phone (661) 387-1569x 24-Hour Phone ( ) - x Pager Phone (661) 627-2750x Pager Phone ( ) - x t---------------------------------------+--------------------------------------+ Hazmat Hazards: Fire ImmHlth DelHlth.~_._ Contact GARY FINLEY Phone: (661) 638-0643x MailAddr: 6001 TRUXTUN AVE C-380 Stater CA City BAKERSFIELD Zip 93309 Owner CENTRAL CALIFORNIA THERAPY CTR IN Phone: (805) 544-3415x Address 1220 MARSH ST State: CA City SAN LUIS OBISPO Zip 93401 Period to TotalASTs: = Gal Preparers _ TotalUSTs: = Gal Certif ' d: RSs : No ParcelNo: Emergency Directives: PROG A - HAZMAT _ _ _ _,--_ - _ - - - -~-~=--~ --- .~. ~_.. - . - -- ~ - ~ ---- w = - - - -- - - - -~ ---- - - - - - - - ---- - -{{fi~nn l ~~~ ~~~ LUG Based on my inquiry of those individuals responsible for obtaining the intormation, I certify under penalty of law that I have personally examined and am familiar with the information submitted and believe the information is true, a and complete. -- ~ 3 ,b - . u - ~ Dat -1- 03/13/2006 UNIFIED PROGRAM INSPECTION CHECKLISTS= L9t.a. '.;.:1':-e_'.4°.~Y:i{P"S;LYfi3PYn':~;"_~.::: "rcT^.,cn.A.R ::..'?ia.2Y k.. .:v... w.i.'.cfk. E....-, ..a ,~..e.... _. ..sT ... ~ r..~, ...'«"., t., t.x ii:'3. SECTION 1: Business Plan and Inventory Program BAKERSFIELD FIRE DEPT ,a Prevention Services 1-IR/ 900 Truxtun Ave., Suite 210 ~RrAI r Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 872-2171 n.. FACILITY NAME ~~~ 1 ~nev~y C~~~ NSPECTION DATE i~ W b'- ~ ~' INSPECTION TIME 1 0 3 0 ADDRESS 60o I L i ru~c~-~.~ 3~ ~~ HONE NO. 66~ - 33`/-~ O OF EMPLOYEES ~ FACILITY CONT~,.T ~~~•, / ~/! o u ~ Y USINESS ID NUMBER `~ ~-7 ~ S'O21 ~ ~2y s / Section 1: Business Plan and Inventory Program r - ROUTINE ^ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V (c=Compliance OPERATION V=Violation COMMENTS ___ _______ ^ APPROPRIATE PERMIT ON HAND . ^ BUSIr1BSS PLAN CONTACT INFORMATION ACCURATE ^ VISIBLE ADDRESS Ltd ^ CORRECT OCCUPANCY VERIFICATION OF INVENTORY MATERIALS ^ VERIFICATION OF QUANTITIES ~/ Ind ^ VERIFICATION OF LOCATION ^ PROPER SEGREGATION OF MATERIAL ^ VERIFICATION OF MSDS AVAILABILITY ^ VERIFICATION OF HAZ MAT TRAINING ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ^ EMERGENCY PROCEDURES ADEQUATE ^ ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE? ^ YES Lfd NO EXPLAIN: _ QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 G~e,bb, W~yers , pia~f' l i -L ~- Inspector (P ease Print) Fire Prevention / 1°~ In /Shift of Site/Station # >?pp5 White -Prevention Services Yellow -Station Copy Pink -Business Copy FD2049 (Rev. 02/05) _.r.. . / / .~~ }:;' '\~ BAKERSFIELD THERAPY ~ER SiteID: ~15-021-002457 Manager : GARY FINLEY Location: 6001 C TRUXTUN AVE 380 City BAKERSFIELD CommCode: BAKERSFIELD STATION 11 EPA Numb: '),~~') ~ ~'\}~ ~ BusPhone: Map : 102 Grid: 34A (661) 638-0643 CommHaz : FacUnits: 1 AOV: SIC Code: DunnBrad: Emergency Contact / Title Emergency Contact / Title GARY FINLEY / ADMINISTRATOR GREG CAGLE / ASSIST MGR Business Phone: (661) 638-0643x Business Phone: (661) 638-0643x 24-Hour Phone : (661) 589-9786x 24-Hour Phone : (661) 387-1569x Pager Phone : (661) 703-9333xCELL Pager Phone : (661) 627-2750x Hazmat Hazards: Fire ImmHlth DelHlth Period : Preparer: Certif'd: ParcelNo: to Phone: (661) 638-0643x State: CA Zip : 93309 Phone: (805) ) 5-4454x43415 State: CA Zip : 93401 TotalASTs: = Gal TotalUSTs: = Gal RSs: No Contact : GARY FINLEY MailAddr: 6001 C TRUXTUN AVE 380 City : BAKERSFIELD Owner Address : City CENTRAL CALIFORNIA THERAPY CTR,IN 1220 MARSH ST : SAN LUIS OBISPO Emergency Directives: ~Q (j¡1~Y hlUt-t:'/ Do hereby certify ihai i have (Tv~ ór print narn<~) O"~iewed the attached hazardous materials. manags- msnt plan 10'f".