Addendum_D-_Health_Service_Design_Standards_3-11-05_07-12-2019_(002).pdf

U. S. Department of Homeland Security Immigration and Customs Enforcement

Contractor Owned/Contractor Operated for Health Services Design Standards

March 11, 2005

FINAL

U.S. Department of Homeland Security

IMMIGRATION & CUSTOMS ENFORCEMENT

Health Services

DESIGN STANDARDS

March 11, 2005

TABLE OF CONTENTS

iii

DHS - Immigration & Customs Enforcement Health Services Design Standards

Table of Contents

Page

1. INTRODUCTION....................................................................................................................................1.1

2. ORGANIZATIONAL REQUIREMENTS ................................................................................................2.1

3. FUNCTIONAL REQUIREMENTS..........................................................................................................3.1

4. SPACE REQUIREMENTS ....................................................................................................................4.1

5. DEPARTMENTAL REQUIREMENTS ....................................................................................................5.1

6. APPENDIX ............................................................................................................................................6.1

1.1

1. INTRODUCTION

Health Services (HS)

- History and Mission

Health Services (HS)

- Design Standards

Health Services

DHS - Immigration & Customs Enforcement Health Services Design Standards

1.2

HISTORY

The Immigration and Naturalization Service, now known as the Department of Homeland Security (DHS)/Bureau of Immigration and Customs Enforcement (ICE), has had a relationship with the United States Public Health Service (PHS) dating from 1891, when the Immigration Act authorized the PHS to examine and quarantine immigrants at Ellis Island.

Today, that historic link is maintained by an interagency agreement between ICE and the Division of Immigration Health Services (DIHS), an agency of the PHS, and its parent organizations the Department of Health and Human Services (DHHS), Health Resources Services Administration (HRSA), Bureau of Primary Health Care (BPHC).

MISSION

The mission of the DIHS is to protect America by pro-viding primary health care and public health services in support of immigration law enforcement. This mission is accomplished through a comprehensive delivery system that emphasizes disease screening and pre-ventive health services and incorporates the provision of high quality, necessary and appropriate medical, dental, and mental health services in a cost-effective manner. Each DIHS medical facility operates in adher-ence to nationally established ICE Detention Management Standards for health care, as well as the standards of the National Commission on Correctional Health Care (NCCHC), the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), and the American Correctional Association (ACA).

FUNCTION

The DIHS has experienced phenomenal growth in recent years. That growth has accompanied the increased detainee population that followed changes in U.S. immigration law enacted by Congress in 1996. As recently as 1995, health care to detainees was provid-ed almost exclusively between the hours of 8 AM and 5 PM, Monday through Friday, in eight medical facili-ties located in Services Processing Centers (SPC). At that time, the average detained population barely exceeded 5,000 per day.

DIHS medical staff currently provide direct services to an average daily detained population of well over 20,000 individuals, 24 hours a day, seven days a week, in fourteen DIHS medical facilities nationwide, located in ICE Service Processing Centers, Staging Facilities, and Contract Detention Facilities (CDF).

Health Check at Ellis Island - Early 1900’s

Port Isabel Service Processing Center Groundbreaking - 2004

1.3

Administration Organization - HS within U.S. Department of Health and Human Services

Secretary Health & Human Resources

Deputy Secretary

Chief of Staff

Executive Secretary

Director, Intergovernmental Affairs, & Secretary’s

Regional Representatives

Assistant Secretary for Health

Assistant Secretary, Administration for Children & Families

(ACF)

Assistant Secretary for Administration &

Management

Assistant Secretary, Administration on Aging (AoA)

Assistant Secretary for Administration &

Management

Administrator, Centers for

Medicare & Medicaid Services (CMS)

Assistant Secretary for Planning & Evaluation

Director, Agency for

Health Care Research and Quality (AHRQ)

Assistant Secretary for Legislation

Director, Centers for

Disease Control and Prevention (CDC)

Assistant Secretary for Public Affairs

General Counsel

Office of Public Health Emergency

Preparedness

Director, Center for Faith-Based and

Community Initiatives

Director, Office for

Civil Rights

Inspector General

Chair, Departmental

Appeals Board

Director, Office of Global Health Affairs

Administrator, Agency for Toxic

Substances and Disease Registry (ATSDR)

Commissioner, Food and Drug Administration

(FDA)

Administrator, Health Resources and Services Administration (HRSA)

Bureau of Primary Health Care

Director, Indian Health

Services

(IHS)

Director, National Institute of Health

(NIH)

Administrator, Substance Abuse and Mental Health Services

Administration (SAMHSA)

Director, Program Support

Center

(PSC)

Division of Immigration Health

Services

Health Services

Five of the facilities have inpatient Short Stay Units.

One additional medical facility, Pearsall in Texas, is scheduled to open in 2005. Based on the increasing detainee population it is anticipated that ICE will con-tinue to expand bed capacity by opening new facilities as needed. The rapid increase in the detained popula-tion of the late 1990s far exceeded occupancy limits of existing ICE facilities. Inter-governmental service agreements (IGSAs) between ICE and various local and county governmental entities were expanded in scope and number to provide bed space in their jails for ICE detainees. As hundreds of IGSAs were enacted, the need to strengthen controls and accountability measures for the expenditure of health care funds was recognized. DIHS answered the challenge by forming the Managed Care Branch.

The Managed Care Branch was composed of a cadre of health care professionals (PHS officers), who estab-lished a mechanism for IGSA facilities to request approval for health services to detainees. These Managed Care "Coordinators" operated from an estab-lished set of principles and criteria whereby requested services would be individually considered and authori-zation would be granted or denied. A network of providers was developed. Contracts, memorandums of agreement, or other blanket purchase agreements were established to maximize return on health care dollars expended.

The Managed Care Branch has continued on a track of development and refinement with automation, informa-tion technology applications, and sub-contracting (ongoing) network development and claims adjudica-tion processes. Claims reimbursement is based upon the provisions of Title 18 (18 U.S.C. 4006b) except where there is a blanket purchase agreement with a given provider or vendor. The Veterans Administration Financial Center in Austin, Texas currently pays claims.

