02C - Katy TX Appendix A_2 - Lease Design Narrative _LDN.pdf

VA Katy Community-Based Outpatient Clinic

December 4, 2024

VA Leased CBOC Design Narrative

FINAL V2

LEASED COMMUNITY-BASED OUTPATIENT CENTER

TABLE OF CONTENTS / SECTION 1 INTRODUCTION

VA Katy Leased CBOC Design Narrative September 30, 2024

Section 1 - Page 1

1. INTRODUCTION

2. GENERAL REQUIREMENTS

2.1 General

2.2 Codes

2.3 Standards

2.4 References

2.5 Pricing Standards

3. PLANNING AND DESIGN CRITERIA

3.1 Background

3.2 PACT Guiding Principles

3.3 Community Based Outpatient Clinics (CBOC) Planning Approach

3.4 Room Data Matrix

3.5 Additional Planning Requirements

4. TECHNICAL NARRATIVE

4.1 Site/Civil

4.1.1 Pedestrian and Vehicle Access & Circulation

4.1.2 Parking

4.1.3 Site Grading

4.2 Architecture

4.2.1 General Criteria

4.2.2 Accommodations for Care of Patients of Size

4.2.3 Acoustics

4.2.4 Equipment/Accessories/Furnishings

4.2.5 Signage and Wayfinding

4.2.6 Critical Dimensions

4.2.7 Entry Canopies

4.2.8 Elevators

4.2.9 Slab Depressions and Thickened Slabs

4.2.10 Millwork

4.2.11 Joint Sealant Systems

4.2.12 Doors and Frames

4.2.13 Hardware

4.2.14 Pharmacy Dispensing Windows

4.2.15 Radiation Shielding

4.2.16 Radio Frequency Shielding and Magnetic Shielding

4.3 Interior Design

4.3.1 General Criteria

4.3.2 Acoustic Ceiling Tile

4.3.3 Concrete Floor Treatment

4.3.4 Fiberglass-Reinforced Panels

4.3.5 Painting

4.3.6 Wall Protection

4.3.7 Window Shades

4.3.8 Privacy Curtains / Screens

4.3.9 Flooring, Carpet

Section 1 - Page 2

4.4 Mechanical

4.4.1 References

4.4.2 HVAC Design Basis

4.4.3 Air Handling Units (AHUs)

4.4.4 Exhaust Systems

4.4.5 Cooling System

4.4.6 Hot Water Heating System

4.4.7 Humidification System

4.4.8 HVAC Piping Systems

4.4.9 Air Distribution and Duct Systems

4.4.10 HVAC Insulation Systems

4.4.11 Testing, Adjusting and Balancing

4.4.12 Automatic Temperature Control Systems

4.4.13 Special Conditions

4.5 Plumbing

4.5.1 References

4.5.2 Plumbing Design Basis

4.5.3 Materials

4.5.4 Medical Gases

4.5.5 Special Conditions

4.6 Electrical

4.6.1 Standby Generator

4.7 Lighting

4.7.1 General

4.7.2 Indoor Lighting Specifics

4.7.3 Lighting Controls

4.7.4 LED Drivers

4.7.5 Special Conditions

4.8 Telecommunications

4.8.1 Scope of Work

4.8.2 Pathways

4.8.3 Spaces

4.8.4 Telecommunications Bonding and Grounding

4.8.5 Equipment Racks and Equipment Cabinets

4.8.6 Power Distribution Units and Uninterruptable Power Supplies

4.8.7 Telecommunications Infrastructure Plant

4.8.8 Special Systems

5. Hardware Groups and Modifiers

Section 1 - Page 3

SECTION 1 - INTRODUCTION

1.1 The purpose of this Leased CBOC Design Narrative is to consolidate the governing codes, standards, references, and guidelines in a document that provides performance-based standards for a VA leased CBOC.

1.2 The governing codes, standards, and references are based on a VA affiliated outpatient clinic.

1.3 The design of the VA leased CBOC shall be based on the Prototype for Standardized Design and Construction of Community Based Outpatient Clinics which is described in Part 3 Planning and Design Criteria.

1.4 This document, and the associated Room Data Matrix (RDM), provides performance-based standards for rooms/functions that are a part of the project’s Program for Design. If there are standards covered by this document, or room types in the RDM, that are not a part of a specific project’s Program for Design, those standards are considered not applicable to that specific project. However, standards added to the grey “additional requirements” boxes in this document are project specific and are applicable.

1.5 Commonly Used Acronyms and Definitions:

PCMH Patient Centered Medical Home

A team based, comprehensive, coordinated patient care model (refer to PACT) PACT Patient Aligned Care Team

Provides service to veterans that is patient-centered with the right care at the right time by the right person. A typical “teamlet” serving a veteran consists of four caregivers: A Primary Care Provider – physician (MD), physician assistant (PA) or nurse practitioner (NP); a Registered Nurse (RN); a clinical staff assistant (LPN or Medical Assistant) and an administrative staff member (Clerk).

CBOC Community Based Outpatient Clinic Is VA-operated, VA-funded, or VA-reimbursed site of care which is located separate from a VA Medical Facility. A CBOC can provide primary, specialty, subspeciality, mental health, or any combination of healthcare delivery services that can be appropriately provided in an outpatient setting.

PFD Program for Design Net square feet (NSF) listing of all spaces and rooms that are to be included in a construction project.

VA Veterans Affairs VHA Veterans Health Administration VISN Veterans Integrated Services Network RDM Room Data Matrix

SECTION 2

GENERAL REQUIREMENTS

Section 2 - Page 1

SECTION 2 – GENERAL REQUIREMENTS

2.1 General

2.1.1 The codes and standards listed below indicate minimum performance requirements.

Minimum requirements or standards may be exceeded by site specific project design.

2.1.2 Compliance is required with applicable codes and standards throughout the process of design, construction, acceptance, and on-going maintenance of the facility.

