GENERAL ADDENDUM TO ATRIUM PLACE ASSISTED LIVING FACILITY COMPREHENSIVE EMERGENCY MANAGEMENT PLAN

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1 Contact Person: Ricardo C. Roces, Administrator/ Owner Atrium Place Assisted Living Facility ALLic.# Dodge Street Clearwater, FL Tel/Fax: (727) Cell: (646) GENERAL ADDENDUM TO ATRIUM PLACE ASSISTED LIVING FACILITY COMPREHENSIVE EMERGENCY MANAGEMENT PLAN Pursuant to Emergency Rule 58AER 17-1, entitled "Procedure regarding Emergency Environmental Control for Assisted Living Facilities." This addendum is supplied an addendum to my current Comprehensive Emergency Management Plan, the Emergency Rule requires a plan be submitted within 45 days from the date of the Emergency Order (September 16, 2017). The Emergency Order further requires plan implementation by November 15, 2017 (60 days from the date of the Emergency order). Scope of Addendum: This addendum is intended to address the implementation of a plan to ensure ambient temperatures will be maintained at or below 80 degrees Fahrenheit for a minimum of ninetysix (96) hours in the event of the loss of electrical power to an assisted living facility. The plan is intended in address the acquisition, maintenance and testing of an installed generator. The plan also addresses the storage of fuel on the premises for the generator. Acquisition of Sufficient Generator/ Generators I. Not later than Wednesday, September 27, 2017 the Administrator/Owner or his/her designee shall meet with our local electrician engineer/ electrical contractor or a generator dealer to discuss generator options and sizes to power a sufficient amount of space during a power outage. The meeting will also discuss the following: a. Permitting process and local ordinance for generator installation in Pinellas County. b. Storage of fuel to adequately store 96 hours of fuel. c. Restriction imposed by the local fire marshal. d. Determine backup energy needs and peak usage requirements. e. Determine whether an electrical engineer will require load monitoring. f. Determine whether a site plan is needed showing the location of the electrical service equipment, fuel tank(s), and generator, with setback dimensions to property lines and buildings, and all building opening (if necessary) g. Determine whether my county requires an update survey of the property. h. Whether the generator must be properly screed from street view. i. Whether testing of permanent installed generator is excluded during certain hours. j. Whether there are certain electrical requirements. k. Whether a detail of the concrete slab(s) is required. I. Whether a fuel piping/connection detail and specifications for natural gas are required. m. Any additional services/ Requirements that are needed. Should option be made available that allows for cost savings, while still ensuring our generators are operable and well maintained, these options will be explored.

2 Acquisition of Fuel. II. Not later than Wednesday, September 27, 2017 the Administrator/Owner or his/her designee shall meet with our local electrician engineer/ electrical contractor or a generator dealer. All permitting and fuel storage requirements, to included permitting if necessary will be explored. Provided the Administrator/ Owner needs to meet with someone other than the person/persons mentioned above to accomplish the safe acquisition and storage of fuel, The Administrator/ Owner will schedule the meeting within 3 business days. Acquisition of Services to Install, Maintain, and Test Ill. Not later than Wednesday, September 27, 2017 the Administrator/Owner or his/her designee will discuss the installation process, needed maintenance, and testing with a local electrical engineer/ electrical contractor or a generator dealer. Provided the Administrator/Owner needs to meet with someone other than the person /persons mentioned above to accomplish the install, maintenance, and testing for requirements, The Administrator/ Owner will schedule the meeting within 3 business days. Final Placement and Installation IV. Upon securing the required permitting, generator, and all approvals required from state and local authorities, we will have the generator installed as required by the Emergency Rule. It is our intention to order the generator and have it installed prior the sixty (60) day deadline. Procedures During the Loss of Power V. If power is lost to the building, staff will make rounds on the residents to ensure they have a light source and check on the safety of all residents. Staff on Duty will perform the following: a. Notify the power company of the loss of electrical service by calling Duke Energy: Staff will not assume it has already been reported. b. Staff will check all breaker panels and reset if necessary. c. Staff will contract the Administrator/ Owner. Additional staff may be called in to assist. d. If the power remains off for longer than 15 minutes, staff will determine whether residents would like to come to an area of the building where temperatures are 80 degrees or below. e. If the temperature is not an issue, staff should regularly patrol the building every 20 minutes for wellness checks, determine the needs for assistance fir residents, the smell of smoke or evidence of fire. f. If the power remains off for a significant length of time and temperatures exceed 80 degrees in the common area of the building designated for resident cooling in a power outage, staff must engage the generator if it does not engage automatically. g. If at any time temperature exceed 80 degrees on the three different reading within an hour after the generator is engaged, evacuation procedures will begin and resident will be transported in accordance to our Comprehensive Emergency Management Plan.

