Attachment J06 Facility User Manual.pdf

Indian Health Service Division of Engineering Services

95% Construction Document Submittal

Contract Number: HHSI102201800005I Task Order Number: 75H70119F30005

Facility User Manual Pueblo Pintado Health Center, Pueblo Pintado, New Mexico mconard Text Box

APPENDIX A7

FACILITY USER MANUAL September 19, 2022

95% CONSTRUCTION DOCUMENT SUBMITTAL

PUEBLO PINTADO HEALTH CENTER

Pueblo Pintado, New Mexico

Introduction

This Facility User Manual for Pueblo Pintado Health Center is intended for all staff members working within the health center and provides an overview of the design and functional organization of the facility.

See the Table of Contents below for topics:

SECTION PAGE #

Introduction

IHS AE Guide Description of the Facility User Manual

Facility Design

Facility Expansion/Flexible Design

Community Engagement

Operational Concept

Services and Departments

Site Design

Sustainability

Building Code Analysis

Logistics and Deliveries

Equipment

Elevators and Vertical Circulation

HVAC Systems

Plumbing Systems

Electrical Systems

Fire Protection Systems

Security Systems

Communications Systems

Wayfinding

PUEBLO PINTADO HEALTH CENTER

IHS AE Guide Description of the Facility User Manual

3.6 Facility User Manual

(1) Prior to project completion, the A/E shall prepare a user manual that will explain how the new health facility is intended to be operated. The manual shall address the use or functional organization of the health facility and explain how to use the health facility in plain language. Major considerations in planning, layout, and design are highlighted. Significant design features, cultural aspects, major pieces of equipment, and potentials for flexibility and expansion are to be made clear.

(2) The manual is intended for all staff members working within the health facility. Since the informational needs will vary among staff, the manual will provide information on the functions and systems at different levels of detail. The manual also needs to be flexible for both its day-to-day use and for the addition of updated material as it is developed.

(3) The manual shall include, but not be limited to the following topics: introduction/executive summary;

an overview of the facility design and operational concept; building circulation/individual department review; HVAC systems; plumbing systems; electrical systems; fire protection systems; security systems;

communication systems; site design; energy conservation; code conformance/waivers; signage/ way finding; and any supplemental information.

The facility user manual is not intended to be an excerpt of the operations and maintenance manual. For building systems, it should present the intended strategy of operations that guides specific equipment sequences. The facility user manual is intended to capture the architectural story of the new facility along with the conceptual operational function of the primary mechanical and operational systems. It will be used in new employee orientation, marketing of service and recruitment of new medical staff to ensure the ideas, themes and cultural references which inspired the design during the project’s planning and conceptual development are retained. The intent of documenting the operational systems of the building is to provide a clear review of the mechanical, electrical and other installed systems that impact users and staff. The facility user manual is not a maintenance manual or operational guide. It should highlight the design intent of the broad systems that are installed along with their function. Primary focus should be on systems that impact users with regard to response, emergency power operation and other primary utility outages, infection control ventilation, building pressure.

PUEBLO PINTADO HEALTH CENTER

Facility Design

The architectural design of the Pueblo Pintado Health Center is a response to the issues and concerns raised by the Navajo Nation Steering committee, the IHS Project Leadership Team, and the IHS Design

Group with the Crownpoint Service Unit. Both groups envisioned a place of community connection and holistic healing. Rising with striking distinction from the silty soils of Pueblo Pintado, the building design comprises imagery inspired by the Visual Preference Survey and follows a directive issued from the members to experience a destination "unlike any other seen in the Navajo Nation." From Rural Route 9, patients and visitors proceed through a generous landscape, convenient parking, and a patient drop-off area adjacent to the prominent entry. Visitors with limited mobility are accommodated through dedicated entry points adjacent to parking and by a pharmacy drive-thru lane for prescription pick-up. Service deliveries, fuel storage, and mobile medical unit areas have been designated just south of the lower level.