2.1.3 Design and construction of the CBOC shall be in compliance with the requirements of the GSA Form L100 Global Lease as well as the codes and standards listed below.

This Leased CBOC Design Narrative covers construction materials and standards not fully addressed by the codes, standards, and references below.

2.1.4 Use the most current edition at the date and time of bid submission.

Additional General Information:

Lessor to provide any Joint Commission required maintenance documentation within 30 days of inspection completion, submit to the COR for review.

Photographic Documentation

• During the construction period through completion, a 3rd party shall provide photographic documentation of construction progress and at selected milestones (such as blocking in walls, stub-up connection points for equipment, security mesh in wall (if required), walls going to deck (where required)) including electronic indexing, navigation, storage and remote access to the documentation, as per these specifications. The commercial photographer or the subcontractor used for this work shall meet the following qualifications:

• Demonstrable minimum experience of five (5) years in operation with at least 500 projects documented to date providing documentation and advanced indexing/navigation systems including a representative portfolio of construction projects of similar type, size, duration and complexity as the Project.

• Demonstrable ability to service projects throughout North America with operational resources within 150 miles of project, which shall be demonstrated by a representative portfolio of active projects of similar type, size, duration and complexity as the Project.

Photographic Specifications

• Each digital image shall be taken with a professional grade camera with minimum size of 6 megapixels (MP) capable of producing 200x250mm (8 x 10 inch) prints with a minimum of 2272 x 1704 pixels and 400x500mm (16 x 20 inch) prints with a minimum 2592 x 1944 pixels.

• Indexing and navigation system shall utilize actual AUTOCAD construction drawings, making such drawings interactive on an on-line interface. For all documentation referenced herein, indexing and navigation must be organized by both time (date-stamped) and location throughout the project.

• Documentation shall combine indexing and navigation system with inspection-grade digital photography designed to capture actual conditions throughout construction and at critical milestones. Documentation shall be accessible on-line through use of an internet

Section 2 - Page 2 connection. Documentation shall allow for secure multiple-user access, simultaneously, on-line.

• Construction progress for all trades shall be tracked at pre-determined intervals, but not less than once every thirty (30) calendar days throughout the project upon commencement of vertical construction (“Progressions”). Progression documentation shall track both the exterior and interior construction of the building. Exterior Progressions shall track 360 degrees around the site and each building. Interior Progressions shall track interior improvements beginning when stud work commences and continuing until Project completion. Refer to Section 4.07 for required progress reports.

• Miscellaneous events that occur during any Contractor site visit, or events captured by the Department of Veterans Affairs independently, shall be dated, labeled and inserted into a Section in the navigation structure entitled “Slideshows,” allowing this information to be stored in the same “place” as the formal scope.

• Customizable project-specific digital photographic documentation of other details or milestones. Indexing and navigation accomplished through interactive architectural plans.

• Monthly exterior progressions (360 degrees around the project) and slideshows (all elevations and building envelope). The slideshows allow for the inclusion of Department of Veterans Affairs pictures, aerial photographs, and timely images which do not fit into any regular monthly photo-path.

• Regular (5 max) interior progressions of all walls of the entire project to begin at time of substantial framed or as directed by the Resident Engineer through to completion.

• Images shall be taken by a commercial photographer and must show distinctly, at as large a scale as possible, all parts of work embraced in the picture.

• Coordination of photo shoots is accomplished through Resident Engineer or other designated on-site point of contact. Contractor shall also attend construction team meetings as necessary. Contractor’s operations team shall provide regular updates regarding the status of the documentation, including photo shoots concluded, the availability of new Progressions or Exact-Builts viewable on-line and anticipated future shoot date.

• Contractor shall provide all on-line domain/web hosting, security measures, and redundant server back-up of the documentation.

• Contractor shall provide technical support related to using the system or service.

• Upon completion of the project, final copies of the documentation (the “Permanent Record”) with the indexing and navigation system embedded (and active) shall be provided in an electronic media format, typically a DVD or external hard-drive.

Permanent Record shall have Building Information Modeling (BIM) interface capabilities.

Refer to Section 4.12 for required as-built documentation.

RE Office

a) Resident Engineer’s Office Space

All costs associated with the Resident Engineer’s office including, but not limited to, construction, demolition, hook-ups to utilities, furniture, fixtures, and equipment (RE Office Costs) shall be paid by the Lessor. Upon acceptance of the space, VA shall reimburse the Lessor for all RE Office Costs as part of the Tenant Improvement Cost.

The RE shall have unlimited access to the construction site for construction observation.

Section 2 - Page 3

b) Design Phase and Construction Phase Resident Engineer Observation Office

Design Phase - The lessor shall provide one (1) office space not less than 120 SF for the sole use of the VA and its delegate, when present. The office space shall be within three (3) miles of the jobsite and may be within the prime contractor’s trailer. Offsite locations must be approved by the Senior Resident Engineer (SRE) considering safety and security. The office space shall have conditioned air and electricity for proper lighting and receptacles in accordance with typical office area standards. Access to high speed wireless internet shall be provided. The space shall be near a restroom, break room, copy room, and conference room in which the RE is able to use as needed. The break room shall contain a shared microwave, refrigerator, and coffee pot. The conference room shall be able to seat a minimum of 10 people. The office space shall contain the following items:

o One (1) Office desk, double pedestal, executive size o One (1) Swivel chair with arms o Two (2) Arm chairs o One (1) 5-drawer file cabinet, letter size o Two (2) Drawing rack, with 12-30 inch “Plan Hold” drawing holders, freestanding o Two (2) Apple I PAD Pro 12” Tablets

c) Construction Phase, Independent Office Space - The field office shall provide not less than 800 gross square feet of floor area in one trailer unit. Installation of the office shall meet all local codes.

8.1.2.1 Provide office with three 36-inch wide exterior doors, including hardware and OSHA approved platform, handicap ramp, and stairs leading to grade. A stainless-steel lock guard shall be provided over deadbolts on exterior at each door. Provide accessible ramp in compliance with VA Barrier Free Design Guide, PG-18-13, 2007.