<· M.t:ItltN c1.MV1""~nd that it along with (Name 01 Business} ©lny corrections ~onstitu~~ Ia1 c©mplsts and corred mêØi1- ~~m~fi1t ~iaJi11oli' my ~~diity. , . ~~ ' SiWUltura 7-,ÃG'- ð3 Date -1- 07/15/2003 , /"'. . :::;- .,.--boT BAKERSFIELD THERAPY C~ER F I f= Mitigation/Prevent/Abatemt Release Prevention SiteID: 015-021-002457 9 Fast Format 9 Overall Site 9 03/21/2003 CHECK QUARTERLY USING REGULATOR PRESSURE GAUGE TO CHECK FOR LEAKS Release Containment 03/21/2003 EMS, 911 AND BAKERSFIELD FIRE DEPT ENVIRONMENTAL SERVICES Clean Up 03/21/2003 ¡HGII'f r.ŒAh'fIICA:rtE IMC. FOR CLEAN ur MID RRCOV¡¡¡:RY Nf 80"0 '7'7' ð - l..UHS C.4/tC hJftZ:>lerl¿ l,vtj., ~DL (!¿.t;14A.J ¿)P 141iJ!) Rct!.(Jv'/.."7t y ,lJ..r Other Resource Activation -5- 07/15/2003 03/17/2003 10:55 6616.2 BAKERSFIELD TJlllÞV PAGE 02 --~.,.._.. fFæ© t:t HAZARDOUS MATERIALS FACILITY INFORMATION ~ø~..r... ..ã.d,*~-.dI.__""""'.""'"""""_""I"~__,,,,.,......IIIIW"Am..af. BUSINESS OWNER I OPERATOR FORM Page 1 of Bakersfield ]fire Dept. Environmental Services . 1715 Chester Ave Bakersfieldt CA 93301 Tel: (661)326-3979 ;:!;iitr.~P¡!);*~!!r~" , ';¡è,i.iiv ',~No C.A a D\,/SINE&S P¡'¡ONIi 1a:t Ü, lsJ I - 1;..3..i..:=-.-0 lID St~. ~')SO 1DI ZIP 1Q CA q~~~ tœ SIC CODE 1IIr (40101111) ...-.--.---" -. ".-.. ,...--...--.-- 1!B no ''1:1 , ',!:~~~~~I~~~i;' "0 na five. 1<. S+~". .3 gO, 122 123 m 130 128 131 ...---.... 127 132 128 133 . :,~",)!i:~!!J::;~ii2i;i;]!;~~~:i:~#~~:~~·::;:'L(~:'!~ Çer1fft....an: l!àalCl on my Inquiry allII_ IndMd~ø" ....pOI'IlII~e fOr oOtlllnlng tha InronnallDn. 1 IIIVIIfy under Plnlll)' lit I... thai ~_ perBONllTY """",Inad and am f8mør wi", tho Inronna/kIn IIUbmIIbId In 1/118 In~ """ bel8V8 Þ InfatmøIllM 18 IfW, .........to, _ oompIol8, 135 136 137 fd2090 83/17/2883 18:55 6616.2 BAKERSFIELD T~V PAGE 83 __._..._ 0_--' HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION Bakersfie1cl Fire Dept. Environmental Serrices 1715 Chester Ave Bakersfield, CA 93301 Tel: (661)326-3979 (0n6 form per matertal per bllÎlding or .res) Page1 of 20' CÞOIEMICAI. ~OC/ITION 202 CONFII:JENrW. (EPCRI\) !::J '1'... 0 /IIcI 2œ GRID No. (GI/onoII) 204 CHI;MlCIII. HAM( 0 xYj~n COMMON N,llUI! Q )(' en CAS No, TRADe SEéFI¡;T r:J '1'89 I5iI' N" 206 If Subee11o EPCRA. rllle~cIIcnII 201 eHô' [J Yea J4 No 208 209 '11 molS ""'fØ$.' ail_nil blat..., l1li11 bolo In Ibe. FIRE CODe HAZARD Cl."MI!S (Com"'." lV4IJetled br loeal 1ft Chlo;ol) 2'0 TYPE P( p I'URe LJ m MICTURIi a w WASTE 21' ~'2 CURES 2'3 PHYSICAL STATE d , 8OI.J) o I ~1QlJD ~OGAS RAOJQAC11Vf 0 v"" þq No 214 LARGEST COlft'AINER 'E;" .. rder J.5 C.r. 215 FED Hl\ZARD CATEOO!'ll§ (Cheek ~lthRIlIJI!ly) c:J 1 FIR!: o 2 AI!ACTlVE (] 3 PR&8SURE FlELEA$E o . ACUTE ItALTH !:II 9 CHRQIIC HElll.TH 216 ANNUA~ WAST!! '--ì r-7''\ "!looNT c:X..-~ U 217 Mt\XIMUM 0A1l V ^IIofOUIVr 0757) 218 A~E DAI~Y AMOUNT c:;,Sü 218 STATe wl\8Tl! CODE a2Q UNITS· (] 00 GAL " EHS. .mount muo! be n lbo, ~ lit CU FT a .. LBS [J tn TONS :!'-1 DAVSON SITE aaa 223 STOIWõIi CONTAlNI!R CJ . ABOV¡;GROUNtI TANK Or CAN LJ k BØ< ~ II TANK WAGON (011"'* 1lil1ho' ep¡¡/yJ d b UNDcRO~ND TAHK [JgCARIIOY )11 CYUNDER [] q RAIL CAR (j II TANK INSfDÉ 8J.lt.OfNG (j ~ tllO (j m GlASS aoTT1.1i: (j r OTHER [J d STæL OAUM d I FIBER DRUM [J n PI.A8TIC BOTTLE (J .. PLASTICINO"""'~TAWC DRUM [] J IJAG [] 0 roT£ SIN CJ . AMBlliNT )( III' AIOVE AMBieNT [J bD eeLOW AMaII!NT 224 STORAOe; PIII!SSURE - ~-'" _.. ..,--- If" AMeI!!HT o RIO ABOVE AM.!II!