The DIHS’ value to ICE is enhanced by the newly cre-ated responders. This corps of deployable DIHS uni-formed officers are available to assist with mass migration influxes, staging operations, and evacuation drills. This has proven invaluable on numerous occa-sions in recent years, including Tinian (Northern Mariana Islands), the Florida Keys, Guatemala, metro-politan New York City, the U.S./Mexican border, and the Port of San Diego.

An even more recent development has been the formal establishment of the DIHS Aviation Medicine Program.

Some DIHS officers have successfully completed the U.S. Air Force's Aviation Medicine Academy at Brooks Air Force Base, Texas, creating a highly skilled cadre of health professionals to assist ICE with the removal of individuals to their countries of origin when medication or sedation is required.

Health Services (cont.)

DHS - Immigration & Customs Enforcement Health Services Design Standards

1.4

Health Inspection Aboard a Ship, Coast of Guatemala - 2003

Commonwealth of Northern Mariana Islands, Tinian - 1999

1.5

Administration Organization - HS within Service Processing Center

Executive Branch of the U.S. Government

U.S. Department Health & Human Services

U.S. Department of Homeland Security

Immigration & Customs Enforcement

Counsel/Attorney Detention and Removal EOIR Courts

Executive Office for Immigration ReviewHealth Services

SPC Health Clinic

Three agencies are present within the SPC: Detention and Removal Operations (DRO), Executive Office of Immigration and Review (EOIR) and Health Services (HS). These groups’ respective areas of responsibility are:

1. Detention and Removal Operations (DRO), which is responsible for managing the detainees, presenting cases for deportation and executing deportations.

2. Executive Office of Immigration Review (EOIR), which is part of the Department of Justice, is responsible for conducting the court hearings.

3. Health Services (HS), which is part of the Department of Health and Human Services, is responsible for providing health services.

Health Services Design Standards

Health Services Design Standards

1.6

DESIGN STANDARDS PURPOSE

The intent of the HS Design Standards is to provide uniform guidelines for the planning and design of new and renovated health services facilities, whether DRO owned and operated or contractor owned and operat-

ed. This document should be used as a tool for design-ers and DIHS staff as they plan, program, design, and build HS facilities. It provides general recommenda-tions that should be used and adopted to fit the specif-ic ICE mission at the location of the planned facility.

The standards contained within this document should be continually upgraded as HS organizational, opera-tional, and functional philosophies change and as new technologies become available.

DESIGN STANDARDS DEVELOPMENT PROCESS

The design standards documented herein have been developed by selected representatives of ICE and DIHS. The standards development team evaluated existing HS standards and existing HS facilities with the intent of developing HS standards that will enhance their organizational, operational, and functional effi-ciencies within an HS unit.

DESIGN STANDARDS DOCUMENT

The design standards document is organized for ease of use. The standards are organized into six sections.

Each section is designed to stand alone so it may be extracted for use in the planning and design process.

The chart to the right briefly outlines the contents of each section of this document.

1. Introduction The Introduction includes Health Services history, mission and the purpose of the Standards with a brief description of each section.

2. Organizational Requirements This section includes the HS organization, staff forecasts, and roles/responsibilities. A staffing model illustrates the number of staff by position based on detainee population.

It also illustrates the type of space based on staff function.

3. Functional Requirements This section diagrams basic functional relationships of HS within the overall Service Processing Center (SPC) or Contract Detention Facility (CDF), and relationships among the four components within a HS Unit.

4. Space Requirements The rationale for determining the size of a facility is dependent on the number of detainees held. The number of staff is predicated on the number of detainees and the services offered. Size of facilities are determined by the number of staff and detainees served as well as specific functional requirements of the Service Processing Center (SPC) or CDF. The space analysis is based on four capac-ity levels of detainee population. These were determined to be representative population levels based on DHS input.

Detainee population levels were defined as <200, 200- 450, 450-900, and 900-2000. As a general rule, function-al spaces within PHS units are similar for each range in detainee population. There may, however, be configuration variations depending on operations and clinical staff mix.

5. Departmental Requirements This section contains detailed information for each of the four components which makes up the HS unit. For each component you will find its organizational model/concept, critical workflow patterns, and room data sheets.

6. Appendix This section contains a listing of reference publications and standards as well as two existing HS case studies.

Report Sections

1.7

1.1

Health Services (HS)

- History and Mission

Health Services (HS)

- Design Standards

1. INTRODUCTION

1.1

2. ORGANIZATIONAL REQUIREMENTS

1.1

3. FUNCTIONAL REQUIREMENTS

1.1

4. SPACE REQUIREMENTS

1.1

5. DEPARTMENTAL REQUIREMENTS

1.1

6. APPENDIX

Health Services (HS)

- Space Requirements Spreadsheet

Health Services (HS)

- Organization

Health Services (HS)

- Organizational Requirements

Health Services (HS)

- Inter-Departmental Adjacencies

Health Services (HS)

- Intra-Departmental Adjacencies

Health Services (HS)

- Space Components

1.0 Administration and Common

Support

2.0 Medical Intake and Processing

3.0 Ambulatory Care Unit

4.0 Short Stay Unit (Infirmary)

Reference Publications

- Case Studies

2.1

2. ORGANIZATIONAL REQUIREMENTS

Health Services (HS)

- Organization

- Staff Requirements

HEALTH SERVICES ORGANIZATION

There are two basic staff organizational components within Health Services as illustrated on the following page. The components are managed by the Health Services Administrator and Clinical Director. The Health Services Administrator oversees the general day-to-day operations of Health Services, while the Clinical Director oversees the clinical operations including Dental and Mental Health Services.