Upon entry from the east vestibule, the interior serves as an extension of the exterior by use of daylighting, natural material selections, and design elements inspired by cultural practices of the Navajo nation. Accent colors influenced by traditional Navajo clothing, beadwork, and jewelry appear throughout the center for wayfinding continuity.

PUEBLO PINTADO HEALTH CENTER

Facility Expansion/Flexible Design

Illustrations below depict possible expansion areas for the EMS and Health Center facilities. Health

Center expansion is connected to the First Floor level, totaling 37,800 sf. The EMS facility floor elevation is near the Ground Floor level of the Health Center and is thus shown together. EMS future expansion is indicated at 1,650 sf.

GROUND FLOOR PLAN

FIRST FLOOR PLAN

mconard

PUEBLO PINTADO HEALTH CENTER

Community Engagement

Access control options would allow for off-hours access to the south-east wing of the First Floor level for use of the larger conference rooms and the Wellness Center. Community access will be dependent upon facility schedules and management priorities.

PUEBLO PINTADO HEALTH CENTER

Operational Concept

The Navajo Area Indian Health Service, in partnership with the Navajo Nation, conducted a comprehensive strategic planning process to define a regional and integrated health care system network. The plan was developed from a population-based planning approach that clearly delineates the services and resources necessary to meet the health care needs of the Navajo Nation tribal members in the Pueblo Pintado Service Area.

The Pueblo Pintado Health Center complex consists of approximately 125,000 square feet of facility, not including staff residences. It is a modern, technologically advanced facility with enough space and staff to provide an expanded level of health care services specifically designed to meet the health care needs of the community in the Crownpoint Service Unit. In addition, to the Indian Health Service programs, several tribally operated health programs have been incorporated into the new facility. This improves access to medical care as well as improve the collaboration and partnership between the Navajo Nation and the

Indian Health Service. The new facility will provide an expanded outpatient department, community health department, and a full array of ancillary and support services.

Services and Departments

The following Services are provided within the facility:

1. Additional Services: Located primarily on the upper floor with food service split (both floors).

a. Cafeteria

b. Community Health Programs Shared Space

c. IHS Special Diabetes Program

d. Navajo Nation Behavioral Health

e. Navajo Nation Infectious Disease Control and Prevention

f. Navajo Nation Community Health Representatives

g. Navajo Nation Emergency Medical Services (separate building)

h. Navajo Nation Health Education

i. Navajo Nation Special Diabetes

j. Navajo Nation Women, Infant, and Children Nutrition Program

2. Administration: Located primarily on the lower (ground) floor.

a. Administration

b. Business Office

c. Health Information Management

d. Information Technology

e. Purchased & Referred Care

f. Security

PUEBLO PINTADO HEALTH CENTER

3. Ambulatory: All space located on the upper floor.

a. Audiology

b. Dental Care

c. Eye Care

d. New Horizons (Social Work)

e. Podiatry

f. Primary Care

g. Specialty Care

4. Ancillary: All space located on the upper floor.

a. Diagnostic Imaging

b. Laboratory

c. Pharmacy

d. Physical Rehabilitation Services

5. Facility Support: Located primarily on the lower (ground) floor.

a. Clinical Engineering

b. Facility Management

6. Preventative: All space located on the upper floor.

a. Environmental Health

b. Health Promotion

c. Public Health Nursing

d. Public Health Nutrition

e. Wellness Center

7. Support Services: Located throughout the facility.

a. Education and Group Consultation

b. Employee Facilities

c. Housekeeping and Linen

d. Property and Supply

e. Public Facilities

PUEBLO PINTADO HEALTH CENTER

Site Design

All site roadways, parking areas, service areas, etc. will be paved with hard surface pavement and curb and gutter. Pavement material is planned to be concrete, for durability. Additionally, BIA Road N7134 that runs along the east side of the property, which is currently a dirt road, has been planned to be paved as far south as the new water tower that will be constructed with the project. A new water tower serving the health center and proposed staff housing will be located at the west end of the site (furthest from the main road).

Parking areas will be designed for light duty passenger vehicle traffic, with service areas, primary drives, and other heavier vehicle areas being designed for a more heavy-duty load. Concrete paving thicknesses will be per geotechnical report recommendations. Sidewalks will be 4” concrete pavement.