¡JoII" tI ba BELOW AMSJENT o c ~"'OOI!NIC 225 $fORAGE TEMPERATURe 228 2Z1 CJ .,... CJ NI!o 228 2ZII 2 e30 331 CJ VBI ONa 232 233 3 234 235 QVaII ONo 230 237 4 238 239 CJ YAA ONO z.4O 241 G 242 243 OVBI ON" 2<14 248 03/17/2003 10:55 6616.2 BAKERSFIELD'T~V PAGE 04 ....- - - .,-. -. HAZARDousMATEmALSMANAGEMENTPLAN~ORMS Section Discovery and Notification Page 1 of2 . Bakersfield Fire Dept. Eøvirolllmenta1 Services 1715 Chester Ave Bakersfield. CA 93301 Tel: (661)326-3979 INSTRUCTIONS 1. To avoid further action, return this fonn within 30 days of receipt. 2. TYPe/PRINT ANSWERS IN ENGLISH. 3. Answer the qoostions below for the business as a whole. 4. Be as brief and concise as possible. kq-.sPield, C'A_ <l=J."-?Q9 ^, ~1iAK Dlm:C'J1ON AND YONTORING I'ROŒDURES: (!..he(!..k q.(}...o....-nrly: l.I..6in~·' t<.e.~u..'-~TßR.-P~SSu..R..E ~F\4gE; " to ~h~~ k. t!or- \ ~~k s B. er.tPl.OYEE ANO AGENCY NOTIFICATION: (ern~ql/ - ßo.k.e,rsf¡e./c{ Fire. D~po..rl-me.n+ C. E/llllllWNMENTAI. ttllSI'ONSE IoIAHAGEMENT: ,~k.~..s.pi~k( Fi.....e Dept. F; I" viR.oy.¡rn~,.¡-I.:a..J $e.rv "~e5 D. Et.IEROENC:V r.tEOICI\L FLAN: (~Ir\ S J q II ~ 0 xy~e-Y\ 5i.A.pp I í er - Ri~h+ He.a..H-hca.r'€ :tne,. ( ioc'J) ì 7ð - J/ gg A. w.v.RD ASSEGMENT AND F'A1W¡iNTION MEASURES: (he.~ 1 u.A......-te.r-f y ~ u..S iC\~ \' R.~~u..LAJO ft.- PR.€,sSUR.€ CbAu..Gg" *=0 c..hl{c,k" ç~", I <tal< s B. ÆL.fAS,. CONTAINMEtfT AND/OR MmOAT1ON: ( l:/VlS J q I,) l?:ø..ke.rs ç ¡ tl. \ cl F i,..~ \J ~p\-. E.f\'( ~ R.,C:lIVIY'le.rtÌ'o..\ ~1Z.("v i ce,S C. ClIAN-UP AIID ReCOVERY PROCEOURE8; ~i~h.+ ~~~l+hcQ..re. I:n.C!-. ~r QJQ.a..Y\ LlÇ\ ~ rec.~very 0.+ ('ìQO}ì70-/lfE fd2085 03/17/2003 18:55 66163.2 BAKERSFIELD T~V PAGE 135 ..- --. - --... Page2of2 IJTIUTV $tiUT.oFF$ (LOCATION OF SHl1ToOFF4! AT yOtJR FACIIJI'V) ..~"'-~~~ ~ ' , ELECTRICAl! C~.ñ , .' ' ..- ~ "'6~. """- IÆ-~ -. $PECIAI.: LOCK BOil:· [] YES [ rtC IF Y9, LOCATI01'I: PI'IIVArI! FIRE P/IOTEOT,QNM'ATER AVAILA6IJ.ITV A, pRIVATE FIRE PROTeCTION: ,rON ~ B, WATER AVAlUlBIUTY (ARE Hyr;¡RANT)1 ø J N \¡oJ ...&6 .J.~r~!J } -r-::; I A ~:. N. ~ ' .t] ~JLu..e.dÚ?tÔ u:.!J .ð7L ,J€.LI.)I..-ru..N Ve .. fS; S o.~ p, ~ s ~ 1'\",," . - - -~ --. .--. "- .-. "'- '-" _. ~AL SAFETY ~TA SHlaETS OM PII"E; _ J. Ad.n,iN'1.s+...afor"(~ offic.e..."¡' I~ '::f.~ BRIëI' SUMMARY 01' TRNN!/>IO PAOGRAMI }~ OX~~~I ~(d~~~+y \io.r"I~t:H.c..t~ ,,)0::\ ç\O''''''.,....d,bl\:+~ ) b~ Þ~opllr Cd. s+r.)rC\~-e. c.) Pf"OpU- D'ð. 'lì.ø..t"\ð.'E.11flC?:JI J.) Prop~r ð~ o.d.Mir''f'3"h-a:bol'\) e) ~~rrt~f"I~"IC!e. ~t- ()a.. '5 '1-:="h rf\.. , c1,) D~",t! r't,6"h"o.-\-"\b \"\ ~ ~ Çr~\ \ouJ II"\~~ Q0 $Gtf~'~ (!.ha.I""\~' \'\~ ç.$)L.'.H'fJ ~~,r" ~n oxy~~t"'¡ S~6~'''\ b~ ~_.ç<:: +<-<?"'5P()rla.-\'I~N a~ C"'Y'j~($ c.~ ~dj~rf'f- \~+ Ç'ou,)Y'Y\E,:m..lç;o .o...~'v\ì~\{f<t p\""CR~,r Ö'J..'tqe.t'\ ¥Iow ~ö ~:"he..rt±-.lLlsin~ oS<.1~~n $~ ~te-'I'f"- d.\J.R.t'L+\O n ~h.d\.rt) ci ~ e...hE:a çf:)r' \ e.ca.k~ .ç"b "^ ~ low~e.~(" tLr"\J... Dx i ~ ~t'\ ~ '\ 6+~ VY\. . -~.... tlased on my Inquiry Of those fndivÎduaf8 responsible for obtafning the informat(on, I certify under pensftyofflJw that f haw personnafy examined and am familiarwíth the inform9tJonsubmilt9d and believe the infomlat/on is true, accurate, and complete. OATE 47., ".._3 --: J 7 :_t?3__ ."__ ___, 418 TITLE OF SIGNER 418 ¡J vJ "£" s FIRE EXIT TRUXTUN AVE. FI RE E rf . Q w "- ~ "'" "- I\) Q Q W ~ Q I" .