HEALTH SERVICES COMPONENTS

The Health Services unit is comprised of four function-al units. These are the Administrative and Common Support Unit, Medical Intake Unit, Ambulatory Care Unit, and Short Stay Unit. The organizational charts on page 2.3 illustrate the interaction between staff and functional unit.

The Health Services Administrator (HSA) manages staff that work in all four units. Staff under HSA man-agement includes the Assistant HSA and Medical Records Technicians, Pharmacist and Pharmacy Technician that are housed in the Administrative and Common Support Unit, Licensed Vocational Nurses (LVN) and Registered Nurses (RN) who work part time in the Medical Intake Unit and part time in the Short Stay Unit and the Nurse Manager who resides in the Short Stay Unit.

The Clinical Director manages clinical professional staff that works in three of the four units. Included are the Clinical Director and Administrative Assistant who work in the Administrative and Common Support Unit, Physicians, Dentists, Mental Health provider along with their assistants, and Nurse Practitioners who work in Ambulatory Care Unit. Physicians, Nurse Practitioners and Physicians Assistants and the Mental Health provider also work in the Short Stay Unit where they provide in-patient services.

FUNCTION

The SPC or CDF is responsible for the health and wel-fare of individuals in its custody. This responsibility mandates the provision of medical staff to provide care to detainees at the SPC/CDF in accordance with the Immigration and Naturalization Service Health Care Program (INS HCP) Policy Manual and in compliance with accreditation standards.

A medical clinic is located within the SPC/CDF to pro-vide the necessary health care and treatment. Non-elective medical care not available at the SPC/CDF, but deemed necessary by the health authority, will be referred to outside sources.

STAFF & ACTIVITIES

Mental and Health services are provided by commis-sioned officers of the U.S. Health Services (PHS) aug-mented by local contract staffing. A Clinical Director or designated health authority is responsible for the provi-sion of health services to the detainees. Health servic-es staff should include physicians, mid-level practition-ers, nurses, mental health professionals, and a phar-macist. Other medical staff such as x-ray technicians may be added as needed.

Activities in the Health Care Unit may vary depending on the SPC/CDF size. All Health care Units are staffed 24/7 to provide intake screening and to respond to emergencies. However, at smaller SPC/CDF facilities, certain activities as routine sick call may not happen every day. At larger facilities, the clinic is typically open every day. Detainees may sign up for sick call daily and have their requests responded to during clinic opera-tion hours. Emergencies are responded to immediate-

ly. Triage or sick call can also be conducted in a med-ical screening area located within each housing unit.

When detention services are provided through a con-tract facility, the Contractor normally provides health care services for the detainees.

Arrangements are normally made with nearby hospitals or other facilities for all health services (medical and psychiatric) that cannot be appropriately provided for within the facility. These services could include Emergency Room services, caring for sever physicl conditions like quadriplegia and caring for violent men-tally ill patients.

HS Organization

DHS - Immigration & Customs Enforcement

2.2

2.3

General Health Services Organization

HEALTH SERVICES

ADMINISTRATOR

Registered Health Information Admin.

Pharmacist

Pharmacist Assistant

Nurse Manager

Assistant HSA

Staff Physician

Physician Assistant

Nurse Pract.

Mental HealthDentist

Dental Assistant

Staff Physician

Physician Assistant

Nurse Pract.

Mental Health

PsychiatristLVN RN

LVN RN

CLINICAL DIRECTOR

Administrative Assistant

1.0 Administrative and Common Support Unit

3.0 Ambulatory Care Unit

4.0 Short Stay Unit

(Infirmary)

2.0 Medical Intake/

Processing Unit

Nurse Assist.

Nurse Assist.

Medical Records Tech.

HS Staff Requirements

Health Services Design Standards

Staff Position by Component Staff Forecast By Detainee Beds

STAFF FORECASTS

The Health Services staff is organized into four func-tional components. The Staff Requirements matrix shown below illustrates the number of staff assigned to each component based on the number of detainees served at the SPC or CDF. The numbers illustrate a general rule and may vary based on the operational model used at the specific detention facility. In all cases the staffing must be verified by management for the specific hours and mix of clinical personnel.

STAFF ASSIGNMENTS

The Health Services staff may serve several functional areas within the facility. The matrix below also illus-trates to which HS component the staff member is assigned.

STAFF DESCRIPTIONS

The chart on the following page contains a listing of all the staff positions by component. For each position, key roles/responsibilities are identified.

1.0 ADMINISTRATIVE and COMMON SUPPORT UNIT

a. Clinical Director (CD) 1 1 1 1 P S

b. Health Services Administrator (HSA) 1 1 1 1 P S S

c. Assistant HSA 1 1 P S S

d. Reg. Health Information Admin. (RHIA) 1 1 P

e. Administrative Assistant 1 1 1 1 P

f. Medical Records Technician (MRT) 1 2 3 4 P

i. Pharmacist .5 1 1 1 P

j. Pharmacist Technician 1 1 P

Subtotal 4.5 6 10 11

2.0 MEDICAL INTAKE/PROCESSING UNIT

a. No permanent assigned staff

3.0 AMBULATORY CARE UNIT

a. Staff Physician 1 1 P S

b. Nurse Practitioner/Physician’s Assist. 2 4 4 6 P S

c. Registered Nurse 3 7 8 8 P

d. Licensed Vocational Nurse 2 5 8 13 P P P

e. Dentist 1 1 1 P

f. Dental Assistant 1 1 1 P

g. Mental Health Provider 1 1 1 1 P P

h. Psychiatrist 1 1 P P

Subtotal 8 19 25 32

4.0 SHORT STAY UNIT

a. Nurse Manager (in SSU’s Only) 1 1 P

Subtotal 0 0 1 1

TO

TOTAL STAFF 12.5 25 36 44

2.4

<200 200-450 450-900 900-2000

Adm ini str ati on Unit

Med . In tak e &

Proc es sin g

Ambu lat ory

Care U nit Sho rt Sta y Unit

Staff Assignment by Component

P = Primary S = Secondary

2.5

1.0 Administrative and Common Support Unit

a. Clinical Director (CD)