All site stormwater drainage from the building and parking/roadway areas will be collected in storm inlets and conveyed through storm sewers to detention basin(s) that will be constructed with the facility. Site security at the clinic facility will be a combination of limited security fencing, livestock fencing, and after-hours security gates at all drives.

All accessible parking spaces and accessible routes to/from the building, along with all exterior gathering areas, will be designed in accordance with ABA requirements for number and slopes of spaces, slopes along walking paths, door landings, etc. Where site ramps (slope > 5%) may be required, they will be provided with handrails and landings at every 30” of rise. Appropriate accessible parking signs will be installed where those spaces are provided.

Site landscaping will be accomplished using species that are native and appropriate for the arid climate.

No permanent irrigation system will be installed with the only watering to occur during the establishment period.

PUEBLO PINTADO HEALTH CENTER

Sustainability

Designed to meet LEED Gold certification from the U.S. Green Building Council and the GSA’s Guiding

Principles (as implemented by IHS), the Pueblo Pintado Health Center will strive to achieve optimal energy performance, protection, conservation of water, and reduce the environmental impact of materials and building systems. The following events and activities contributed to planning and design efforts:

April 2005 Initial Phase 1 Site evaluation. Eight potential sites for the Pueblo Pintado medical facility within the Navajo Nation Reservation were evaluated in terms of area requirements, accessibility, adequacy of support space, and potential flood problems. Site H was eventually chosen as the project site, which would include a modern healthcare facility and staff quarters comprised of 82 homes.

Around this same time, the Steering Committee representing chapters served by the proposed health center began to meet regularly.

February 2020 Phase 2 Site Selection & Evaluation Report. A site was selected with proposed area (acreage) to provide for the health center, housing, site circulation, and infrastructure.

April 2021 The design team received their Notice to Proceed and subsequently initiated design discussions and charted a project schedule for this new 122,000 SF facility.

June 2021 Sustainability Charrette with owner, design team, commissioning agent, building operator representatives, and stakeholders (Steering Committee).

June 2021 Pre-Design Submittal

July 2021 Project Registration with GBCI

August 2021 Concept Design submittal

November 2021 Schematic Design Submittal

1March 2022 Design Development submittal

June 2022 65% Construction Document submittal

September 2022 95% Construction Document submittal

November 2022 Final Construction Document submittal

PUEBLO PINTADO HEALTH CENTER

Building Code Analysis

Pueblo Pintado Health Center is comprised of two separate buildings. Building 1 is the primary health center facility and Building 2 is a separate structure for Emergency Medical Services. The two buildings have a separation distance of 50’-1”.

Building 1 is type II-B [II (000)] construction and the primary occupancy classification for the structure is B

(Business). This building is allowed 4 stories, 75’ of height, and 161,000 square feet of area per floor. By building definition it is a single story with a basement, 68’ in height, and 117,516 square feet of enclosed building area (122,284 square feet total code area including the overhang of primary roofs).

This building has two areas that are accessory to the business occupancy. The kitchen and serving area downstairs is an A-2 Assembly space covering about 9.9% of the floor area. The conference center upstairs is an A-3 Assembly space covering about 2% of the floor area. There are also three assembly spaces upstairs classified as small assembly less than 750 square feet: physical therapy exercise room, wellness center classroom, and wellness center activities room.

The main lobby space contains two convenience openings in the floor that connect the two floors of the building. Smoke partitions separate these convenience openings in the lobby from the remainder of the building per NFPA 8.4.1.2. All other vertical circulation stair and elevator shafts are enclosed by 1 hour fire partitions. Vertical shafts for ductwork are also enclosed by 1 hour fire barriers as well as the following hazardous areas: major mechanical area, medical gas storage, and hazardous storage. The shop maintenance and storage areas were also requested by the facility users to be enclosed by a 1-hour fire barrier. All other storage areas are considered accessory to the business occupancy per IBC 311.1.1.

