HomeMy WebLinkAbout1971 Original Documents I e(.(Jrr.e//�mC.'/�.�r
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May 17 , 1971
Mr. Walter Margerison ` Mass . Project No. 4-L-5
100 lr'elisway West Proposed Rest Home
Somerville, lvia:sc�ch�rsetts 02145 C)S(Jood & part.
North Andover, Massachusetts
Dear Mr, Marc�erisari:
I am pleased tQ advzse you that t ,� F;, ; ; , ,`,r�, plans dated March
18 , 1�71, recently submitted on the abo:)vo ;:: �>, Psai�act, have been re-
triewod and are approved with comMent.
in order to assta;re an Orderly revi �v 017 CIO ;ur•ther project development, ,
it is requested that two sets of l'ir3d1 ;pc�.iiicatiot]s (stamped
approved by the OariIner1t of Public Safi',tY) kz=, e;trbmiUed to this office
not later than UvO (5) months from the Cl;3to of this letter.
please find, attached, a copy of "13<i�:i�: IX-lciwients - Plans and
Specifications" which indicates the r*nt.ents under each plan
subm is Sion.
QOMMEN` S ARE AS FOL-LOWS
SSP--1
1. Certificate of Deed indicates 16CI boot 'Pilroved plans submitted
only indicate 120 beds.
1. T Kitchen toilet Shall r►crt ¢pcn dircOGY iOtO i;itchen area .
2. C(Irt st0y&ge , also consider d as c�rrt: wr:tt7}y area.
3. Toilets next to elevator considered vt. iLot,!; ,
F All Janitor's closet, �requircd to he wit-thiju[n of 5' x 51 .
I
` 5 , MediQ411 record stor�rc o required,
01-re public t(-leph()IIc required for patti:q1t u!;c.
7 . Questlot7 on use of blan), areas .
Walter Margerison
lob} Fellsvray West
Samervllke , Massachusetts
1, All special care rooms eonsicicrecl as Private room5 ,
2. Minimum Width of elevator (100r openinc
r ; . Trafiic.from utility rooms shall not be throj.jgh nurses station .
4 . Sttggest only rough plumbing in utility roo
js .
corn or sz�tir,g room regklired per nurse' s unit S scivare feet
One day r .
required per authorizedc;arr'arab bars . nursing unit-
All tubs , showers , toilets req►sirn g
1 . Handrails
xcc�uired can both sacl� s of gatieyzk corridor;, miniinum width
Of 81-0" required.
Closet space required in all Pat
ier►t r for s 'patient privacy.
. Cut-tain tvicks with curtains required
Very truly yours,
-72
MIC HAEL 7, EGAN
Junior Hospital Fa ciliti(.s Fngincer
. Eureau of planning and Construction
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HIS CE,RTTFIBS 'T.�AT �.-a-?�. ~. . . }, .`.. . . .� .;,.
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S7as per;nission t� ezec der---xary.���!yE'?�! _�. .bu�r�a�tt�� �ar�-�.. •. . . , . .-�., .�. �'
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4CCu�?!nd as .. =� +r�` : ��r�:..-C{ ! .pia' . a .»,5 �G
provi�.p_d that the penon accepting t3-is permit shad in evU).,t'esp:r: c��iifarnz-��.�3ze iL:x€z�s of the application on h1a
of the Stsftc i .� }1;j. .D. -Alteration and Con
ai€his osce, and to tae pxovisia i.: s z
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'��'i:� .I� .� . �•_.-.I.� .. '�•.±•irl+ _ if Z�:.�rllLEvtkl. lr`G�I�LL��f f. '
siruclion of Buildings in the TO�m-.Qf Norffi Andover,
�TJGLATIONof tho Zming.br Building Re ala#:ons ' oirls hip F'erlaait. '
e . . • . . . . ..[ t • w I • .. . . . L . . .. . . . . • . 1
. . . . . . . . . . . . . . . . . . . . . . . . .. . . . .. . . . - GAS.LitiS�ei
.. •. BUILifJ.L O MSPECi02 1'r.Rrr __�—� ...��.....................L�:.-':
Ta Occupy BuiMd g7 Apply at BulldinL Inspector's O ce,TcZan HaIL
This Gard Must be- 115playcd firs a- msplrcuaus -dace On th�
711a1-d I�Gt -.Tbr[I Dbwn .or R.e n-1 Gvc
'
�r L ng ZO �. �o .Until Permission is Issued b hj`jin� InsDI-Xicor
M
Val,
December 11, 1972
Mr. Walter Margerison Ro: Mass, Project 48-0050
100 Fellsway West Proposed Long-Tern- FaclliLy
5omerville, Massachusetts Park & Osgood Street
North Andover, Massachusetts
Dear Mr, Margedson:
With reference to Your recent inquiry, please be advised that this
Bureau has no objection to the construction of a 120 bed long-term-care
facility at the above address as our records indicate approval for 160 beds
was granted by the Department,
it is permissible to reduce the number of beds from what was actually
certified by the Department.