(J' (J' (jt (jt .... (jt . I\) t¡; þ ^ fTl ~ H fTl r t:J .. < FRONT DOOR ~ Q (jt 03/17/2003 10:55 66163.2 BAKERSFIELD T~V PAGE 01 flfiLD i~ 13 A Tr'CIU.Il" '·1 ' , .. ~~,,: .,1, I TfIEIU\,}='Y 6001 TRUXTUN AVE. sre 380 BAKERSFIELD. CA 93309 PHONE: 661·638-0643 FAX: 661·638·0812 FACSIMILE TRANSMITTAL SHEE1' '1'0: ß q... t+ COMPANY: ~ ~t> G:S PAX NUMBER! ~sa- ~\~ \ PHONB IIItJMB£R.¡ .. PROM: .j , IÀ.n~ DATEr ~ \ ,3, \\ ~~ TOTAL NO. 01' pAGBS INCLUDING COV:ER: iA SBNDBR',S UnlmNC!1.' NUMBBIl: IlB: \\0. oz."- 'r d. CJ \^. S fY\.ccl-e... i "- \ S YOUIlIIBPBIlBNCB NUMIJ:BR.: o UR.Gf.>NT 0 POR REVIEW [J PL£ASE COMMENT 0 PLEASE REPL¥ D PLEASB RBCYCLB NOTBS/COMMENTS: ~, ~ .J.d ,V'rNi- ~ (' 1 lW vrwuJ.... ~T~~ -D @ S2/07/2003 14:24 e 6616380812 ¡; - BAKERSFIELD THERAPY Baketsfield Fixe Dept. ~ ! -~ --- RevieweraSignature: / ~=-- Date: ,;¿ - 7-03 Reviewers Name: o ~ "V1f(5 PAGE 11 q . I ~OJ rIì \ ~(\ \}\Y ~ Á0> reviewed and approved. ).02/07/2003 14:24 e 6616380812 BAKERSFIELD THE~V PAGE 02 Effective Date: BAKERSFIELD THERAPY CENTER 8/28/02 Title: Drills and Staff Trainina RevlêW Date: Subjeçt: On-going training and drills for personnel associated with the facilitv in disaster c recaredness Revision Dates: Key Words: I-Codes: Number of Pages: Emergency 1-599 - 601 Page 1 of 1 Drills Policy Name: Drills and Staff Training policy Statement: The facility will provide ongoing training and drills for all personnel associated with the aspects of disaster preparedness. All new personnel must be oriented and assigned specific facility disaster plan responsibilities within two weeks of their first workday. Purpose: To ensure smooth and effective procedures In case of an emergency Procedure: A fire evacuation drill will be conducted quarterly. and it will include the patients and staff. Each facility staff member will assume his/her pre-assigned fire station. When the location of the fire is announced, the Administrator will instruct staff which side of the building to use to evacuate patients. The alarm monitoring company will be advised of the drill in advance to avoid dispatching the fire department. Patients will be evacuated to the front parking lot. If that location is unavailable or cannot be reached, the alternative location will be the back parking lot. The Administrator will contact the local fire department or Emergency Management Services EMS) to ensure the disaster plan is consistent with the local disaster plan. The names of the staff and patients, and the evacuation time will be recorded in the Disaster Drill Log and retained by the Administrator. The first drill will be conducted and documented prior to the time of the first survey. The following procedures will be observed, and the personnel assigned are as follows: Procedure Personnel Contact Central Station in advance Notify and coordinate staff Announce location of alarm Assist mobile patients to exit the facility Assist non-mobile patients to exit the facility Check restrooms, storage areas, office areas and meeting areas Re-check restrooms, storage areas, office areas and meeting areas Confirm completion and evacuation with staff and aocountftoreveryone Note and record In log elapsed evacuation time Notify Central Station of test completion .132/1371213133 14: 24 e 66163813812 e BAKERSFIELD THERAPY PAGE 133 .' BAKERSFIELD THERAPY CENTER EMERGENCY DRILL REPORT TYPE: o Earthquake Drill 0 Medical Emergency (please Check Appropriate Box) o Fire Drl,II D.Bomb Threat Drill Persons In