Serves as the on-site medical authority Develops and coordinates all aspects of health care delivery at the

SPC/CDF

b. Health Services Administrator (HSA) Provides administrative oversight for clinic

c. Assistant Health Services Administrator (AHSA) Provides an administrator trainee position Provides primary support for HSA Oversees of day-to-day operations of clinic

d. Registered Health Information Administrator (RHIA) Professional management of health information and supervises Medical Records Technicians

e. Administrative Assistant Provides administrative support to the HSA/CD

Common Support

f. Medical Records Technician

Performs clerical work in support of the care and treatment given to patients including maintaining patient medical records in a

SPC/CDF

Sets patient appointments Performs QC checks on medical records Inputs data entry of lab reports Consultation (from ancillary sources)

g. Pharmacist Fills, labels, and dispenses prescription medications based on physician instructions Manages inventory and orders/stocks pharmacy Screens all medication orders for harmful interactions Educates staff and detainees on medication use

h. Pharmacist Technician Performs all duties related to preparation and dispensing of medical orders Conducts inventory.

2.0 Medical Intake and Processing Unit

There are no permanent positions assigned to this unit. Temporary staff is available when needed from the Ambulatory Care Unit.

a. Registered Nurse/Licensed Vocational Nurse (part time) Conducts general health screening of intake detainees Completes chest x-ray Collects urine and blood sample - submits to Lab Inputs data entry for medical record including lab reports Clears detainee for processing to housing or requests further treat-ment or isolation

3.0 Ambulatory Care Unit

a. Staff Physician

Provides direct medical, mental health care, and infirmary care (in-patient) to detainees including examination, diagnosis, and treat-ment Emergency care of patients

b. Nurse Practitioner/Physician’s Assistant Provides direct care to detainees per guidelines Performs medical histories and physical exams on detainees Carries out all orders directed by physician

c. Registered Nurse Provides direct primary nursing care to detainees in ambulatory care and Secured Housing Unit (SHU) settings Takes medical histories and performs physical exams Conducts triage and screening of detainees during sick call Refers medical problems to physician

d. Licensed Vocational Nurse Provides primary nursing care under the direction of an RN or physician or NP/PA Performs screenings and digital TB chest screening

e. Nursing Assistant Assists Nursing in providing basic nursing care

f. Dentist Provides full range of direct dental services to ICE detainees locat-ed at detention facility

g. Dental Assistant Provides assistance to the Dentist during exams and operations

h. Mental Health Provider Provides limited range of mental health services to include screen-ing, group counseling, and case management

i. Psychiatrist Provides full range of psychiatric treatment of ICE detainees Prescribes medication

4.0 Short Stay Unit

a. Nurse Manager

Generally classified as a Registered Nurse Oversees Short Stay Infirmary on a day to day basis.

Manages nurse staff and activities in Medical Intake and Processing, Common Support, Ambulatory Care, and Short Stay Units

HS Staff Descriptions by Component

3.1

3. FUNCTIONAL REQUIREMENTS

Health Services (HS)

- Inter-Departmental Adjacencies

- Intra-Departmental Adjacencies

3.2

Inter-Departmental Adjacencies

SERVICE PROCESSING CENTER/CONTRACT

DETENTION FACILITY

Service Processing Centers and Contract Detention Facilities (SPC/CDF) are detention facilities where DHS detains those who have entered the United States illegally or violated their immigration status. The purpose of this facility is to provide a place of detention for aliens who are taken into custody pending comple-tion of their deportation case, released on their own recognizance, or pending release. The SPC’s purpose is not for punishment, correction, or reformation, nor is the SPC used to confine direct street arrests. Federal and state prisoners may, however be held in SPC facilities.

DHS uses SPC’s/CDF’s to process and detain appre-hended aliens who are illegally in the United States, regardless of whether the alien entered the United States illegally or entered legally but subsequently vio-lated the terms of their visa. All detained individuals are transferred from other institutions or facilities to the SPC/CDF. Legal processing of detainees and determi-nation of custody status is done prior to arrivals at the

SPC/CDF.

SECURITY ZONES

The secure zones of the facility correspond to the degree of detainee and public access required in the components. General zones within the facility include the following:

- Office Zone

- Court/Interface Zone

- Detainee Living Zone

- Service Zone

- Facility Support Zone

HEALTH SERVICES LOCATION

The medical facility should be located within the primary secure perimeter in a secure zone restricted from general detainee access. The medical facility should have its own secure perimeter to restrict unauthorized individuals from having access to medications, instruments, and supplies stored in the clinic. The pharmacy must also have a secure perimeter to prevent unauthorized individuals from obtaining medications.

The medical facility should be located on the ground floor to minimize vertical movement during medical emergencies. Corridors and exit ways leading to the facility exterior must be large enough for ambulance equipment, wheelchairs, and gurneys.

Office Components Normal office setting for administrative and public func-tions of the SPC/CDF. (They are located outside the secure perimeter.)

- Lobby

- Public Visitation

- Deportation

- SPC Administration

- Staff Services & Training

Detainee Living Components Located inside the secure perimeter they are used by the detainees during their normal daily routine.

- Security Command

- Housing

- Commissary

- Recreation

- Law Library/Recreational Library

- Food Service Dining

Court/Interface Components This component includes the EIOR Courts work area and courtroom space.

- EIOR Courts

- Detainee Visitation

Service Components Service functions for the SPC/CDF detainee population.

They are typically placed in a secure area because detainees require frequent access to them or are given work details in these components.

- Processing

- Health Services

- Food Preparation

- Laundry

Facility Support Components These elements support the facility but do not provide direct services to the detainees and may be located outside the secure perimeter.