8.1.2.2 Enclose the entire perimeter of the office from the floor to the ground and finish to match exterior. Provide R7 insulation and seal tight to ground with a painted ¾-inch exterior grade plywood skirt.

8.1.2.3 Exterior finishes shall be manufacturer's standards. Provide roof canopy areas above entry doors approximately 6’ x 6’. Provide HC ramp at one entry.

8.1.2.4 Provide floor, wall, and roof with not less than R5 insulation.

8.1.2.5 Provide floor, wall, and roof with not less than R5 insulation.

8.1.2.6 Interior finishes shall consist of resilient flooring, plywood paneling or painted wallboard on walls, and acoustical tile lay-in ceilings. Interior doors may be either painted or stained.

8.1.2.7 Interior shall be subdivided with full height partitions to provide two offices, one sample room, one conference room, two separate toilets. Provide each space with three-foot wide door with KIWI Smart locks. Section off an area with a low partition and counter for the administrative assistant's desk. Provide countertop space with sink, and upper/lower cabinets.

8.1.2.8 Provide 2-1/2 ft wide x 3 ft high operable windows; two in each room (none required in sample room), except provide only one 2-foot high window with frosted glass in toilet room(s) and three windows in conference room. Provide steel mesh over all glass in doors and windows. The windows shall have mini-blinds.

8.1.2.9 Provide sufficient fluorescent or LED lighting in each room to deliver 30-foot candles of light at desktop height without the aid of daylight. Provide one light switch in each room, except conference room shall have two 3-way switches. Provide one cordconnected, portable 24-inch fluorescent task light at each secretarial workstation and office desk.

8.1.2.10 Provide one quadraplex receptacle in each wall of each room. If a wall is 10 feet long or more, provide two quadraplex receptacles for each 10 feet, or portion thereof, of wall. Provide two quadraplex receptacles in low partition at administrative assistant's desk.

Section 2 - Page 4

8.1.2.11 Provide one each telephone / data outlet adjacent to quad receptacle on two walls in each room.

d) Utilities and Services

The Lessor shall provide the following:

• Electricity, hot and cold water, and necessary utility services (including telephone (5 lines) with dedicated VA Wi-Fi and LAN highest available speed internet services and cable service.

• All necessary piping, power circuits, electrical fixtures, lighting, and other items necessary to provide a habitable structure for the purpose intended.

• Thermostatically controlled, centralized heating and air conditioning system designed to maintain the temperature between 70 and 80 degrees F with 50% relative humidity. The relative humidity shall be uncontrolled.

• Two water closet(s), lavatory, with mirrors, exhaust fans, toilet paper dispensers, paper towel dispensers, trash cans, plastic trash can liners, soap dispensers, paper cups for water fountain, towel bars, and two-prong coat hooks for each toilet room.

One toilet shall have shower with hot

• water.

• Telephone and Internet connections: Provide one (1) high speed Internet cable service.

Lessor shall, for the duration of the Resident Engineer's occupancy, provide the following:

• Secure, safe, clean, and sanitary conditions in and around the field office and

• parking area.

• Maintenance of gravel surfaced area, weed-free, including the area for

• parking, in an acceptable condition for vehicle and foot traffic at all times.

• Maintenance of utility services.

• Daily janitorial services and supplies (toilet paper, paper towels, soap, trash

• removal, etc.).

• Potable water, fuel, and electric power for normal office uses, including lights,

• heating, and air conditioning.

• Lessor shall be responsible for all maintenance for field office and equipment

• including replacement of burned out light bulbs or tubes and changing of A/C

• filters.

• Lessor will provide construction testing equipment as required not to exceed

• $500 quarterly.

2.2 Codes

2.2.1 All VA leased CBOC facilities are to conform to the most recent applicable codes, which include but is not limited to following:

2.2.1.1 State and local codes as required by the local Authority Having Jurisdiction

(AHJ).

2.2.1.2 National Fire Protection Association (NFPA), NFPA 101 Life Safety Code and those codes and standards referenced by NFPA 101. (NFPA 99 Health Care Facilities Code, etc.)

Section 2 - Page 5

2.2.1.3 NFPA 70B Standard for Electrical Equipment Maintenance, NFPA 70E Workplace Electrical Safety, NFPA 75 Standard for the Fire Protection of Information Technology.

2.2.1.4 Architectural Barriers Act Accessibility Standards (ABAAS), current edition.

2.2.1.5 International Building Code (IBC): The latest edition shall be used for structural, wind load and seismic design.

Additional Code information:

• Applicable to NFPA 99, the facility is considered Category 3. The Lessor will maintain utilities and equipment as prescribed by local codes and references listed in Appendix D. Lessor will provide records of the maintenance in the format and frequency required by the VAMC and Life Safety Code to ensure compliance with TJC.

2.3 Standards

2.3.1 All leased CBOC facilities are to conform to the following standards:

2.3.1.1 FGI Guidelines for the Design and Construction of Outpatient Facilities, current edition (referred to as FGI Guidelines herein).

2.3.1.2 The Joint Commission (TJC) accreditation standards apply to the facility under the affiliated VA medical center license. Building construction and on-going maintenance procedures shall meet TJC standards. Lessor shall provide and submit all documentation that is required for TJC requirements.

2.3.1.3 Facility Security Level (FSL) shall be as outlined in GSA Form L100 Global Lease.

2.3.1.4 Sustainability standards shall be as outlined in GSA Form L100 Global Lease.

2.3.1.5 American Society of Heating, Refrigerating and Air-Conditioning Engineers

(ASHRAE) Standard 170, Ventilation of Health Care Facilities, current edition (referred to as ASHRAE 170 herein)

2.3.1.6 ASHRAE Standard 12, Minimizing the Risk of Legionellosis Associated with Building Water Systems, current edition.