Building 2 is type II-B [II (000)] construction with three separated mixed occupancies: B (Business), S-2

(Storage), and R-3 (Residential). This building is allowed up to 4 stories, 75’ of height, and 161,000 square feet of area per floor. It is 1 story, 24’ in height, and 4,839 square feet in area.

PUEBLO PINTADO HEALTH CENTER

Logistics and Deliveries

See following plans for suggested delivery paths for Ground Floor and First Floor.

PUEBLO PINTADO HEALTH CENTER

Equipment

Most non-computer-related equipment in the facility has been provided as part of this project.

Specifications for equipment (types, quantities, locations) originated with a Project Room Contents List provided by IHS and has been modified per the Whole Building Design Guide and per Crownpoint

Healthcare Center department and facility management input.

Elevators and Vertical Circulation

The facility contains two 4,500 lb passenger/service elevators (Elevs. #1 & #2) and one 5,000 lb service elevator (Elev. #3), each providing a travel speed in the range between 100 – 150 feet per minute. Each elevator is hydraulically operated with a holed jack assembly, an elevator pit, and a separate nearby machine room.

Elevator #1 is a dedicated passenger elevator that also may be used as a service elevator. It is accessed from the main lobby on the Ground and First Floors.

Elevator #2 is a passenger elevator that also accommodates an emergency exit route for patients with acuities beyond the Health Center’s capabilities to treat. This elevator faces the main lobby on both floors, but also allows for a direct path from the Ambulatory Care Department to a dedicated emergency patient exit.

Elevator #3 is a service elevator that connects Property & Supply to the First Floor.

Two sets of stairs connect the two floors. One is an enclosed shaft stair in a primarily staff-occupied area.

The other stair is in a convenience opening that connects the upper and lower lobbies.

PUEBLO PINTADO HEALTH CENTER

HVAC Systems

The HVAC system type is a variable air volume (VAV) air handling system that is served by air-cooled chillers and hot water boilers. The VAV air handling units will distribute air to single duct terminal units with hot water reheat coils for individual space temperature control. All of the air handling units (AHUs) will be installed in rooftop penthouses to promote a high level of maintenance and maximize the lifespan of the equipment. Each AHU will consist of a supply and return fan arrays, chilled water coil, hot water coil, humidifier dispersion grid, pre- and final filtration, and economizer/mixing box sections. The supply and return fan arrays will have multiple direct drive plenum fans for redundancy, efficiency, ease of maintenance, and noise control.

A packaged makeup air unit (MAU) with direct expansion (DX) cooling and propane gas fired heating will serve the kitchen/food service area. The MAU will also provide temperature control for the area and will be capable of 100% outside air during kitchen exhaust hood operation and will also be capable of minimum outside air when the kitchen exhaust hoods are not in use.

The chilled water system will consist of three (3) air cooled chillers to provide N+1 redundancy. Each chiller will have variable speed compressors and high turndown capability to maximize system efficiency.

The chilled water working fluid will be a 30% propylene glycol/70% water mixture. Base mounted end suction pumps with variable frequency drives (VFDs) will be located in the main mechanical room to distribute chilled water throughout the facility. Chilled water distribution will be configured in a variable primary fashion.

The heating hot water system will consist of two (2) high efficiency condensing boilers to provide N+1 redundancy. Each boiler will have modulating heat exchanges and high turndown capability to maximize system efficiency. The heating hot water working fluid will be a 30% propylene glycol/70% water mixture.

The boiler system will also serve the heat exchangers that provide domestic hot water for the facility.

Base mounted end suction pumps with VFDs will be located in the main mechanical room to distribute hot water throughout the facility. Hot water distribution will be configured in a variable primary fashion.

PUEBLO PINTADO HEALTH CENTER

Plumbing Systems

The domestic cold water service will enter the main mechanical room and will have a backflow preventer and meter. A water softening system will be provided to serve the domestic water service with the exception of the exterior wall hydrants. The domestic water service will include several submeters to support water management and track water consumption for restroom groups.

Domestic hot water will be generated by heat exchangers served by the HVAC boiler system.