- Warehouse and Supply

- Maintenance

- Central Utility Plant

SPC/CDF Operational Components

3.3

SPC/CDF Organizational Model Site Perimeter (Rural Settings Only)

Primary Perimeter Barrier

Service Access

Primary Perimeter Barrier

Secondary Perimeter Barrier

Deportation

Lobby

Public Entrance

Recreation Yards

HEALTH

SERVICES

Vehicle Sallyport

Food Preparation

Warehouse

Maintenance

Recreation Yards

Visiting

SPC

Admin.

Staff Services and Training

EIOR

Court

Central Recreation

Housing

Housing Secure Segregation

Housing

Housing So ci al

Pr og ra m s

Li br ar y

Housing

Dining

Nurse Triage

Nurse Triage

C om m is sa ry

La un dr y

Pr oc es si ng

Utility Plant

Security Command

O ffi ce Z on e

FUNCTION SECURITY ORGANIZATION

N on

-S ec ur e

Zo ne

Se rv ic e

Zo ne

S er vi ce

Z on e w ith R es tri ct ed

D et ai ne e M ov em en t

Fa ci lit y

Su pp or t

Zo ne

R es tri ct ed S up po rt Zo ne

Secure Perimeter

C ou rt In te rf ac e

Zo ne

In te rfa ce

Z on e

D et ai ne e Li vi ng

Z on e

S ec ur e

Zo ne w ith

N or m al

D et ai ne e M ov em en t

Security Check Point

Intra-Departmental Adjacencies

Health Services Design Standards

Document Ref. #3.4

HEALTH SERVICES

The Service Processing Center (SPC)/Contract Detention Facility (CDF) is responsible for the health and welfare of individuals in its custody. This responsi-bility mandates the provision of medical staff to provide care to detainees at the SPC in accordance with the Immigration and Naturalization Service Health Care Program (INS HCP) Policy Manual and in compliance with accreditation standards.

A medical clinic is located within the SPC/CDF to pro-vide the necessary health care and treatment. Non-elective medical care not available at the SPC/CDF, but deemed necessary by the health authority, will be referred to outside sources. The HS unit is organized into four functional components described to the right and illustrated on the following page.

HEALTH SERVICES LOCATION

The Health Services Unit must be located inside the secure perimeter and have a close adjacency to the Segregation Unit and Intake/Processing Unit. The unit will have secure access to the Vehicle Sally-Port for emergency transport of ill detainees to medical services outside the SPC/CDF. Access to a nurse triage room adjacent to, or within, the housing units for sick call, medication administration and other medical activities is required to minimize detainee movement.

Detainees are admitted to the Health Services area for health related issues either from initial intake screening, when an incident occurs with an existing detainee through sick call, or due to accident or trauma.

HEALTH SERVICES ORGANIZATION

The conceptual diagram on the following page illustrates the critical intradepartmental adjacencies for Health Services. Access to the facility occurs in two locations. One is from the general detainee intake and processing area, the other is from detainee housing.

Detainees being processed for initial admission to the detention facility will enter Medical Intake for health screening. During this process the detainee is returned to a holding cell in Intake and Processing. The second access is for resident detainees who are being exam-ined or treated for illnesses or health related incidents.

They are brought into the facility from housing and are placed in holding cells where they are scheduled for examination and treatment (Ambulatory Care or Short Stay) by the Nurse Coordinator. Adjacent to both

1.0 Administrative and Common Support Unit

The Administrative and Common Support Unit houses the management and staff offices, records storage, medical storage, pharmacy and support space. It should have direct access to the Ambulatory Care Unit and contain a separate secure entrance for HS staff.

2.0 Medical Intake and Processing Unit

General Intake and Processing is a function administered by U.S. Immigration and Customs Enforcement (ICE) for detainees being admitted to the SPC/CDF. Part of pro-cessing a detainee involves screening the detainees for health related issues. These procedures are conducted in the Medical Intake Unit of Health Services. Included is detection of communicable diseases and any physical conditions requiring medical attention. Screening includes x-raying intake detainees. Detainees suspected of having tuberculosis or other highly contagious diseases are sent directly to holding cells and transported to a hospital for isolation and treatment. Detainees with other communicable diseases are sent to the Isolation Medical cells within the Short Stay Unit (Infirmary) for processing.

Due to the need for health screening to take place during the general intake process, this function needs to be in close proximity to the Health Service area within the

SPC/CDF.

3.0 Ambulatory Care Unit

The Ambulatory Care Unit is the center for detainee sick call and administration of outpatient health care. This unit is essentially a clinic containing nurse triage, medical and dental exam rooms, laboratories, and pharmacy. One entrance to the Ambulatory Care Unit is for detainees entering from housing/triage and the other entry is from detainee general intake/processing. The Ambulatory Care Unit is connected directly to the Short Stay Unit (Infirmary) and Administrative and Common Support Unit.

4.0 Short Stay Unit (Infirmary)

The Short Stay Unit houses the primary functions for the treatment of detainees that need inpatient services. The unit includes a nurse station, clean and soiled utilities, and individual patient rooms complete with showers and toilets.

The Short Stay Unit contains patient Isolation Medical Cells.

Ambulatory Care and the Short Stay Units, the Administrative and Common Suppoert Unit is a secure area segregated from detainee movement yet directly accessible from Ambulatory Care. A central control vestibule is located between the four functional units.

Located in this vestibule is a Security Guard and Nurse Coordinator who monitor and control detainee move-ment.

Functional Components

3.5

Health Services Organizational Model

3.0 AMBULATORY

CARE UNIT

Incoming Detainee from Processing

PROCESSING

UNIT

2.0 MEDICAL

INTAKE/

PROCESSING

UNIT

Detainee Access from Housing/

HS Staff Access

Secure Perimeter

Main Detainee Traffic Flow

Primary Check Point

Secondary Check Point

Secondary Circulation

1.0

ADMINISTRATIVE

& COMMON

SUPPORT UNIT

4.0 SHORT STAY UNIT

(Infrimary)

Holding Holding

KEY

Primary Perimeter Barrier

Service Access

Primary Perimeter Barrier

Secondary Perimeter Barrier

Deportation

Lobby

Public Entrance

Recreation Yards

HEALTH

SERVICES

Vehicle Sallyport

Food Preparation

Warehouse

Maintenance

Recreation Yards

Visiting

SPC

Admin.

