36C25618R0775-006.docx

QUALITY ASSURANCE SURVEILLANCE PLAN

For: Substance Use Disorder Services (SUDS) Program

Contract Number: < Upon award, Government will enter contract number>

Contract Description: The contractor shall provide 5 Emergency Residential Contract beds for Homeless Veterans. The contractor will also provide therapeutic and supportive services, room and board, and laundry facilities.

Contractor’s name: <Enter your company name.> (hereafter referred to as the contractor).

1. PURPOSE

To specify the systematic methods for evaluating performance of the Emergency Contract Housing program.

A. Scope:

Residential Contract Housing program will provide immediate housing to eligible homeless Veterans. The will provide the following:

ROOM AND BOARD: Room and Board to include a bed and other furnishings such as a dresser, storage, and personal linens (towels and bed sheets). Meals to include three (3) nutritionally adequate meals a day, 7 days a week and availability of nutritious snacks between meals and bedtime for those requiring or desiring additional food, when it is not medically contraindicated.

LAUNDRY FACILITIES: Laundry facilities for residents to do their own laundry or to have laundry done.

THERAPEUTIC AND SUPPORTIVE SERVICES: Therapeutic and Supportive Services determined to be needed by each individual Veteran referred for treatment as stated in the plan developed by the contractor, with input from the Veteran and the VA Homeless Program Coordinator (or designee). Services which the contractor shall furnish:

(1) Structured group activities as appropriate – examples include group therapy, social skills training, Alcoholics Anonymous, Narcotics Anonymous, vocational counseling and physical activities as appropriate.

(2) Collaboration with the VA program staff, which will provide supportive psychosocial services.

(3) Skilled professional counselors of high quality geared for a population with chronic psychiatric problems, including substance abuse/dependence, e.g. and addiction therapist and/or psychiatric technicians. The counselors possess assessment and crisis intervention skills.

(4) Individual professional counseling, including counseling on self-care skills, adaptive coping skills and, as appropriate, vocational rehabilitation counseling, in collaboration with VA program and community resources.

(5) A drug and alcohol-free setting and consistent support for drug and alcohol-free lifestyle. The contractor will have a system to do admission and random breathalyzers as needed. The Veterans Affairs Medical Center (VAMC) will provide drug screening upon request, in a timely manner.

(6) Assistance to develop responsible living patterns, to maintain an acceptable level of personal hygiene and grooming, and to achieve a more adaptive level of psychosocial functioning, upgraded social skills, and improved personal relationships.

(7) Support for an alcohol/drug abuse-free lifestyle provided in an environment conducive to social interaction and the fullest development of the resident’s potential.

(8) Assistance to gain and to apply knowledge of the illness/recovery process in an environment supportive of recovery models.

(9) A program that promotes community interaction.

In addition, the Contractor shall collaborate with the VA program staff, who will conduct treatment and discharge planning reflecting a team assessment of health, psychosocial and vocational needs and the involvement of residents’ families and appropriate community resources in resolving problems and setting goals. The Contractor shall have the right to discharge beneficiaries to preserve the health and safety of other beneficiaries and staff. The SUDS Coordinator will be immediately notified of such discharge by the next business day. Other routine discharges due to rule violations will be cleared through the SUDS Coordinator. In emergent situations, the contractor will evaluate and link veterans to an appropriated level of care management.

The Contractor shall maintain an individual record on each veteran placed in the facility by the SUDS Coordinator. The Contractor shall comply with the requirements of the Confidentiality of Medical Records (38 USC 4132) and the Confidentiality of Alcohol and Drug use of a veteran (42 CFR part II) when appropriate, and is considered a part of this contract. All case records will be made available on a need to know basis to appropriate VAMC staff members involved with the treatment program of the veteran concerned. In addition to reasons for referral, the clinical record, maintained by the contract facility will include the following:

1. All essential identifying data relevant to the resident. Records should reflect admission and discharge summaries, weekly progress notes and interim notes documenting any significant alterations in functioning.

2. Data relating to the resident's admission, to include the targeted goals for constructive changes, and the anticipated length of stay.

3. Copies of any medical prescriptions issued by physicians, including orders, if any for medications to be taken.

4. Reports of periodic re-evaluation by program staff, to include any measures of movement toward rehabilitation goals, with particular focus on the attainment of self-help skills.

5. Final summaries on each veteran who leaves the program, to include a description of beneficial changes realized during the residential period, reasons for leaving, the resident's future plans and follow-up locator information.

Monitoring of Facility and Program:

Prior to the award of a contract and annually during the contract term, a multidisciplinary VA team consisting of a social worker, dietitian, registered nurse, a representative of the VA Police, and a Facilities Management Safety Officer, and other subject matter experts as determined necessary by the medical center director or SUDS Coordinator shall conduct a survey of the Contractor’s facilities to be used to provide Veterans food, shelter, and therapeutic services to assure the facility provides quality care in a safe environment. Inspections may also be carried out at such other times as deemed necessary by the Department of Veterans Affairs.