attendance: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Staff Response to Drill: Areas that need to be addressed: Time Stated: Time Completed: Administered by (Signature): Date: .02/07/2003 14:24 e 6616380812 e BAKERSFIELD THERAPV PAGE 04 .' Effective Date: BAKERSFIELD THERAPY CENTER 8/28/02 Title: Fire ReQulations Review Date: Subject: Procedures concerning a fire in the facility Revision Dates: Key Words: I-Codes: Number of Pages: Fire Alarm 1-572 - 575 Page 1 of 2 1-597 - 598 Policy Name: Fire Regulations Policy Statemênt: The building in which the facility resides has an approved installed fire alarm system in place and operational. The facility will ensure maintenance of the fire alarm system according to the contract with the building owners. Purpose: The facility will have alarm systems, signals and emergency fire fighting equipment to ensure the safety of all patients, families and staff. Procedure: Instructions regarding the location and use of alarms, and fire fighting equipment will be visibly posted in various places throughout the facility and its exits. Personnel will be trained in the use of such equipment and periodic fire drills will be conducted. In the event of an alarm, fire, smoke, explosion or other disaster, all patients, visitors and personnel are to immediately evacuate the building by the identified routes. Upon hearing a fire alarm, evacuate all patients, visitors and staff and search your assigned areas. Tell people to leave the area immediately and direct them to the closest safest exit. Move throughout the area to direct people. Check all areas of the building such as treatment rooms, restrooms and offices. If smoke is heavy - - crawl along the floor to the exit. If you must leave a room through a hallway, check the temperature of the door with the back of your hand first. TVDes of Fires Class A: Fires with ordinary combustible materials such as paper, wood, textìles, rubbish. Extinguishing agents for this type of fire are: water, foam, and multi-purpose dry chemical. Portable hand extinguishers should always have an underwriter's rating of at least 2A. Class B: Fires in flammable liquids, oils where a blanketing or smothering effect is essential. Use carbon dioxide or dry chemical extinguishers. Class C: Fires in live electrical equipment, such as switch boxes, motors, generators, circuit. etc., where the use of a non-conducting extinguishing agent is of first importance. Use carbon dioxide or dry chemical extinguishers. The facility will maintain exit lights by each exit door or route, and emergency lighting in case of power outage. Upon weekly inspection of the facility, all exits and emergency lights will be checked. If they are not functioning properly, they will be repaired or replaced immediately. Exit signs are well lit and illuminated and located over every exit of the facility. Emergency backup batteries are within the case of each exit sign to .02/07/2003 14:24 e 6616380812 e BAKERSFIELD THERAPY PAGE 05 . Effective Date: BAKERSFIELD THERAPY CENTER 8/28/02 Title: Fire Regulations Review Date: Subject: Procedures concerning a fire In the facility Revision Dates: Key Words: I-Codes: Number of Pages: Fire Alarm 1-572 - 575 Page 2 of 2 1-597 - 598 make sure they will stay illuminated in the case of power failure. Battery back-up systems will be inspected for efficiency, on a monthly basis Alarm Pull-Down. Stations are located at the front door entrance and throughout the center. To activate, push in and