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Home My WebLink AboutBUSINESS PLAN 10/3/2007:~;. n [~~ ~~) ~'~~ • II: ~ 1 ~° ~, ~ u ~ 1 a `1F$T.Id~'%3 I1l~D ~1Fd~i 0 ~~ II II v+~, .: BEVERLY MANOR CONVALESCENT HOSP Manager Location: 3601 SAN DIMAS ST City BAKERSFIELD SiteID: 015-021-000210 BusPhone: (661) 323-2894 Map 103 CommHaz Low Grid: 19B FacUnits: 1 AOV: CommCode: BFD STA 04 EPA Numb: SIC Code:8051 DunnBrad: p. ., ,.,, e ~ r~ Emergency Contact / Title Emergency Contact / Title / ADMINISTRATOR PETE LOPEZ / MAINT SUPR Business Phone: (661) 323-2894x Business Phone: (661) 323-2894x 24-Hour Phone (909) 648-9954x 24-Hour Phone (661) 325-3624x Pager Phone (~) Cps p~~~ 'Pager Phone (877) 705-3573x Hazmat Hazards: Fire Press ImmHlth Contact ~+1~~- E •~~e.R58N Phone: (661) 323-2894x MailAddr: 3.601 SAN DIMAS ST State: CA City BAKERSFIELD Zip 93301 Owner BEVERLY ENTERPRISES Phone: (877) 823-8375x Address 1000 BEVERLY WY State: AK City FORT SMITH Zip 72919 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT PROG C - COMM HOOD ~N~'D 0 C ~' 5 2aO7 D``c` ~+ can '72Y inq~.;iry or these ir;di~~iJu~ is resp~nsible ,'ur oirta in:'ng the irifo . rmatlon, ! c:rtify under penalty of !aw that I have personally e,sami a ne and am familiar with the information submitted and believe th i e nformation is true, accurate, and cornpiete, I~ ~ Signature 7 Date -1- 10/01/2007 S F BEVERLY MANOR CONVALESCENT HOSP SiteID: 015-021-000210 ~ ~~.Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers on Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP OXYGEN F P IH G 1686.00 FT3 Low -2- 10/01/2007 -3- 10/O1j2007 t~ S F BEVERLY MANOR CONVALESCENT HOSP ~` ;Inventory Item 0001 COMMON NAME / CHEMICAL NAME OXYGEN Location within this Facility Unit OXYGEN ROOM SE FRONT STATE TYPE PRESSURE _ Gas TPure -Above Ambient SiteID: 015-021-000210 ~ Facility Unit: Fixed Containers on Site ~ Days On Site 365 Map: Grid: CAS# 7782-44-7 TEMPERATURE CONTAINER TYPE Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 1686.00 FT3 1686.00 FT3 I 1400.00 FT3 ri['~G1-~tCL V U.5 lr V1~lY V1V L' 1V 1-.7 %Wt . RS CAS# 100.00 Oxygen, Compressed No 7782447 titiGl~ttL 1',~ 51; a J1~1~1V 1 J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Low -4- 10/01/2007 F BEVERLY MANOR CONVALESCENT HOSP SiteID: 015-021-000210 Fast Format ~ Notif./Evacuation/Medical Overall Site ~ Agency Notification 07/24/2000 CALL 911. 9 9 Employee Notif./Evacuation 07/20/2006 SAME AS BELOW. Public Notif./Evacuation 10/11/2006 EVACUATION PLAN LOCATED THROUGHOUT FACILITY, INCLUDES EVACUATION ROUTE LOCATION OF FIRE ALARMS, FIRE EXTINGUISHERS, EMERGENCY, 911 ALL EMERGENCY SHUT-OFF VALVES, FIRE DOORS, FIRE ALARMS/PANEL, OXYGEN STORAGE AND SHUT-OFF, EMERGENCY STORAGE SPACE. EVACUATION IS TO BEGIN WITH PERSON EXPOSED TO MOST IMMEDIATE DANGER. INFORM OTHER STAFF AND FIRE DEPT. AMBULATORY PATIENTS TO EVACUATE FIRST AND NON-AMBULATORY AND WHEELCHAIR PATIENTS SECOND. EVACUATED PERSONS MUST TRAVEL AWAY FROM THE DIRECTION OF THE FIRE TO ANOTHER SECTION OF THE BLDG BEYOND THE FIRE. EVACUATION: PATIENTS TO BE EVACUATED USE BEDS, WHEELCHAIRS, BLANKET DRAG. RESIDENTS THROUGH NEAREST EXIT OUT TO PARKING LOT AND COVER WITH A BLANKET. DO NOT LEAVE UNATTENDED. MEDICAL FACILITIES IN AREA TO BE NOTIFIED OF EVACUATION AND THAT RESIDENCE WILL BE DIRECTED TO THEM. SCHOOLS MAY ALSO BE CONTACTED TO RECEIVE EVACUATED RESIDENCE. MEDICAL RECORDS WILL BE KEPT UP TO DATE. IN CASE OF MAJOR EXTERNAL DISASTER MANY DECISIONS MAY BE MADE BY OUR LOCAL AUTHORITIES. -5- 10/01/2007 F BEVERLY MANOR CONVALESCENT HOSP SiteID: 015-021-000210 Fast Format ~ Notif./Evacuation/Medical Overall Site ~ Emergency Medical Plan 10/11/2006 WE ARE A SKILLED NURSING FACILITY WHO HAVE TRANSFER AGREEMENTS WITH