2.3.1.7 ASHRAE Standard 188, Legionellosis: Risk Management for Building Water Systems, current edition.

2.3.1.8 ASHRAE Standard 62.1, Ventilation for Acceptable Indoor Air Quality, current edition (referred to as ASHRAE 62.1 herein)

2.3.1.9 ANSI/ASHRAE/IES Standard 90.1-2019 -- Energy Standard for Buildings Except Low-Rise Residential Buildings

2.3.1.10 Sheet Metal and Air Conditioning Contractors National Association (SMACNA) Standard, HVAC Duct Construction Standards - Metal and Flexible.

2.3.1.11 USP General Chapter 795 Pharmaceutical Compounding – Nonsterile Preparations

2.3.1.12 USP General Chapter 797 Pharmaceutical Compounding – Sterile Preparations

2.3.1.13 USP General Chapter 800 Hazardous Drugs - Handling in Healthcare Settings

2.3.1.14 Association for the Advancement of Medical Instruments (AAMI) standards as applicable to SPS and RME storage

2.3.1.15 Illuminating Engineering Society North America (IESNA) Handbook - latest edition

Section 2 - Page 6

2.3.1.16 VA Signage Design Manual PG 18-12

2.3.1.17 H 18-8 Seismic Design Handbook is required when the clinic includes

Ambulatory Surgery

2.3.1.18 VA HVAC Design Manual (Specifically regarding the AHU design requirements for Pharmacy Compounding Suite, Sterile Processing Service (SPS), and Surgical Suite)

2.4 References

2.4.1 The following guides, manuals, and other references developed by VA are for reference only:

2.4.1.1 VA Enterprise Facility IT Support Infrastructure Standard, most current.

2.4.1.2 Prototype for Standardized Design and Construction of Community Based

Outpatient Clinicshttps://www.cfm.va.gov/til/prototypes.asp#CBOC

2.4.1.3 PACT Space Module Design Guide

https://www.cfm.va.gov/til/dGuide/dgPACT.pdf

2.4.1.4 Room Templates, Leased Community Based Outpatient Clinics https://www.cfm.va.gov/til/rTemplate/LeasingCBOCw.asp

2.4.1.5 VA Design Guides (PG18-12)

2.5 Pricing Standards

2.5.1 Building Shell Definition

2.5.1.1 Building shell is the complete enveloping structure, the base building systems, the complete HVAC system, and the finished common areas (building common and floor common) of a building that adjoin the occupant areas.

2.5.1.2 Any demolition cost necessary shall be included in the building shell rental rate.

2.5.1.3 Third-party green building certification do not change what elements are considered part of building shell or tenant improvements. Instead, building elements may be required to have certain attributes, such as low volatile organic compound emissions.

2.5.1.4 Section 3 of the L-100 provides minimum requirements of the shell. Any further requirements identified in this LDN to items in Section 3 shall remain shell unless specifically designated as TI.

2.5.1.5 The following table shows the Shell requirements of the Base Building and the Occupant Areas.

https://www.cfm.va.gov/til/prototypes.asp#CBOC https://www.cfm.va.gov/til/dGuide/dgPACT.pdf https://www.cfm.va.gov/til/rTemplate/LeasingCBOCw.asp

Section 2 - Page 7

Base Building Occupant Areas

Base structure and building enclosure components (windows with exterior finishes) and any required enhancements (canopies, progressive collapse, etc.)

are complete.

Broom-clean concrete floor slab, with a flat and level floor.

Base building electrical and plumbing systems (e.g., central fire alarm, chiller plant, cooling tower) are complete and functional.

Gypsum wallboard, spackled and prime painted, on exterior perimeter walls and tenant demising walls, without suite entry door.

Entire HVAC system is complete and functional. Conditioned space per the RDM.

All common areas, such as lobbies, elevators, fire egress corridors and stairwells, garages, and service areas are complete.

Suspended acoustical ceiling system including grid and lay-in tiles (or other building standard). Lighting luminaires should be installed in the ceiling grid for an open office plan at the rate of fixtures per 80 USF. Lighting controls with ambient lighting adjusted per daylight availability, occupancy, vacancy, or other building automation system signals.

Building common restrooms are complete and operational.

Tappable domestic water riser, service sanitary drain, sanitary vent, ready for extension to tenant demised areas.

All electrical power distribution panels and circuit breakers available in electrical closets, with capacities at 120/208 volt, 3- phase, 4-wire and 277/480 volt, 3-phase, 4-wire.

Any portion of a code required alternate power source (emergency generator, Essential Electrical System, etc.), required to support building life safety requirements including but not limited to transfer switches and distribution.

Designated connection point to the central fire alarm system for extension to tenant demised areas.

All fire alarm devices necessary required by tenant layout and AHJ.

Fire suppression system ready for extension to tenant demised areas.

Sprinkler mains and distribution piping in a protection layout (open plan) with heads turned down, concealed with an escutcheon or trim plate, are installed.

Conduit pathways to distribution backboard within a demarcation room for connection to tenant telecommunications MCR or TR.

All security requirements designated as “Shell” in the Facility Security Level (FSL) Appendix are complete.

Proposed and required exterior site (property) improvements required for VA’s use of the premises and local municipality required off-site improvements are complete.

Arc Flash study to be performed in addition to Arc Flash labels on Electrical Panels upon successful inspection.

Section 2 - Page 8

2.5.2 Tenant Improvement Definitions

2.5.2.1 TIs are the finishes and fixtures that typically take space from the shell condition to a finished, usable condition. The resulting space is complete and meets applicable building codes.

2.5.2.2 TIs are typically items in addition to the items listed in the table above.

2.5.2.3 Section 5 of the L-100 provides minimum requirements of the TI. Any further requirements identified in this LDN to items in Section 5 shall remain TI unless specifically designated as Shell.

2.5.2.4 Typical Tenant Improvements include:

2.5.2.4.1 Electrical wiring, outlets, and horizontal conduit, including cable trays and hooks, within the demised premises. Telephone jacks, data, jacks, and horizontal conduit, including cable trays and hooks, within the demised premises.