3 ADDENDUM TO COI\tfPREHENSIVE El\1ERGENCY MANAGEMENT PLAN Plan for Providing Emergency Environmental Control Pursuant to Emergency Rule 58AER17-1 for Assisted Living Facilities Type of Facility: Assisted Living Facility Date: Facility Name: Atrium Place ALF License No.: AL4946 Address: 2179 Dodge Street Clearwater, FL Phone No.:(727) Fax No.:(727) Emergency Contact: Ricardo C. Roces Phone No.:(727) Address: This Plan for Providing Emergency Environment Control is submitted on or before October 31, 2017 in compliance with Emergency Rule 58AER17-1, Florida Administrative Code, and the interpretations provided in the document produced by the Agency for Health Care Administration and the Department of Elder Affairs, Questions and Answers, dated September 21, 2017 and October 2, A. Plan for acquisition of a generator or sufficient generators to ensure ambient temperature will be maintained at or below 80 degrees Fahrenheit 1. The locations or areas in the building that are to be maintained at 80 degrees: a. Describe the rooms, areas, locations of the building. In Living room of the Facility and also on the dinning place. b. Describe approximate square footage. 220 sq. ft. c. Identify the approximate number of residents that will utilize the space. l O residents if it is full d. Identify how residents will be relocated to the space or how residents will use the space [will beds be located in the area to be cooled]. Staff can encourage them to stay on the living room or dining room. The facility has enough sofas and some same big comfortable chairs.

4 Facility Name: Atrium Place ALF License No.: AL The equipment or methods to maintain ambient temperature at 80 degrees: a. Describe the generator(s)- make, model, size. Generator Information Facility Name: Atrium Place Assisted Living Facility Manufacturers Name: Generac Model Number Generac Portable RS5500W Generator Serial Number KVA/KW Rated Output Power(KW)- 5.5, Surge Output Power (KW) 6.9 Voltage 120/240 Phase Single Type of Fuel: Unleaded Fuel (If natural gas, is there a switch to change to diesel or propane?) Fuel Capacity 30L Running hours at 75% of 12.5 capacity: (Running@75% capacity runs longer hours than@l00% capacity) Running hours at 100% of 10.5 capacity: b. Describe where the generator(s) is located. East outside part of the building. Generator place 20 feet away from the building c. Describe how the generator(s) is connected to supply emergency power and how generator power is initiated. Connect to electrical sub-panel with transfer switch beside the main electrical panel. The power initiated to pull start and it only needs a few minutes to install and run it. d. Describe the air cooling equipment the generator will power - whole building HV AC, portable AC, spot air coolers, fans, etc. Two backup portable AC 12,000 BTU, spot air coolers and fans e. Describe the life safety equipment and other equipment that the generator will power - emergency lighting, fire alarms, fire suppression equipment, refrigeration and ice makers, oxygen, etc. Backup portable AC 12,000 BTU, air coolers and fans that can run by our available generator. More than the AC and fans the generator will power also emergency lighting, fire alarms, refrigeration, freezer and some lights in common area. Atrium Place doesn't have any resident who's on oxygen or life device run by electricity.

5 Facility Name: Atrium Place ALF License No.: AL 4946 f. Describe how staff will monitor the ambient air temperature in the locations or areas in the building that are to be maintained at 80 degrees. Our Portable AC has a temperature indicator that will tells what's the temperature of the place. Staff will double check it every hour. B. Plan for acquisition and safe maintenance of sufficient fuel to operate generator(s) for a minimum of 96 hours 1. Describe the type of fuel used to operate the generator. Regular Unleaded gasoline with an octane rating of 90 no more than 10 % of ethanol 2. Describe how much fuel will be required to operate the generator for 96 hours. It needs more or less 68 gallons of Regular Unleaded gasoline. 3. Describe the location and storage method for the fuel stored onsite. The gasoline should be located at the back of the shed w/ proper cover to protect it from rain and debris (far from the facility). 4. Indicate if a piped fuel will serve as an additional resource. C. Plan for acquisition of services necessary to install, maintain, and test the system to ensure the safe operation of the generator system 1. Describe the process or plan for installing the generator and fuel storage system, including compliance with all required regulations and codes. The electrical sub-panel with transfer switch beside the main electrical panel which will be the connector of the generator was installed by a license Electrician and installed in accordance with all applicable laws and electrical codes. And on time of using the generator unit, it should be 20 feet away from the building. 2. Describe how the generator, fuel supply tank, and distribution equipment will be protected from debris impact as required by the Florida Building Code. Portable 30 Gallon Gas Caddy Fluid Fuel Transfer Tank Rotary Pump Siphon, and it place on the back of the shed w/ proper cover to protect it from rain and debris (far from the facility). 3. Describe the maintenance or service to be provided that ensures the safe operation of the generator. By starting the generator once a month and running the unit for about 30 minutes.

6 Facility Name: Atrium Place ALF License No.: AL Describe the maintenance or service to be provided to maintain the viability of the fuel in the storage tank. The generator should be keep clean and dry. Operated, stored the unit in a clean dry environment and not exposed to excessive dust, dirt, moisture and other foreign substances are visible on its exterior surface. 5. Describe procedures for testing the generator and fuel storage system. Before starting the unit make sure to check the gasoline level if it has enough to run it. Check the oil to avoid burning the motor power, hour meters and also the battery. For the fuel tank storage regularly check it make it sure that there is no leakage and make it sure it's always full tank. This Plan for Providing Emergency Environmental Control is submitted to the Department of Elder Affairs at ALFEMP@elderaffairs.org and to the local emergency management agency, [ Pinellas County emergency management], at [ address or mailing address] on this 31st day of October, Ricardo C. Roces

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