then pull down. Signs and instructions are located and clearly marked on top of each pull down station. Pull-Down Stations are tested monthly and are connected to a central monitoring dispatch service. Upon notification by anyone of a fire or disaster in progress, the personnel of the facility or its patients or visitors can activate the alarm systems. Multi-Purpose Dry Chemical Fire Extinguishers are located in several conspicuous and accessible places In the facility. All staff members are trained in their use. The fire extinguishers are inspected monthly for condition by a staff member, and annually by an outside certified professional. The staff member closest to a small fire in process is expected to secure and operate any of the several fire extinguishers in the facility. The contents are dIscharged by pressure and the procedure Is as follows: · Hold the extinguisher firmly in an upright position · Stand a minimum of 6-1 0 feet from the fire · Stay low to avoid inhalation of smoke, and aim discharge just under the flames using a slde-to-slde motion, sweeping the entire width of the fire · Wall fires: start at the bottom, sweep from side to side and progress upward · Floor fires: sweep from side to side and move forward as fire diminishes to reach far edge · Never move Into area where fire was burning, even though it appears to have been extinguished; you could be trapped and burned if the fire re-flashes · Never use water on electrical fires · Never use extinguishers at a distance of less than 6-10 feet Evacuation routes and procedures for leaving the facility are posted .02/07/2003 14:24 e 6616380812 e BAKERSFIELD THERAPY PAGE 06 Effective Date: BAKERSFIELD THERAPY CENTER 8/28/02 Title: Occurrence Reports Review Date: Subject: To document work-related incidents at the facility Revision Dates: Key Words: I-Codes: Number of Pages: Occurrence, Page 1 of 1 Incident Policy Name: Occurrence Reports Policy Statement: Unusual occurrences, accidents, incidents and other events requiring documentation and investigation must be reported. Purpose: To ensure appropriate follow-up of all unusual occurrences, accidents, and incidents; and to prevent future similar events, if possible Procedure: All incidents involving patients, visitor, or staff will be reported by the Involved personnel on the appropriate form! generally Occurrence Report. Medical device reporting is on FDA Form 3500A (MEDWATCH), completed by the personnel involved. The Administrator will investigate and report findings to the Administrative Board and when appropriate to the interested State and Federal agencies. Any bodily injury incident shall be timely reported to the insurance company when facts are reported by witnesses. Any incident Involving thievery or assault shall be reported to local law enforcement immediately. .02/07/2003 14:24 e 6616380812 e BAKERSFIELD THERAPV PAGE 07 J BAKERSFIELD ~ ~ An incident is any happening, which is not consistent with the routine operation of the facility of the routine care of a particular patient. It may be an accident or a situation, which might result in an accident. ¡-rI-IERAPY 'If' !I 0[[îiE- "'1] ~"H'"" ,1,;'" /1 "I '''' 'I,,, "j""" ~ I ~! !~J \ "'It; !nt' ~~I I "" ,'W ij"1'.