Staff Services and Training

EIOR

Court

Central Recreation

Housing

Housing Secure Segregation

Housing

Housing

So ci al Pr og ra m s

Li br ar y

Housing

Dining t

Nurse Triage

Nurse Triage

La un dr y

Pr oc es si ng

Utility Plant

Security Command

Overall SPC/CDF Diagram

4.1

4. SPACE REQUIREMENTS

- Space Requirements Summary

Space Requirements Summary

Health Services Design Standards

4.2

SPACE FORECAST MATRIX

The space requirement for Health Services (HS) were developed through interviews with HS/ICE staff repre-sentatives. They were developed as a tool for delin-eation of space needs based on the number of detainees housed within a SPC/CDF.

Size of facilities are determined by the number of staff and detainees served as well as specific functional requirements of the SPC/CDF. There may, however, be variations depending on operations and specific types of clinical staff available.

The Space Requirement’s Matrix on the following page is organized by individual space description. The space descriptions and corresponding area (net square footage) are organized vertically (by row) into the four functional components housed within a typical HS unit.

They are: 1.0-Administrative Unit, 2.0-Medical Intake Unit, 3.0-Ambulatory Care Unit, and 4.0-Short Stay Unit (Infirmary).

The matrix is organized horizontally into separate columns representing four ranges of detainee popula-tion. These population ranges include: less than 200 detainees, 200-450 detainees, 450-900 detainees, and 900-2000 detainees. The detainee ranges were deter-mined to best represent the capacity range for existing and planned detainee populations and the relative operations, services provided and associated function-al space. The matrix on the following page is com-prised of the following components:

Item Number: Sequential numbering system relat-ed to the unit type

HS Components & Spaces: Room names

Current Space Standards: The Space Standards are square footage areas for specific functional space. They are based on the National Commission on Correctional Health Care (NCCHC) facility stan-dards .

Capacity: Number of persons (staff and detainees) in a given space

Units: Number of spaces

Unit NSF: Net Square Footage for a given space

Total NSF: Total Net Square Footage = Number of units (spaces) x Unit Net Square Footage

SPACE CALCULATIONS

The total Net Square Footage is the sum of all net areas of the spaces listed. This number is multiplied by a Net Usable factor (1.55) (an industry factor based on facility type and utilization efficiency) to determine Usable Square Footage. The Net Usable Area is multiplied by a usable Gross factor (1.05) to determine the Total Gross Square Foot for the HS Space Requirement.

Net Square Footage (NSF) Total clear floor area within a given room, excluding walls, corridors, mechanical equipment rooms, shafts, stairs, and chases.

Usable Square Footage (USF) Total floor area including mechanical and electrical equipment rooms, general circulation spaces includ-ing corridors, stairs, and elevator shafts.

Gross Square Footage (GSF) Total of building area measured from outside face of exterior walls.

Document Ref. #

Space Requirements Matrix

4. SPACE REQUIREMENTS SUMMARY

5. DEPARTMENTAL REQUIREMENTS

1.0 Administrative and Common Support Unit

2.0 Medical Intake/Processing Unit

3.0 Ambulatory Care Unit

4.0 Short Stay Unit (Infirmary)

5.1

5.3

1.0 ADMINISTRATIVE and COMMON SUPPORT UNIT

Administrative and Common Support Unit - Functional Adjacencies

Health Services Design Standards

5.4

1.0 ADMINISTRATIVE AND COMMON

SUPPORT UNIT

The Administrative and Common Support Unit contains the Administrative Offices, Medical Records Storage and Common Support Space for Public Health Services. Common Support areas include those areas that are shared between Administrative, Ambulatory Care and Short Stay functions and are Central to all three. The Administrative and Common Support Unit has direct access to the Ambulatory Care Unit. The Refer to the diagram on page 5.5.

and Co

Critical Issues

Administrative Unit should be segregated from direct detainee access

Administrative Unit should have direct access to the Ambulatory Care Unit.

Special Requirements

The Administrative and Common Support Unit should be contained in a secured area separated from detainee flow.

It is desirable for offices to be located on exterior walls for natural daylight. It should be immediately accessible from the main entry vestibule and contain centralized access to support functions used by both Ambulatory Care and Short Stay Units. Several functions are centrally located common support for both Ambulatory Care and Short Stay Units.

These functions include Medical Records, Medical Supply Medical Laboratory and Pharmacy. The Pharmacy and Medical Records should contain secure, pass-through win-dows accessed from the main vestibule outside of the secure Administrative and Common Support Unit corridor.

Direct access from Administrative and Common Support shall be provided to Ambulatory Care and where possible into the Short Stay Unit. All doors accessing the Administrative and Common Support Unit must be secured.

The walls separating the Administrative and Common Support Unit from other functions in the facility must be secure construction. The Pharmacy, Pharmacy Storage and Medical Supply rooms must be of secure construction.

Space Requirements

1.0 ADMINISTRATIVE UNIT

1.1 Medical Records Administrator Office

1.2 Health Services Administrator (HSA) Office

1.3 Clinical Director (CD) Office

1.4 Assistant HSA Office

1.5 Administrative Assistant Workstation

1.6 Work Area

1.7 Multi Purpose Room

Common Support Area

1.8 Medical Records Technician (MRT) Workstation

1.9 Medical Records Room

1.10 LAN Room

1.11 Pharmacy

1.12 Pharmacy Supply Room

1.13 Ambulatory Medical Supply Room

1.14 Medical Laboratory

1.15 Janitor Closet

1.16 Staff Toilet/Locker Room

1.17 Biohazard Waste/Storage Room

Administrative and Common Support Unit

5.5

2.0 ADMINISTRATIVE AND COMMON SUPPORT UNIT ORGANIZATIONAL MODEL

3.0 AMBULATORY CARE UNIT

4.0 SHORT STAY UNIT

1.0

ADMINISTRATIVE

UNIT

4.0 SHORT STAY UNIT

(Infrimary)

Medical Records

Staff Lockers

Medical Lab

To/From Ambulatory Care

To/From Short Stay Unit

Main Detainee Traffic Corridor

Multi-Purpose

Office

Office

Pharmacy

Bio-Waste Pharmacy Supply

Jan.