Ve ruly yo rs,
Ill 0
ARTHUR IACOVELLI
Assistant Director
Bureau of Planning and Construction
Al/kff
I05 CUR, UFPARTAgE .�
NT OF PUgL1C HEALTH
� 150,001. 11� eFinitions
(A) Lon
54 charity or Tn Care FacProfi1'
implied m Purpose o which ! a at shall me
r dvertised, any institut.
care resident Providing
u v tng three ° °unced or mainta nedther
lncfdenf to Old m�°g' COnvalescemore individuals for the Ducted for
elderly persons. Longg age
ambuIato�nteor rehabili#ativadmitted "Pre or
the es, rest ho care P rsons a care- thereto
aged. mes, infirmaries facllltiy shall °r retirement supervision and
thereof and Fa as used maintained nclude home units herein, shall in towns andonvalescent vrcare for
a, 23, S. 32, within acute hos charitable
Pitals mealy a ion - nursing
twntl` t shall g #e care hO for
p converted facility or
under
(Z) Aden are adjacent bU;j' estabiis prOVfsfons of Sl 1 88
or tifiable Unit dings hment housed
ward and shall me in a sin
bePartrpen# shall include w a section of a gle building
new construct.Or all facilities adlaCent roomsfaaflit
shall correspond
additions c° d whe e s acce ch s a wing, floor
applicable Pondructi ' cony stecte after ?March P#able
const to the definitionroFns'or alter For the
standards a ations, 1g' 1968 and
approxr cted prior to °n andards unit
as an identifiable aJ!
more than 4p beds March 19 of the stated In unit
(�) Co 60 beds In Fa rn facllaties1968` an id apartment, the current!
nvales cities that pro videntiflable For facilities
To cent that Provide Levei I ° wit shall -^
those to d Charitable Horn Level [II mean
rms defined in me f°HQ b Rest Hornet i or IV coral care, and not
Fro l'0n -Term C for
L A ed shall nflrma Maintai
m acute short re shalt Laws, chapter 111have the same ned In a
Four Levels of rnr c mew care of si , section 71, meanin
e Fins it .1 Basedte� care Provided in genorwt duration as gs as
separate! Lon facilities under hos distin
facilities sh censed Te these re pital. Thera guished
unit paused Care Facilit regulations shall he
Nursing Facilies eel the
exce Provisions premises of shalt
(13) Levels Pt as s of this cha mew
o£Lon otherwise Prov' pt acute applicable hospital.
-Te rded herein, to Suc
a intensive Nu Care Facilities Skilled
facility or rsin
organized wits thereof d RehabI )tat, t�nr nit
care and seprograrn of Provide Care FaciJlt
shall ca services required c°ntinuous skilled me
mply with restorative servIcE5 nu shall
Facilities the in these
and addition to g care and a
—� wdshall under Title XV Conditio ragulations,the minimum basic
Provide care For ill of the partici Leve! i f
S i e Nursin are Patients as SeaurityaA°n f°r acilities
thereof that Prescribed t ct of Extended C availabill, pr°vlde aC1 es 1966 (p L 89 are
Y of restor °°ntfnuous eve11] Shall 97)
e the alive skilled mean a facility or
regulatlo inlmurn basic ca tic nursing
to a stabilized Pa tie es and°they therapeutic units
'Ile condo an h° showd services required serves ad rngfu!
Care. w potential
for }m in these dition
(a) Skilled N or who have a deteri mprovement rules and
ursin Care In8 condition re°ration
services facility or Facilities for
thera and/or Irate wit/s thereat Children SN requiring
IndfvidUolsC treatme nsfve supportive nh�t Provides
CFC LeVeIII
medic birth oI wd habilitative Bing care skilled nursin shall
a!/nursi (zz j rvices to services g care
by a multi-"sing needs retwenty_two mu1#i t° ether with
services whq rsciplina requiring irate Years of a Ply handica
definition ' team ofProfess
rventlon, able ge, who a Peed
or of a aged fifteen o£� sionals. rvation exhibit
Re Lew deal) units PlY hwdloa15 ent Individuals and supervision
is earn with prior peed' may be or who do not
these
not an a (MRTj and the approval fro milted not meet the
ad
custodial PproPriate facllitY orpartment' m the r) to adult (Lev
l 11
(b) care, unit for s llcensingAartment's Medical
SNCF ire Care in Individuals re genc ,
handica shall a S:111killed quiring lOnSNCFC
Peed Indio duo temporal Nosh tt Care g'term
Provide relief Fact
( ) Su e Nu0 a farnilyith to twenty_tw° z rtn careitoffor Children
units fheortry n Prim
ofskiiJed eat that Providere Facilitiesry aL�ygrver� 2j Years o£ age in multiply
t
5/25/90 addi nursing, restor rOutin el l[I tiara the mu a nursln ) shall
to mini alive and other g services and mew a facility or
m, basic care therapeutic s'a Periodic availability
a
and service rvlces, as i Y
s q t
aired in these Indicated
in
�,: re 1E15 rules
105 CMR: DEPARTMENT OF PUBLIC HEALTH r
160.001: continued
and regulations' for patients whose condition is stabilized to the point that
they need only supportive nursing care, supervision and observation.