~ Person Involved Last name: First Name: Middle Initial: I Home Address: I Home Phone: I Male/Female Age: City: State: Zip Employee 0 Business Phone: Cell Phone: l Occupation: Job Title: I Visitor 0 Other 0 Specify: - I l Patient 0 Date of Incldent-'_/_ Time of Incident _:_ Exact Looation of incident: Was the erson authorized to be at location of incident? Yes 0 No 0 I Reason for Presence in this Facilit~: Patients Condition Before Incident: Normal 0 Senile 0 Disoriented 0 Sedated 0 Other: Describe exactly what happened, why it happened and what the causes were. If property or equipment were involved or damaged, describe damage, If an injury occurred, mark the part of the body injured on drawing below. Attach if needed. Was it necessary to notify physician? Yes 0 No 0 If yes, time notified A.M.lP.M. Time WaLH~nø"rson i~<MtlRjf"een by a physician? Yes 0 No 0 If yes, When Whére Physician's Wmufirst aid admioißtered? Yes .D No 0 If yes, When Where By Wåølthe person involv.ed t:lkM to tbe hospital? Yes 0 No' 0 If yes, When Where 6y Whom r02/07/2003 14:24 e 6616380812 e BAKERSFIELD THERAPY PAGE 08 ;¡ BAKERSFIELD ~ Ö THERAPY Indicate location of Injury. TYPE OF INJURY In~.I,C!lte.J~g!.tl?!! of ilJ.J..I!ry. 1. Laceration 0 2. Hematoma 0 3. Abrasion 0 4. Burn 0 5. None Apparent 0 6. Other Fatall Non-fatal Name, address & phone number of witness{s): Date of report: Title & Signature of person preparing report: ~Ø2/07/2003 14:24 e 6616380812 e BAKERSFIELD THERAPV PAGE 09 Effective Date: BAKERSFIELD THERAPY CENTER 8/28/02 Title: Extreme Weather Conditions Review Date: Subject: Safety of patients, personnel and visitors during extreme weather conditions Revision Dates: Key Words: I-Codes: Number of Pages: Extreme, Page 1 of 2 Weather Policy Name: Extreme Weather Conditions Policy Statement: The facility will be prepared to respond to extreme weather conditions typical for this area, and any potential disturbances. Protection will be afforded to patients, visitors, staff, contractors, and any other person in the facility affected by the extreme weather conditions. Purpose: To ensure the safety of all patients, visitors and staff during extreme weather conditions and/or disturbances or threats Procedure: During violent weather, the Administrator will monitor public broadcast stations for weather advisories. Some of the major weather conditions are: · Tornadoes and micro-bursts · Severe thunderstorms Tornadoes and microbursts normally occur between March and September, but can occur at any time. Tornadoes form several thousand feet above the earth's surface, usually during warm thunderstorms. They appear as funnel shaped clouds and rotate in a counterclockwise direction. Their paths are about ~ mile wide, 16 miles long, and they travel at about 30 mph. Emergency actions would be as follows: · Keep tuned to local radio or television station -Keep appropriate windows and doors open to reduce air pressure and keep the building from exploding · Move all staff, patients and visitors away from glass windows, doors · Provide towels or sheets, that can be passed out quickly for patients, visitors and staff with which to cover to avoid injury from flying glass or splinters · Keep portable radio, flash lights, first aid kits, and emergency medication readily available · If a warning is announced that a tornado is in the area NOW, move patients. staff and visitors to a central area - away from windows and reassure and calm patients as best as possible. · Should damaging wind strike. help patients take cover In any way possible. Keep listening to the radio for further updates and information · Under no circumstances will an employee leave the facility in the event of a tornado warning if there are patients in the