All plumbing fixtures throughout the facility will be standard healthcare/commercial grade and all water closets and urinals will have flush valve operation. A grease interceptor will be provided for the food service drainage fixtures.

PUEBLO PINTADO HEALTH CENTER

Electrical Systems

The electrical system is a 480Y/277 volt, 3 phase, 4 wire underground electrical service that is served by an exterior pad mounted utility transformer. The utility transformer is located to the south of the building and feeds the electrical service in the main electrical room. The building has complete backup power generation via three exterior pad mounted diesel generators. The generators have two above ground fuel oil diesel tanks to serve the generators. The building is equipped with advanced electrical energy meters and measures total electrical energy, HVAC systems, interior lighting, exterior lighting, receptacles and kitchen loads. On-site generation of energy is provided with a photovoltaic system, that is located on the roof.

Lighting throughout the facility utilizes energy efficient LED fixtures with integral dimming capability.

Dimmable or multilevel lighting is provided for at least 90% of occupant spaces. Dimming is not provided in areas such as storage, mechanical, electrical and utility type rooms. Automatic daylighting dimming is provided in the areas that achieve signification daylight, including in particular the main lobby area.

Occupancy and vacancy sensors are provided in all areas as required.

All exterior lighting for the facility utilizes energy efficient LED fixtures and will be cutoff type to reduce light pollution beyond the building site. Exterior lighting will have photocell and timeclock controls capabilities to turn on when adequate daylight is not available and to dim down or turn off at set times.

The facility has an intelligent microprocessor, addressable fire detection/fire alarm/emergency audio system. The fire alarm system will be voice, mass notification type. The fire alarm system includes:

• Manual pull stations

• Smoke Detectors/Duct Mounted Smoke Detectors

• Audible speaker/visual notification devices

• Connection to fire sprinkle flow and tamper switches

• Connection to fire/smoke and smoke dampers

• Connection to fire/smoke doors

• Connections to elevator recall

The facility has a lightning protection and facility grounding system consisting of aluminum main conductors around the perimeter of the building and roof equipment to allow for connection of air terminals and grounding of rooftop equipment. Main conductors are connected to a building perimeter ground lop system via conduit downleads and ground rods.

PUEBLO PINTADO HEALTH CENTER

Fire Protection Systems

Both the Health Center and the EMS Facility will be fully sprinklered. A more detailed description is included below:

Narrative to be added…

Security Systems

The facility has a security system that is comprised of security cameras and an access control system.

The security camera system is a complete system that provides coverage of all entrances into and out of the building including the main entrances, employee entrances, pharmacy entrance and EMS building entrances. Security cameras also provide coverage of loading docks, waiting rooms, and pharmacy dispensing areas. Security cameras are all POE type cameras.

The access control system is a complete system comprised of card readers throughout the facility.

Locations for card readers include all secured entryways, telecommunication rooms, pharmacy, patient record storage, and corridors separating public and staff areas. The system will monitor and control facility access.

Communications Systems

The facility has a complete telecommunication system that includes an entrance facility, telecommunication rooms, server room, equipment racks, cable tray and pathways, patch panels, backbone cabling, horizontal cabling, data jacks, and cover plates.

Backbone cabling between telecommunication rooms is single mode fiber. Horizontal cabling between patch panels and data jacks is Category 6a copper cabling. The telephone system is all voice over IP

(VOIP) and utilizes Category 6a horizontal cabling.

The facility has a complete paging/intercom system. The system is a building wide public announcement system throughout to allow for paging and announcements to be heard throughout.

The facility has a complete nurse call system. The nurse call system communicates patients and staff calls for assistance and information. The system includes emergency pull cords in single use toilets, staff stations in exam and treatment rooms, dome lights and master stations for annunciations of calls.

PUEBLO PINTADO HEALTH CENTER

Wayfinding

Key wayfinding elements will be bi-lingual, with Navajo prioritized and English in parenthesis. Planned language format is depicted below:

Diné Bizaad (English)

Note: this example is not a translation, but rather a depiction of the two languages in their native forms.

Facility User Manual