alp. (4) Resident Cara Facilities(Levet N shall mean a facility or units thereof
that provides care
toe in addition to the m
or arranges to prov inimum basic rove
and services required in these rules and regulations, a supervised suppo
and protective living environment and support services incident to old age
for residents having difficulty in caring for themselves and who do not
i require Level 11 or Ill nursing care or other medically
lseek related
foster services persona
routine basis. This facility's services and programchosocia functioning, and
w f ell-being, independence, an optimal level of psy
integration of residents into community living.
(b) Community Support Facile (CS
shall mean a Resident Care Facility
in which the Department determines that fiftpResidentent s%) or more of the
The Community
facility's residents are Community Support
Support Facility is the only Level IV facility allowed to routinely admit
Community Support Residents and will be expected to maintain 50% or more
of these residents. The central purpose of a CSF shall be to provide its
current Community Support Residents, and new Community Support
Resident admissions, with the mental health and support services outlined in
these regulations. These services will be provided in order to assure resident -
these security and the provision of appropriate care, as well as to maximize
titutionalization, and wherever possible
resident independence, prevent reins
provide rehabilitation and integration into the community.
(C) Single Level Facility shall mean a facility that provides only one level of
care in one o�identifiable units.
(D) Multi le LeveluFaonetor more identnfiablecunits far each level of care that provides twot �ree or
four levels of car
(E) Minimum Basic R uirements for Care and Services shall mean the least
quantity of personnel and services allowable for each level of care for licensure
as prescribed in these rules and regulations. This iin otrtatn feel precld esthe fact
meet
that additional staff and services will be necessary
patient needs.
(F) De a��rtment shall mean the Department of Public Health of the
CommonweaAth of Massachusetts.
(G) Medical Care shall mean services provided by a physician or
physician-nurse practitioner team or physician-physician assistant team
including: physical examination and diagnosis; . orders -for for treatments,
c
medications, diets, and associated services; emergency ref 'care and
supervision and review; and determination of appropriateness
placement,
(H) Or ranized Medical Staff shall mean an organized group of physicians as
defined by the Joint Commission on Accreditation of Hospitals.
(1) Ph__tsd to shall mean
medic medicine in Massachusetts pursuantor of medicine or doctor totGenernal Laws,
y who is
registered to practice
chapter 1�2, section 2.
(1) P dial trician shall mean a physician licensed to practice medicine in
Massachusetts who is certified or eligible for certification by the American
Board of Pediatrics.
(J) Advisory Physician shall mean a physician who advises on the conduct of
medical and medically related services in a facility. Advisory physician in a
SNCFC shall mean a pediatrician who advises on the conduct of medical and
medically related services in a facility.
106 CMR - 597
4/27/90
rt rt ♦�tpp -1.
DEPARTMENT OF _ PUBLIC HEALTH
x
LICENSE TO MAINTAIN A CONVALESCENT OR NURSING HOME
4
In accordance with the provisions of the General Laws Chapter111, Section 71, and regulations established thereunder,
a license is hereby granted to
New Stevens Hal•1.7 c
.....17 ,..................................................•....................................................•..............
..........................................................I..................I............
Name of Licensee
for the maintenanceof............tew..MediCo Rehabilitation .and...Skilled Nurs.ing..Center at....S. evens...Hall...............................
Name of Home
75 Park Street ,.....Nor.th...Andove.r.7....I?A...��,$45...............................................................
Address
Quota not to exceed.....................1.22.....................................Beds, as follows:
First Floor Second Floor Third Floor Fourth Floor Total
Level I:................