BAKERSFIELD MEMORIAL HOSPITAL, SAN JOAQUIN HOSPITAL, KERN VALLEY HOSPITAL, KERN MEDICAL CENTER, WESTSIDE DISTRICT HOSPITAL, NORTH KERN HOSPITAL. WE ALSO KEEP A LIST OF EMERGENCY PHYSICIANS AT EACH OF OUR TWO NURSING STATIONS AND EMERGENCY AND DISASTER MANUAL. MEMORIAL HOSPITAL, 420 34TH ST, 327-1792 OR MERCY HOSPITAL, 2215 TRUXTUN AVE, 327-3371. -6- 10/01/2007 F BEVERLY MANOR CONVALESCENT HOSP SiteID: 015-021-000210 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 07/20/2006 ~ OXYGEN TANKS CHAINED IN A LOCKED CLOSET. NO SMOKING OXYGEN IN USE SIGNS PLACED IN ALL ROOMS WHERE OXYGEN IS USED. SPECIFIC FIRE PROCEDURES IN CASE OF EMERGENCY PROCEDURES DUE TO FIRE IN BLDG. STAFF INSERVICED IN THESE EMERGENCIES. INFECTIOUS WASTE CONTAINED ON TREATMENT CART AT END OF SHIFT DOUBLE BAGGED AND TAKEN TO METAL STORAGE CONTAINER PROVIDED BY ENVIRONMENTAL SECURITY DISPOSAL TO BE DISPOSED OF IN A PROPER MANNER. PEOPLE HANDLING INFECTIOUS WASTE ARE INSERVICED ON PROPER HANDLING PROCEDURES. Release Containment 07/24/2000 FACILITY WILL TRY TO SHUT OFF VALVES SO THAT LEAKS ARE CONTAINED AND EMERGENCY HELP WILL BE REQUESTED BY DIALING 911. Clean Up THE AREA WILL BE AERATED TO CLEAN UP THE VICINITY OF THE PROBLEM. 10/11/2006 V1.11C1 iLCAVU1l.C til:L1VGLL1V11 -7- 10/01/2007 F BEVERLY MANOR CONVALESCENT HOSP SiteID: 015-021-000210 ~ Fast Format ~ `Site Emergency Factors Overall Site ~ _, .~Nc~.iai nac~aiu~ Utility Shut-Offs 08/31/2007 GAS - NW CRNR OF BLDG OUTSIDE ELECTRICAL - BACK N MIDDLE OF BLDG INSIDE WATER - BACK N MIDDLE OF BLDG INSIDE Fire Protec./Avail. Water 01/26/2007 PRIVATE FIRE PROTECTION - SPRINKLER, FIRE EXTINGUISHERS, AND ALARM SYSTEM. FIRE HYDRANT - NE CRNR FRONT OF BLDG SITE AT PROP LINE. Building Occupancy Level 03/22/2006 110 EMPLOYEES -8- 10/01/2007 F BEVERLY MANOR CONVALESCENT HOSP SiteID: 015-021-000210 ~ Fast Format ~ ~~Training Overall Site ~ ~ Employee Training 10/11/2006 ~ MATERIAL SAFETY DATA SHEETS ON FILE. BRIEF SUMMARY OF TRAINING PROGRAM: INSERVICE ON HAZARDOUS MATERIALS IN BLDG HELD TWICE A YEAR, CONDUCTED BY DIRECTOR OF STAFF DEVELOPMENT. WILL COVER TOPICS OF: 1) OXYGEN (HANDLING OF, AND STORAGE OF); 2) INFECTIOUS WASTE (HANDLING OF AND STORAGE OF); AND 3) EVACUATION PROCEDURES IN CASE OF EMERGENCY. rayc c. i1c 1u 1V.L t UI. I.LLC U5C nC11..1 1VI t ULULC USC'' -9- 10/01/2007 ;. + BEVERLY MANOR CONVALESCENT HOSP _____________________ SiteID: 015-021-000210 + Manager Location: 3601 SAN DIMAS ST City BAKERSFIELD BusPhone: (661) 323-2894 Map 103 CommHaz Low Grid: 19B FacUnits: 1 AOV: CommCode: BFD STA 04 ~ ~ ~ SIC Code:8051 ~ ~ EPA Numb : IAA y/~a1a DunnB red ------------------ ---------------------------------------- ------------- Emergency Contact / Title Emergency Contact / Title R / ADMINISTRATOR PETE LOPEZ / MAINT SUPR Business Phone: (661) 323-2894x Business Phone: (661) 323-2894x 24-Hour Phone (~Y) 24-Hour Phone (661) 325-3624x - Pager Phone Hazmat Hazards: Fire Press ImmHlth ----------------------- ' N' Calk ' ~ ' ---------------- Contact Md~f ~~ ~ ~G~'Ir- 0~ ta - Phone: (661) 323-2894x MailAddr: 3601 SAN DIMAS ST State: CA City BAKERSFIELD Zip 93301 Owner BEVERLY ENTERPRISES Phone: (877) 823-8375x Address 1000 BEVERLY WY State: AK City FORT SMITH Zip 72919 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: ~ Emergency Directives: ~v'/ PROG A - HAZMAT /0~/~~ PROG C - COMM HOOD L/ i ~~~J ~~~_ ~'g~~~ Based on my inquiry of those individuals responsible for obtaining the information, (certify /~ / /~r~ under penalty of law that I have personally exarnined and am familiar with the information I submitted and helleve the information is true, accurate, and Compl C 5 ..~- J ignatu ~ `.2- Date ~m~~~: ~~/ (fx~rn ~Grft l~i,e ecf~,r: ENT'D J U L 2 0 2006 -1- 03/22/2006