2.5.2.4.2 Carpeting or other floor covering; raised access flooring.

2.5.2.4.3 Plumbing fixtures within the demised premises and all distribution, drainage and vent piping connecting to the building core – except for common bathrooms.

2.5.2.4.4 Partitioning and wall finishes

2.5.2.4.5 Doors, sidelights, frames, and hardware.

2.5.2.4.6 Millwork

2.5.2.4.7 Window treatments

2.5.2.4.8 Adjustments or repositioning of fire sprinkler to avoid conflict with partitioning; additional sprinklers required by code to meet layout.

2.5.2.4.9 VA required signage on site, in the common areas and within the demised premises.

2.5.2.4.10 Additional lighting over the open office layout at a rate of fixtures per 80

USF.

2.5.2.4.11 Exterior site amenities required such as therapy gardens, gait training therapy areas and dining areas (site amenities proposed as building improvements by the lessor shall be shell).

2.5.2.4.12 Interior and exterior components of special systems required such as nurse call and duress systems.

SECTION 3

PLANNING AND DESIGN CRITERIA

Section 3 - Page 1

SECTION 3 – PLANNING AND DESIGN CRITERIA

3.1. Background

3.1.1. VHA has committed to the development of a patient-centered medical home model for enhanced outpatient primary care services to veterans. The result was a patient care delivery model and a set of planning and design standards.

3.2. PACT Guiding Principles

3.2.1. An operational and planning design guide was developed which identified key principles and objectives. Refer to PACT Space Module Design Guide under References Section 2.4.

3.3. Community Based Outpatient Clinics (CBOC) Planning Approach

3.3.1. The development of the PACT Planning Module was complimented by the development of a Prototype for Standardized Design and Construction of Community Based Outpatient Clinics. Using the PACT Module as the building block, prototypes were developed for three types and sizes of outpatient facilities.

3.4. Room Data Matrix

3.4.1. A collection of typical rooms within leased CBOCs. It lists the required finishes, STC ratings, ceiling heights, door size and type, hardware sets, HVAC space ventilation, number of electrical receptacles, lighting controls and fixture types, and number of standard density work area outlets for each room type.

3.4.2. The Lessor shall associate rooms listed on the program for design with the room data matrix by room name. Use department level room names and types when available, otherwise use general room/space for like room function.

3.4.3. FGI Equivalent for ASHRAE 170 – Where HVAC space ventilation requirements are omitted, ASHRAE 170 Tables 8-1 and 8-2 shall be followed. Column “FGI Equivalent for ASHRAE 170” lists the equivalent room name for use in the tables.

3.4.4. FGI Equivalent for Table 1.2-5 “Minimum Sound Isolation” - Where Column “STC” in the Room Data Matrix states “See FGI”, Column “FGI Equivalent for Table 1.2-5 Minimum Sound Isolation” lists the equivalent room name for use in FGI Table 1.2-5.

3.4.5. Additional Requirements in this LDN take precedence over the standard in the RDM.

3.5 Additional Planning Requirements

3.5.1. Adjacencies shown on the block diagram shall be maintained.

The following functional areas are required to be located on the first floor.

• Police

• Logistics

• Mental Health

• MRI

• Radiology

• Pathology / Laboratory

• Pharmacy

• Primary Care (At Minimum two PACT Modules)

• PMR

• Prosthetics

• Canteen

• Health Administration Service

• OIT

• Voluntary Service

• Service Organizations

• Education

SECTION 3

PLANNING AND DESIGN CRITERIA

Section 3 - Page 2 gisticsI Radiology Pathology / Laboratory Pharmacy

PMR

Prosthetics Lab Canteen Health Administration Service

OIT

Voluntary Service Service Organizations Education

SECTION 4

TECHNICAL NARRATIVE

Section 4 - Page 1

SECTION 4 – TECHNICAL NARRATIVE

4.1 Site/Civil

4.1.1 Pedestrian and Vehicle Access & Circulation

4.1.1.1 Minimum traffic lane width is 12 feet, and minimum sidewalk width is 4 feet. Curves for traffic lanes and radii at intersections must be adequately sized to prevent vehicles from encroaching on an opposing lane of traffic.

4.1.1.2 Primary pedestrian access and circulation paths shall comfortably accommodate two-way wheelchair traffic.

4.1.1.3 An accessible route must be provided from the public right-of-way abutting the site to the accessible building entrance.

4.1.1.4 For one way traffic lanes that are used as fire and emergency equipment access the minimum width shall be 20 feet.

4.1.1.5 Provide a service/loading area designed to accommodate truck (WB-62) maneuverability. Provide canopy for unloading in adverse weather conditions with 14 feet of clearance from grade to the underside of the canopy.

4.1.1.6 Service area shall accommodate vehicles that pick-up trash and recycled materials.

Locate service area away from public and patient areas.

Additional Site/ Civil Requirements:

• Provide three trash compactors, 1 regular waste and 1 cardboard waste and 1 red bag waste. All to be located against the loading dock to allow loading directly from the loading dock. These items are in addition to the two loading bays.

• The driveway shall be off a two-directional entry (i.e. Do not locate on a one-way street or boulevard).

• Provide a separate service/ambulance entrance.

• Benches are required within the parking areas and around the building; should play an integral part of this design. Provide concrete pad for VA-furnished benches in green spaces. Pads shall be equipped with means to anchor benches.

• Provide direct access from Physical Medicine & Rehabilitation (PM&R) to an outside terrace for gait training.

• Provide an exterior paved dining area adjacent to the Canteen.

• Green spaces visible from within the building, waiting rooms, and exam rooms are a high priority.

• Provide buffers of either greenery and/or barriers along adjacent property lines.

• Provide a pet relief area.

• Dumpsters are to be placed on a concrete pad completely fenced in with mesh netting and shall not be visible to patients. Enclosure materials shall meet AHJ standards and complement the building architecture.