........Beds Level I.........................Beds Level I.........................Beds Level I.........................Beds Level I.........................Beds
Level ll:...... ............Beds Level ...............Beds Level IIc........................Beds Level 11.........................Beds Level II---A2............Beds
Level III:....... ...............Beds Level Ill:........................Beds Level III:........................Beds Level III:........................Beds Level III:.......................Beds
bevel Iv:........................Beds Level IV:........................Beds Level IV:........................Beds Level IV:........................Beds Level IV.........................Beds
.9...... .............. .... .................... . subject to revocation for cause. :. .-
'Fhis license is valid until................�.ul.y.....1&.......1.9.$
*8/14/91 reclassify 40 level III beds to
level. II beds.�s,� •
License No. 3508
cattunissioner of Public Health
..................... .....Lu 1y.... .g......-19 8 8.............•...............................................
Date Issued
POST CONSPICUOUSLY
N°
car Tontin111malt4 of ffiaggar4ugrtfii
DEPARTMENT OF = PUBLIC HEALTH
6 -
.k �r
August 4, 1992
In accordance with the provisions of the General Laws, Chapter III, Section 71. as amended, this
INSPECTION CERTIFICATE
isissucclto New Medico Rehabilitation and Skilled Nursing Center at Stevens Hall
75 Park Street, North Andover, MA 01845
The • New Medico Rehabilitation and SNC at Stevens Hall meets fire standards for egresses,
fire extinguishment, and containment.
Expires August 3 , 1993 _
Commission
David H. Mulligan
EXISTING BUILDING
PLEASE POST THIS CERTIFICATE --
i
--^ � FORM SBCC-S-74
Lit
NORTH ANDOVER
•= �� Toran� o� � I
Section 108. 15, this
In accordance with the Massachusetts State Building Code,
GBH s+~ e
CERTIFICATE OF INSPECTION
NORTH ANDOVEK
GREENERY EXTENDED CARE CENTER OF NO .. . ..
is issued to. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . {
Mq, - .-Zng, q M? .known as. . . .
C�.Frltf� that I have inspected the. . . . . . . . . . . . . . - ' Norc�h Andove..x . . . . . . . . . .. .. . .
75 Paxk Stkc -e-t . . . . . . . .in the. . . own• _ . . .of. . . . .
Zocated at. . . . . . . . . _ . . . . I 1
E1,,SeX Commonwealth of Massachusetts. The means of egress are sufficient for the fonowing
County of . . . . . . . . • • •
4.
'r
number of persons:
BY STORY
Capacity Story Capacity
Story Capacity
Story Capacity : : Story
Gxou.nd jt00A : no
2ntf " 40 [ 1 unkt
BY PLACE OF ASSEMBLY OR STRUCTURE
Place of Assembly acaty Lncation
.�-
place of Assembly or Structure
'
"
or Structure Capacity Location
Gnou-nd itcox, DZn-Zng Rm. 725 :: =
n - n Activity Rm: 60
F�bnuaA 26 7494 2ciaZ Y
_ A u u.�t 1 1 9 9 2 Expi4res
Bui Zdin Cff
Certificate Number
Date Certificate issued
Date Certificate
. ormatLon.
-_ --_ changes in the above inf
'J.d<�vithz�n_..�10) days _of an
DEPARTMENT ,OF PUBLIC HEALTH
6
LICENSE TO MAINTAIN :A CONVALESCENT OR NURSING HOME
4
Chapter.III, Section 7 1, and regulations established thereunder,
In accordance with the provisions of the General Laws
a license is hereby granted to �!
New Stevens......HaII...........j....Inc ..................................................
.........................
...................................................... . ........
Name of Licensee
forrhemaintenanceof............ .ew M-edCo_-.Rehab -1 ,ta.t.ion_.and..S,kil.led...Nurs .ng Center...at Stevens a...................
.......... ..
Name of Home
75 Park Street North Andover : MA 01845 ..............................................
.................................................................................
"' Address
Quota not to exceed.....................12-2.....................................Beds, as follows:
7bird Floor Fourth Floor Total
First Floor Second Floor
Level I:.......................Beds Level 1:.............,..........Beds Level 1:.................I......Beds Level I:........................Beds Level I:........................Beds
Level 11:......$!............Beds Level II:.. . ..........—.-Beds Level 11:........................Beds Level II:........................Beds Level II:...122..........-Beds
Level Ill:....... ...............Beds Level III:_........................Beds Level Ill:......................
..Beds Level 111--............. .Beds Level III:........... ............Beds
Levelly:........................Beds Level IV:........................Beds Level IV:........................Beds Level IV:........................Beds Level IV:........................Beds
....subject to revocation for cause.
This license}s valid until...............au l.y 1.8. 19 8 9............. ............
,-
*8/14/91 'reclassify 40 level III beds to
levelII beds ................................
License No. 3508 cozrl `.;sioner of Public health
Ju1 y....19........19 8 .............................................................
Date Issued
POST CONSPICUOUSLY