facility at the time .02/07/2003 14:24 e 6616380812 e BAKERSFIELD THERAPY PAGE 10 Effective Date: BAKERSFIELD THERAPY CENTER 8/28/02 Title: Extreme Weather Conditions Review Date: Subject: Safety of patients, personnel and visitors during extreme weather conditions Revision Dates: Key Words: I-Codes: Number of Pages: Extreme, Page 2 of 2 Weather Thunderstorms are generally not directly hazardous to individuals. Danger could be encountered from loose or downed electrical wires, altered traffic conditions, and slippery surfaces. Also, the storm could cause utility failures. Public warning is often received via radio. Precautionary measures should be minimal except that patients, staff and visitor should not go outside directly holding up metallic objects under conditions of thunderstorms. Umbrellas and similar devices should have some form of insulation if used during a thunderstorm. There can also be outside activities unrelated to weather which may create a dangerous and/or volatile atmosphere for the facility. A few of these are: · Civil disturbances · Demonstrations · Riots · Strikes · Bomb Threats Health care facilities should be prepared to cope with these disruptive conditions. The character and severity of the disturbances threatening will dictate the actions to be taken. The local coordinator of emergency services, police and public broadcast stations are sources of information about these emergencies. Emergency Actions would be as follows: · Monitor local broadcasts and coordinate actions with local emergency center · Evaluate the situation and determine appropriate action · Request assistance through the local coordinator of emergency service, if needed For Bomb Threats: · Stay calm · Keep caller on the phone line as long as possible, get as much information as possible · Be alert for distinguishing background noises, such as music, voices, aircraft and church bells, ete · Note distinguishing voice characteristics · Ask where the bomb will explode and at what time · Keep the caller on the phone line and alert other staff so they can notify police, Administrator, and other personnel · If the caller indicates a specific area, that area should receive immediate attention. · If any suspicious articles are found, DO NOT TOUCH THEM; clear all patients and staff away from the area __,~~/06/2003 09:43 . /é),) -3;/.4 //. 6616380812 BAKERSFIELD THERAPY PAGE 02 ó/S-(J;J-/ ~ óÓ ~(j57 HAZARDOUS MATERIALS FACILITY INFORMATION BUSINESS OWNER I OPERATOR FORM Page 1 of E5 Ç/t5/9 Bakersfield I1.re Dept. Environmental Serrices 1715 Chester Ave Bakersfield, CA 93301 Tel: (661)326-3979 101 tID 101 ZIP 11& CA q~~o'f tœ SIO oOOd (4 DlOIt #') '11ft 118 1m U1 132 133 184 MANE OF DOCUMENT PReP~ 135 JClI"\e...t l. \1eJ'\d.~t"so 131 fd2090 03/06/2003 09:43 e 6616380812 e BAKERSFIELD THERAPY PAGE 01 'D ^' TZ"'&'I'ID~'1:rI':&'LD·· ~ un.ø.J3.'\(Jr~ .ill.' ... :~ ú TIIEI{Þ~P:t~ : 6001 TRUXTUN AVE, STE 380 BAKERSFIELD, CA 93309 PHONE: 661.638·0643 FAX: 681.638-0812 FACSIMILE TRANSMITTAL SHEET TO: ße-# COMPANY:· y ß~b FAX NUMBER: ~5;). - ;),/71 PHONB NUMBER: DATE: FaOM: -.J D.. n e:t- 3-lD-03 TOTAL NO, OF P.AG1?$ INCLUOING COVER; ól. SBNDER'S RBPBJœNCB N1)M13ER: IŒ.: YOU!!' RP..I"ERßNCE NUMBER: J./Al..M..DðuS fYI,""+~,, i CA}S Fdc:íI rI-y ÎhPo, o URGENT 0 FOR REVIEW 0 PLEASE COMr.rENT 0 PLEASE REPLY o PLEASE RECYCLE NOTES/COMMENTS: Be H-y) P)~ø.S€ i-hi,..,~ ~r<;e, Je + yY\E:, k no w i.(l V (Ju..., n 'If e& a. n~ \h ~ n k "Jf.) u.... Pol' 'J 0 tI ( h~ I f> Q)