St af f C or rid or

Staff Toilet

Office

Office

Admin.

Assistant WS

Work Area

LAN

MRT

Workstation

Ambulatory Medical

Supply Room

Pa ss

-T hr u

3.0 AMBULATORY

CARE UNIT

Incoming Detainee from Processing

PROCESSING

UNIT

2.0 MEDICAL

INTAKE/

PROCESSING

UNIT

Detainee Access from Housing/

HS Staff Access

Secure Perimeter

Main Detainee Traffic Flow

Primary Check Point

Secondary Check Point

Secondary Circulation

1.0

ADMINISTRATIVE

UNIT

4.0 SHORT STAY UNIT

(Infrimary)

Holding Holding

KEY

HS Orientation Diagram

5.6

Administrative and Common Support Unit - Concepts

INTRODUCTION

In order to delineate Administrative Common Support Unit operational imperatives, the following diagrams describe and diagram the relationships between HS staff, detainees and specific processes.

1. Centralized Secure Functions

Three functional areas have been identified as needing special secure construction. These are the Pharmacy and Pharmacy Storage, Medical Supply Storage, and the Administration area. Since all three of these areas serve both Ambulatory Care and the Short Stay Infirmary, they should be located central to these functions with secure entry away from detainee circulation corridors. The dia-gram illustrates how these functions may be collocated.

2. Segregated/Isolated Flow between Detainee and Staff

The concept of isolation and segregation of flow illus-trates how detainee and staff circulation patterns may be organized to minimize conflict and maintain a hierarchy in access and help to further define the location of secured spaces.

Adminstrative Unit

To Ambulatory Care Unit

To Medical Intake/Processing

To Short Stay Unit

Common Support

Admin and Support Access

S ec ur ity

W al l D et ai ne e

A cc es s

Detainee Movement

Staff Movement

Administrative and Common Support Unit - Space Materials and Room Data Sheets

DHS - Immigration & Customs Enforcement Health Services Design Standards

5.8

ROOM DATA SHEETS

The following provides specific data regarding the rooms located within the Administrative and Common Support Unit of Health Services. Each room data sheet includes the following information:

Functional Description Representative Photograph Room Floor Plan Isometric Space Materials Matrix Room Equipment Matrix

SYMBOL LEGEND

BI - Built-in F - Furniture ME - Medical Equipment

Administrative and Common Support Unit - Room Data Sheet

Health Services Design Standards

5.10

MEDICAL RECORDS

ADMINISTRATIVE OFFICE

The Medical Records Administrative Office is a private office for the Medical Records Administrator. The function of the Medical Records Administrator is to manage the recording and storage of detainee medical records. It is important for this space to be near the Medical Records Room. This office should have visu-al access to the medical technician workstations.

Photo

Floor Plan (100 nsf)

Isometric

1.1

FUTURE

5.11

SPACE MATERIAL MATRIX1.1

Walls Floors Ceiling Doors Hardware Glazing Gypsum Carpet Acoustic Tile Standard H.M. Builders Hardware Tempered Glass

Plumbing HVAC Lighting Power Elec./Security Communications GFI Outlets Telephone/LAN

SPACE EQUIPMENT MATRIX1.1

5.12

Administrative and Common Support Unit - Room Data Sheet

Photo

Floor Plan (120 nsf)

HEALTH SERVICES

ADMINISTRATOR (HSA) OFFICE

The office of Health Services Administrator (HSA) is a private office located within the Administrative Unit.

The office should provide seating for meeting with one to three visitors.

Administrative activities include :

Planning, budget management, travel Answer correspondence: written, electronic, phone and fax Employee counseling Storage of files: projects, employees' health and leave records, etc… Assists in the maintenance of facility accreditation

(ACA, NCCHC, JCAHO)

Coordinates implementation of policy and procedures.

Mentors junior officers

1.2

Isometric

5.13

SPACE MATERIAL MATRIX1.2

Walls Floors Ceiling Doors Hardware Glazing Gypsum Carpet Acoustic Tile Standard H.M. Builders Hardware Tempered Glass

Plumbing HVAC Lighting Power Elec./Security Communications

SPACE EQUIPMENT MATRIX1.2

5.14

Administrative and Common Support Unit - Room Data Sheet

CLINICAL DIRECTOR (CD) OFFICE

The office of the Clinical Director is similar to the HSA office. The responsibility of the Clinical Director is oversight of Medical, Dental and Mental Health servic-

es. In some cases this office is located in Ambulatory Care Unit to be close to these clinical functions.

Clinical Director functions include the following:

Administrative activities like planning.

Answer correspondence: written, electronic, phone and fax.

Coordinates daily clinical operations, consults\ and mentor clinical staff.

Peer review on charts daily Directs patient care.

Evaluate of charts for compliance with local operational policies/procedures.

Assists in the maintenance of facility accreditation.

Reviews medical competency of staff and provide in-services.

Assumes medical care of difficult medical cases.

Mentors junior officers.

Assumes medical care of difficult medical cases.

Mentors junior officers.

Photo

Floor Plan (120 nsf)

Isometric

1.3

5.15

SPACE MATERIAL MATRIX1.3

Walls Floors Ceiling Doors Hardware Glazing Gypsum Carpet Acoustic Tile Standard H.M. Builders Hardware Tempered Glass

Plumbing HVAC Lighting Power Elec./Security Communications

SPACE EQUIPMENT MATRIX1.3

5.16

Administrative and Common Support Unit - Room Data Sheet

ASSISTANT HSA OFFICE

The Assistant HSA position is the primary support of the HSA and should be located in a private office near HSA office.