Section 4 - Page 2

• Including the United States flag pole, provide a total of three lighted flag poles either near the entry to the building or along the entry drive in a landscaped setting. Confirm with the VA in final site selection and landscape/parking layout.

• The Lessor shall furnish and install a minimum of one rack each at patient and staff entrances for a minimum of 6 bicycles per rack.

4.1.2 Physical Security

4.1.2.1 The physical security requirements are listed in the FSL Appendix as developed by the ISC process.

4.1.3 Parking

4.1.3.1 Parking lots with 90-degree stalls must have minimum parking stall dimensions of 9 feet by 18 feet, and a minimum drive aisle width of 24 feet. Angled parking must have one-way drive aisles with the same stall sizes as 90-degree parking. Angled parking drive aisle width must comply with a published design standard for a designated parking angle.

4.1.3.2 The total amount of accessible parking spaces provided shall be 6% of the total required spaces, unless more is required by local code.

Additional Parking Requirements:

• Provide ten (10) percent of the accessible parking as van-accessible parking, per ABAAS.

• Provide 4 designated spaces, with signage, for senior staff parking.

• Structured parking is acceptable but cannot be located under the clinic.

• Offeror shall provide a minimum of six (6) Motorcycle parking spaces.

• Provide three (3) minimum covered designated waiting areas throughout vehicle circulation areas for patient drop-off/pickup.

• Provide designated government vehicle section in staff area

• Provide two (2) police parking spaces near the police service / main entry.

• Provide Parking and Charging for Golf Cart Station to accommodate two (2) carts, area to have a canopy above cart charging stations.

• Provide Emergency Blue Call Stations

4.1.4 Roadway & Walkway Cross Slopes

4.1.4.1 Roads and walks should have a typical cross slope of 2% unless adequate surface

Section 4 - Page 3 drainage is provided by other slope conditions.

4.2 Architecture

4.2.1 General Criteria

4.2.1.1 Refer to Appendix: Room Data Matrix for Door, Hardware and Acoustic requirements listed by Room Type.

4.2.2 Accommodations for Care of Patients of Size

4.2.2.1 Refer to FGI Guidelines for Outpatient Facilities for accommodations for care of patients of size. Minimum requirements are to provide access to a Procedure Room and Procedure Room Toilet in one PACT Module. A 750lb capacity must be used for the design of the space and its contents to include but not be limited to the lavatory, toilet, patient lifts (ceiling), and the lessor to provide the all structural support. Additional capacity may be required and listed in the project-specific requirements.

4.2.2.2 Rooms that are designed for access by individuals of size as noted on the PFD as Bariatric must have space for bariatric wheelchairs along the whole accessible route from the front doors to the bariatric spaces, including elevators and lobby doors.

4.2.2.3 Turning Radius, Bariatric must be 1830 mm (6’0”)

4.2.2.4 T-Shapted Turning Space, Bariatric must be 1830 mm (6’0”) x (6’0”)

4.2.2.5 Distance from edge of toilet to side sall, Bariatric must be 915 mm (3’0”)

4.2.2.6 Grab bar configuration must have double swing-up bars with an integral toilet paper dispenser.

4.2.2.7 Minimum width of doors in route to bariatric space must be 1220 mm (4’0”)

Additional Architecture Requirements:

• Separate employee entrance shall be located convenient to staff parking.

• A Back Of House Elevator (Staff Corridor) should be co-located near the Staff Entrance.

• Provide one (1) elevator close to the Ambulance Entrance

• All interior partition walls shall be secured to the deck above.

• Reception Areas- All reception areas should have direct visibility to waiting area.

• Logistics – One (1) Freight Elevator that should be placed in or adjacent to the Logistics area and should be accessible to the back-of-house corridors on all

Section 4 - Page 4 floors.

• Logistics – The Primary Sterile Supplies should have an entrance from the Logistics area and an exit to the back of house corridor.

• Education - Education Demo Kitchen should share a wall with a Shared Group / Multifunction Room with a 10’ft wide coiled door for viewing into the Demo Kitchen.

• Primary Care – All PACT Modules (Teamlet Areas) should have Huddle Spaces with windows that emit natural light into the Team Work Area spaces. (See Appendix B.)

• Primary Care – Each Reception Area should have a front and back side with counter. A minimum of two (2) Patient Check-In Areas in front off of the waiting area and a minimum of two (2) in the rear which would be Patient Checkout as depicted in Appendix B.

• Primary Care – At minimum There should be two PACT Modules for Primary Care on the First Floor. One of those PACT modules is to contain the Airborne Isolation Exam Room and should meet the requirements of an Airborne Infection Isolation room, and this room should be close to the front of a PACT module.

• Primary Care – Shared Group / Multifunction Rooms should be adjacent to each other via a folding partition. If Lessor provides a multi-story solution provide two of these room adjacent to each other on the first floor with a dividing wall in between, and the remaining three should have a similar setup on another floor.

• HBPC / Staff Lockers/ Staff Gymnasium – should be collocated near the Staff Entrance.

• Police Service – A door to the outside of the building should be located from the Police service.

• Police Service – The I.D/ Registration Room should have an outside door from a public corridor as well as one from inside the police department.

• Lobby- Upon entering the Lobby From The Main Entry Vestibule A Wall Displaying All Six Branches of Services should be visible within the lobby space.

Section 4 - Page 5

• Lobby- In a multi-floor solution, that multi-story volume space that is open to below shall have floor-to-ceiling glass that extends from the finish floor of the deck above.

• Pharmacy- All Receiving / Dispensing Windows should be recessed from off of any public corridor to provide privacy as well as to keep veterans out of a path of circulation.

• Pathology – The Bulk Room Storage should have access to a Back-Of-House Corridor to provide easy access to Logistics.

• Pathology- Specimen collection toilets shall have pass-thru cabinets.

• Canteen- Canteen Area should be placed off of the Main Lobby

• Women’s Clinic- Women’s Imaging area is to be adjacent to the Women’s Clinic as displayed via Appendix B. There should be private access for Men from a PACT Module so that men can utilize the Mammography Rooms. See Appendix B.