Special attention will be directed to the adequacy of the veteran's records. Site visits will also include a spot check of records to ensure contractor invoices accurately reflect the veteran's length of stay.

Monitoring of the facility and program will be documented on VISN designed templates.

2. GOVERNMENT ROLES AND RESPONSIBILITIES

The following personnel shall oversee and coordinate surveillance activities.

a. Contracting Officer (CO) - The CO shall ensure performance of all necessary actions for effective contracting, ensure compliance with the contract terms, and shall safeguard the interests of the United States in the contractual relationship. The CO shall also assure that the contractor receives impartial, fair, and equitable treatment under this contract. The CO is ultimately responsible for the final determination of the adequacy of the contractor’s performance.

Assigned CO: Phyllis M. Shealey Organization or Agency: Department of Veterans Affairs, Network Contracting Office 16, Overton Brooks VA Medical Center

b. Contracting Officer’s Representative (COR) - The COR is responsible for technical administration of the contract and shall assure proper Government surveillance of the contractor’s performance. The COR shall keep a quality assurance file. The COR is not empowered to make any contractual commitments or to authorize any contractual changes on the Government’s behalf.

Assigned COR: Dr. Norma Charles

c. Other Key Government Personnel – Other SUDS staff

3. CONTRACTOR REPRESENTATIVES

The following employees of the contractor serve as the contractor’s program manager for this contract.

a. Program Manager - <Enter name.>

b. Other Contractor Personnel - <Enter name(s) or delete these lines if not applicable> Title: <Enter title(s) or delete these lines if not applicable.>

4. PERFORMANCE STANDARDS

Performance standards define desired services. The Government performs surveillance to determine if the contractor exceeds, meets or does not meet these standards.

The Performance Requirements Summary Matrix, paragraph B.3 in the Performance Work Statement (PWS), includes performance standards. The Government shall use these standards to determine contractor performance and shall compare contractor performance to the Acceptable Quality Level (AQL).

Availability of laundry facilities for residents to do their own laundry.

5. INCENTIVES

The Government shall use Exercise of Option Periods as incentives.

6. METHODS OF QA SURVEILLANCE

Various methods exist to monitor performance. The COR shall use the surveillance methods listed below in the administration of this QASP.

Direct obs ervation, periodic inspections, and progress meetings

a. DIRECT OBSERVATION. (Can be performed periodically or through 100% surveillance.)

1-14

b. PERIODIC INSPECTION. (Evaluates outcomes on a periodic basis. Inspections may be scheduled [Daily, Weekly, Monthly, Quarterly, or annually] or unscheduled, as required.)

1-14

d. PROGRESS MEETINGS.

Monthly meeting with Contracting staff and Veterans.

3 & 6

8. RATINGS

Metrics and methods are designed to determine if performance exceeds, meets, or does not meet a given standard and acceptable quality level. A rating scale shall be used to determine a positive, neutral, or negative outcome. The following ratings shall be used:

Quarterly Reports will be use d to reflect the rating of “exceeds, meets, or does not meet a given standard. These reports will be combined to incorporate in to the annual inspection assessment.

9. DOCUMENTING PERFORMANCE

a. ACCEPTABLE PERFORMANCE

The Government shall document positive performance. Any report may become a part of the supporting documentation for any contractual action.

b. UNACCEPTABLE PERFORMANCE

When unacceptable performance occurs, the COR shall inform the contractor. This will normally be in writing unless circumstances necessitate verbal communication. In any case the COR shall document the discussion and place it in the COR file.

When the COR determines formal written communication is required, the COR shall prepare a Contract Discrepancy Report (CDR), and present it to the contractor's program manager.

The contractor shall acknowledge receipt of the CDR in writing. The CDR will specify if the contractor is required to prepare a corrective action plan to document how the contractor shall correct the unacceptable performance and avoid a recurrence. The CDR will also state how long after receipt the contractor has to present this corrective action plan to the COR. The Government shall review the contractor's corrective action plan to determine acceptability.

Any CDRs may become a part of the supporting documentation for any contractual action deemed necessary by the CO.

10. FREQUENCY OF MEASUREMENT

a. Frequency of Measurement.

During contract performance, the COR will periodically analyze whether the negotiated frequency of surveillance is appropriate for the work being performed.

b. Frequency of Performance Assessment Meetings.

The COR shall meet with the contractor as needed to assess performance and shall provide a written assessment.

Signature –Contractor

Signature – Contracting Officer’s Representative

Signature – Contracting Officer