Assistant HSA functions include the following:

Performs administrative activities Answers correspondence: written, electronic, phone and fax File maintenance and retrieval, archiving documents, records and correspondence. Maintenance of creden-tial files Assists with staffing issues and or day to day operation of the clinic.

Assists in the management of the operating budget Assists in the maintenance of facility accreditation

Photo

Floor Plan (100 nsf)

Isometric

1.4

5.17

SPACE MATERIAL MATRIX1.4

Walls Floors Ceiling Doors Hardware Glazing Gypsum Carpet Acoustic Tile Standard H.M. Builders Hardware Tempered Glass

Plumbing HVAC Lighting Power Elec./Security Communications

SPACE EQUIPMENT MATRIX1.4

5.18

Administrative and Common Support Unit - Room Data Sheet

ADMINISTRATIVE ASSISTANT

WORKSTATION

The Administrative Assistant provides direct support for HSA and Clinical Director. This workstation should be located with direct access to both the HSA and Assistant HSA offices.

Administrative activities include :

Provides clerical support to HSA and CD Answer correspondence: written, electronic, phone and fax Completes filing and storage

Photo

Floor Plan (64 nsf)

Isometric

1.5

5.19

SPACE MATERIAL MATRIX1.5

Walls Floors Ceiling Doors Hardware Glazing Gypsum Carpet Acoustic Tile Standard H.M. Builders Hardware Tempered Glass

Plumbing HVAC Lighting Power Elec./Security Communications

SPACE EQUIPMENT MATRIX1.5

5.20

Administrative and Common Support Unit - Room Data Sheet

WORK AREA

The Work Area is essentially an open work station with document scanner, workstation and cabinets for use by administrative staff. It should be located close to Medical Records and Medical Records Technicians.

The Work Area includes the following functions:

Location of fax, shredder, cabinets.

Storage of stationary supplies.

Photo

Floor Plan (120 nsf)

Isometric

1.6

5.21

SPACE MATERIAL MATRIX1.6

Walls Floors Ceiling Doors Hardware Glazing Gypsum VCT Acoustic Tile Standard H.M. Builders Hardware Tempered Glass

Plumbing HVAC Lighting Power Elec./Security Communications GFI Outlets

SPACE EQUIPMENT MATRIX1.6

5.22

Administrative and Common Support Unit - Room Data Sheet

MULTI PURPOSE ROOM

The Multi-Purpose Room is a conference and training space located in the Administrative Unit. It contains a kitchenette with sink, reference materials and bookshelves. This room may be used as a break/lunch room.

The Multi-Purpose Room includes the following functions:

General staff meeting Staff Training Food preparation Break/Lunch

Photo

Floor Plan (150 - 400 nsf)

Isometric

1.7

5.23

SPACE MATERIAL MATRIX1.7

Walls Floors Ceiling Doors Hardware Glazing Gypsum VCT Acoustic Tile Standard H.M. Builders Hardware

Plumbing HVAC Lighting Power Elec./Security Communications GFI Outlets Intercom, Audio Monitor, Telephone/LAN

PA

SPACE EQUIPMENT MATRIX1.7

5.24

Administrative and Common Support Unit - Room Data Sheet

Photo

MEDICAL RECORDS TECHNICIAN

(MRT) WORKSTATION

The Medical Records Technicians occupy workstations located within the Medical Records Room or directly outside the door.

MRT include the following functions:

Clerical work: print labels, make copies, answer the phone Enters all new arrivals into the system Schedules appointments Compiles charts Reviews charts as they come back to medical records for signatures, completed notes and labels placed on all forms Files completed charts Pulls charts for Sick Call and Physical exams Pulls charts upon request for peer review or studies Compiles charts for transfer Collects and file routing slips Conducts quarterly chart audits for completeness of medical records Pulls inactive charts and file Faxes Medical Hold list to detention and deportation staff daily Conducts other clinics to request information,reports, release of information for continuation of care Conducts other clinics to request information, reports, release of information for continuation of care

Floor Plan (64 - 256 nsf)

Isometric

1.8

5.25

SPACE MATERIAL MATRIX1.8

Walls Floors Ceiling Doors Hardware Glazing Gypsum VCT Acoustic Tile Standard H.M. Builders Hardware Tempered Glass

Plumbing HVAC Lighting Power Elec./Security Communications GFI Outlets

SPACE EQUIPMENT MATRIX1.8

5.26

Administrative and Common Support Unit - Room Data Sheet

MEDICAL RECORDS ROOM

The Medical Records Room is a secure and fire rated room with direct access to MRT workstations. One consideration in the planning of this room is the need for technology in the development of electronic documentation. In the new model technology may reduce the need for a Medical Records Room.

Medical Records includes the following functions:

Enters all new arrivals into the system.

Makes copies of forms needed for the charts.

Storage of patient's charts, inactive and active charts.

Storage all routing slips.

Schedules outside referrals, release of information, PI reports Refers medical holds, supply orders, schedule sick-call appointments.

Conducts medical record review, filing and data entry.

Archiving records, medical record storage.

In some locations is used for: Nursing stations, lunch room, Clinical Directors work station.

Photo

Floor Plan (100 nsf)

Isometric

1.9

5.27

SPACE MATERIAL MATRIX1.9

Walls Floors Ceiling Doors Hardware Glazing Gypsum VCT Acoustic Tile Standard H.M. Builders Hardware Tempered Glass

Dutch Door Plumbing HVAC Lighting Power Elec./Security Communications

GFI Outlets Telephone/L:AN

SPACE EQUIPMENT MATRIX1.9

5.28

Administrative and Common Support Unit - Room Data Sheet

LAN ROOM

The Local Area Network (LAN) Room is a secure space for computer servers that is located within the acceptable range for length of runs of fiber-optic cabling.

The LAN Room includes the…