• Women’s Clinic – A separate accessible area from Primary Care should be collocated with the Women’s Imaging Area (Standing Breast Imaging Room) so that it may be used by men without directly going through the Women’s Area.

Please see Appendix B for example).

• Audiology & Eye Clinic – Audiology is sensitive for sound and is preferred to be as far away as possible from spaces that create a lot of noise (main lobby, toilets, etc).

• Eye Clinic prefers space without natural daylight. Eye Exam Rooms on exterior walls shall have no windows.

• General - Evacuation chairs at each stairwell for patients of size will be required; chairs should have minimum rating of 750 pounds.

4.2.3 Acoustics

Section 4 - Page 6

4.2.3.1 Refer to FGI Guidelines for Outpatient Facilities for acoustics requirements for enclosed rooms. Refer to the Room Data Matrix-Interior Construction for information on rooms not covered under FGI or rooms with special acoustics requirements.

4.2.4 Equipment/Accessories/Furnishings

4.2.4.1 Refer to CBOC Project Contents List and Room Template sheets provided with the

RLP for equipment, accessories, and furnishings descriptions and locations. Items to be provided and/or installed by Lessor are noted on the list. Provide partitions, partition backing, and above ceiling structural support as required for wall and/or ceiling mounted equipment, accessories, and furnishings. Provide required utility connections for scheduled equipment.

4.2.5 Signage and Wayfinding

4.2.5.1 Refer to VA Signage Design Guide in Section 2.4 for signage standards and requirements.

Additional Signage Requirements:

• Site Monument Sign shall be type El-01.01. Monument sign shall display the facility name as directed by the Resident Engineer and the facility address. It shall have a backlight.

• Building signage, in addit ion to VA logo, shall read EI-09.9 “Outpatient Center”.

• All above ceiling utilities and HVAC-related equipment to be labeled with signage.

4.2.6 Critical Dimensions

4.2.6.1 Patient-use corridors are to be 6 feet minimum. Staff corridors for transport of supplies from loading dock area to services shall be 6 feet minimum. Hallway access to Audio Booths shall be 8 feet minimum to allow for open booth doors.

4.2.6.2 Patient-use corridor doors must be a minimum of 42 inches wide.

4.2.6.3 Refer to Room Data Matrix – Interior Construction for required ceiling heights by room type.

4.2.7 Entry Canopies

4.2.7.1 Provide non-combustible canopies over the following locations: patient entry to clinic, staff entries, ambulance building access point and receiving area/loading.

4.2.7.2 At patient entry, provide a covered patient drop-off zone with space for at least f o u r

( 4 ) full-size passenger vehicle (80 feet long). The drop-off zone must have minimal change in level from drive isle to walkway for a minimum length of 20 feet.

4.2.7.3 At ambulance building access point, provide a covered patient drop-off zone with space for at least one ambulance (typical size used in area) and an accessible access aisle.

4.2.7.4 At staff entry vestibule provide be covered canopy on the exterior of the staff vestibule.

Section 4 - Page 7

4.2.7.5 Provide clearance from grade to underside of canopy with for typical emergency and transport vehicles used in the area.

4.2.8 Elevators

4.2.8.1 Where elevators are provided in a leased facility, not less than one elevator car shall accommodate an ambulance stretcher of 24 inches by 84 inches in the horizontal open position and shall be identified by the international symbol for emergency medical services (star of life). The symbol shall be not less than 3 inches high placed inside on both sides of the hoist way door frame.

4.2.8.2 Where bariatric spaces are above ground level, elevator doors must open minimum 48 inches.

4.2.8.3 Freight elevators shall be provided and sized per the requirements of this section.

4.2.9 Slab Depressions and Thickened Slabs

4.2.9.1 At new construction, provide slab depression and thickened slabs as required to provide flush threshold installation at audiology booths, MRIs, and other equipment requiring recessed installation or additional structure as recommended by equipment manufacturer. At these equipment locations, concrete slab levelness shall be level and true to meet vendor requirements and shall have a minimum flatness and levelness of FF=45 and FL=35. At existing construction, provide ramp to meet ABAAS.

4.2.10 Millwork

4.2.10.1 Quality compliance to conform to Architectural Woodwork Institute (AWI) and

Woodwork Institute (WI) quality standards.

4.2.10.2 Wood Veneer Casework Construction: Combination of custom wood casework and countertops to conform to program and functional requirements. (Location: Lobby, Reception)

• Construction: Flush overlay construction with concealed hinges. AWI custom grade.

4.2.10.3 Plastic Laminate Casework Construction: Custom plastic laminate casework to conform to program and functional requirements. (Location: Typical).

• Construction: Flush overlay construction with concealed hinges, AWI Custom Grade.

• Cabinet Hardware:

4.2.10.3..1 Concealed hinges, all metal, 110 degree opening, self-closing.

4.2.10.3..2 Full extension drawer guides, 100 lbs. capacity.

4.2.10.3..3 Door and drawer pulls: 4” center to center wire pull, 5/16” diameter round, 1 ¼” projection, satin chrome.

4.2.10.4 Solid Surface Fabrications: Hard, solid, non-porous mineral-filled acrylic resin

(methyl methacrylate) material in color to be selected by designer. Thickness: 1/2” minimum.

• Locations:

4.2.10.4..1 Transaction tops at nurse stations and reception desks.

4.2.10.4..2 All counters in patient treatment areas to have solid surface countertop with 4” high minimum integral coved side and backsplash.

4.2.10.4..3 Where scheduled as wall protection, provide ¼” thick material with

Section 4 - Page 8 welded seams.

4.2.10.5 Heavy gauge stainless steel (SS): fully welded with a work surface load capacity of at least 300 lbs. per linear foot and antimicrobial

• Locations:

4.2.10.5..1 SPS Decontamination, Scope Processing, Preparations and Assembly, and Sterilization Areas.

4.2.11 Joint Sealant Systems

4.2.11.1 Joints at plumbing fixtures, ceramic tile to be mildew-resistant silicone.

4.2.12 Doors and Frames

4.2.12.1 Refer to Room Data Matrix for door and hardware requirements by room type.

4.2.12.2 Minimum width of any door for patient use not specified in the RDM must be 42”.

4.2.12.3 Finish: Prefinished in compliance with AWI Section 1500.

4.2.12.4 Access Panels:

• Flush stainless steel at toilet areas.

• Flush gypsum board surface with concealed hinges at public and office areas.

• Fire rated steel at rated construction.

Additional Door Requirements:

• Loading dock shall have 10’x10’ roll-up door on clean dock and 6’x8’ double door on dirty dock. Loading dock shall have a staff 42-inch door.

• Between Logistics receiving and bulk storage shall have 6’x8’ double door with air curtain.

• All doors within Logistics shall be metal doors, metal frames.

• Doors to clinic entrances shall be full glass. Doors from patient to staff areas shall be full wood.

• Provide a 6-ft double door from the clinical chemistry area in the Pathology service.

• All clean and soiled utility closets should have automatic closers.

4.2.13 Hardware

4.2.13.1 General Note

• Hardware sets shall be provided as per RDM and Section 5 Hardware Groups and Modifiers. Provide extra heavy duty, Grade 1 hardware for all components.

4.2.13.2 Major components and finishes are as follows:

• Cylinders and Keying: Key locks/cylinders in groups with new master key or grandmaster key system as directed by Owner. Provide three (3) keys per lock. Provide construction master keying. Cylinders shall meet the requirements of ANSI/BHMA A156.5-14.

• Electronic access control: Electronic access control system/device(s), power supplies (unless otherwise noted in hardware group) and monitoring/alarm(s) are provided with Security System. General Contractor to coordinate the provision and installation of the products. Refer to documents with Security Information for location(s) and type(s) of control(s). Connection by Electrical.

Section 4 - Page 9

Additional Hardware Requirements:

• Lessor to coordinate the provision and installation of the products that match the current badge access system utilized at the Michael E. Debakey VA Medical Center.

• All patient toilets, specimen toilets, dressing rooms, and lactation rooms shall have occupancy indicator on hardware.

• All Primary Care exam rooms shall have two locking mechanisms on staff side door: one will be a one-sided deadbolt, lockable from patient side, with occupancy indicator and coin turn on opposite side, the other will be an office lock, lockable from staff side.

• Soiled and biohazard/hazard rooms shall have door closers.

• Automatic Door Openers shall be required in the following locations:

• Vestibule entrances (main lobby, PMRS, Prosthetics, Ambulance/Staff, etc).

• All patient toilet areas and main lobby toilets.

• Doors leading from clinical areas to lobby.

• 7-pin, tumbler cylinder cores shall be used and compatible with MEDECO key system. Lessor is responsible for keying and any necessary rekeying.

• The hardware lockset shall be compatible with existing Michael E.

DeBakey VA Medical Center MEDECO keying system.

4.2.14 Pharmacy Dispensing Windows

4.2.14.1 Provide secure transaction drawer/pass through cabinet and window with amplified speak thru at Pharmacy Dispense/Consult windows for staff to patient transactions.

4.2.14.2 Provide stainless steel, type 304, #4 finish, pass-through cabinet with mechanical interlock doors with clear tempered safety glass windows to comply with USP 800 clean air requirements at Pharmacy pass-through windows. (location: Clean Room- Chemotherapy Compounding)

4.2.14.3 Provide protection for dispensing windows, and for walls around windows, window and the wall around a dispensing window shall meet U.L. Standard 752 for Class III Ballistic level via the use of concrete block walls with cores filled with sand, or appropriately rated metal panels, and extension of perimeter walls to structure above.

4.2.15 Radiation Shielding

4.2.15.1 For Radiology, Fluoroscopy, Mammography, CT Scan, and Dental X-Ray Rooms, obtain the services of a physicist to design, specify the level of radiation protection required, test and certifies the installations. Submit a copy of the lead compliance test to the local VAMC Radiation Safety Officer.

Section 4 - Page 10

4.2.15.2 Comply with requirements of the National Council on Radiation Protection and Measurement (NCRP) Report #49.

4.2.15.3 Provide lead lining of gypsum wall board, wood doors and hardware, hollow metal frames, and lead glass view window.

4.2.15.4 Lead sheet to be FS QQ-L-201, Grade C, thickness as required by physicist report but not less than 1/16 inch.

4.2.16 Radio Frequency Shielding and Magnetic Shielding

4.2.16.1 Magnetic Resonance Imaging (MRI) Radio Frequency Interference Shielding: It is required that the RF shielded room and all penetrations through the RF Shielding, i.e., electrical plumbing, and venting be electrically isolated by 1000 ohms or greater and RFI filtered to meet the minimum attenuation level of 100dB (10 MHz- 100 MHz) for plane wave and 90 dB (10 MHz-30 MHz) for magnetic wave.

• Material should be brass-copper or aluminum which has been treated to prevent oxidation and all joints should be either welded or lapped and bolted.

• Shielding to include wall, floor, door, and windows.

4.2.16.2 Magnetic Shielding System: Annealed steel plate, accessories, and coordination of shielding work.

4.2.16.3 Applicable Standards: Comply with requirements of State and Local regulating agencies where standards and criteria apply. Comply with MIL-STDS-220A and 285.

4.2.16.4 Employ Independent Testing Laboratory (ITL), experienced in testing and design of RF and magnetic shielded rooms, to review fabrication, design and installation, and perform tests of radio frequency shielding as required to ascertain correct functioning of shielding.

4.3.20.4.1 Correct part of work which is found to be deficient in electromagnetic shielding.

4.3.20.4.2 Provide second test of RF enclosure after construction is complete.

4.3.20.4.3 Submit certified test results.

4.3 Interior Design

4.3.1 General…