36C25619R0008-012.pdf

QUALITY ASSURANCE SURVEILLANCE PLAN

For: Mental Health Service/Health Care for Homeless Veterans Program

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

Contract Description: The contractor shall provide 25 Emergency Residential Safe Haven Contract beds for Homeless Veterans. The contractor will also provide therapeutic and supportive services, room and board, transportation 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 Safe Haven Contract Housing program will provide immediate housing to eligible homeless Veterans. The will provide the following:

RO_OM 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, incllfding cou·nseling on self-care skills, adaptive coping skills and, as appropriate, vocational reliabilitati'on·counseling, in collaboration with VA program and community resources .

(5) Assistance to develop responsible living patterns, to m?lintain an acceptable level .of personal hygiene and grooming, and to achieve a. more adaptive level of psychosocial functioning; upgraded social skills, and improved,personal relationshiP,S.

(6) . Support for an_ alcohol/drug abuse-free lifestyle provided in an. environment conducive ·to social interaction .1u1d the-fullest developm_ent of the fesident's potential.

(8) . Assistance to gain and to apply knowledge of �he illness/recovery process in an . �nvironment supportiye_ of recove'Y. mod�ls.

(9) A progr�m that promotes community interaction.

In addition,-the Co'ntractor shall collaborate with tfie VA program staff, who will conduct treatment and discharge planning reflecting a team assessment of health, psychosocial �md vocation.al needs p11d the involvement of residents1-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 HCHV Coordinator will be immediate·1y notified of such discharge by th�e next business day. Other routine discharges due to r.ul� violations will be cleared through the HCHv Coordinator. In emerger:,t situations, tt,e contractor vyill evaluate aod link veterar,s to an appropriated ,level of care manageo,ent.

The Contractor shall ntail)tain .an individual r�cord on each veteran placed in the facility by the HCHV Coordinator: The Contractor shall comply-with the requirements of the Confidentiality of .Medical Recqrds (38 USC 4132) and the Con{identiality of Alcohol and Drug use of a veteran (42 CFR p'art II) when appropriate, and is considered a part of this contract. All case records·will be made available on a need to L<now basis to.appropriate VAMC staff membe�s involved with the treatment program of the veteran concerned. ,In addition to reasons for referral, the clinical record, mairit_ained by the contract facility will inc�ude 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 significc:int alferations in functioning.

2. Data relating to the r�sident's atlmission, to include the-,targeted goals for constructive changes, and the ar:iticipated length of stay.

3. Copies. of any medical prescriptjons iSS\Jed .by ,phy_sjcians, 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 t�e 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 HCHV 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: Sheronda Stewart Assigned CS: Phyllis M. Sh�aley Organization or Agency:

Network Contracting Office 16 (NCO16)

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: Kelly Herpin

c. Other Key Government Personnel - Other HCHV 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 P.erformance 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).

Acceptable Method of

Task to Indicator Standard Quality Surveillance

Incentive Level

Room and board to include a bed and other furnishings such as a dresser, storage and personal linens. Meals to include 3 nutritionally adequate meals daily, 7 Observation Exercise of

1 days a week and Daily. 100% and random Option availability of nutritious inspection. Periods snacks between meals and bedtime for those requiring or desiring additional food, when not medically

Basic Services contraindicated.

Laundry Facilities Availability of laundry <Observation Exercise of

2 facilities for residents to Daily 100% and random Option do their own laundry or inspection. Periods to have.

Therapeutic and Supportive Services individualized as stated Observation, in the plan developed random <Exercise of

3 by the contractor, with Daily . 100% inspection Option input from the Veteran and progress Periods and VA Homeless review.

Program Coordinator or designee.

Acceptable Method of

Incentive Task ID Indicator Standard Quality Surveillance

Level

Skilled Professional counselors of high quality experience in Observation Exercise of

4 working with a Daily, 100% and random Option population with chronic inspection, Periods psychiatric problems including substance, Individual Records must be maintained on each Veteran. To

Upon include essential admission identifying data relevant and Observation, to the resident (weekly throughout random Exercise of progress notes and the 100% inspection Option interim notes

Veteran's and progress Periods documenting any residency. review.

significant alteration in

Including functioning and discharge.

treatment plan with identified problems and goals for achievement.)

Evidence that food is Observation Exercise of prepared, served and

Daily 100% and random Option stored under sanitary inspection. Periods.

conditions.

Provide Close Observation Exercise of

7 monitoring of Daily 100% and random Option medication. inspection.· Periods.

Observation Exercise of

Confidentiality of all

Daily 100% and random Option patient information.

inspection. Periods.

Provide housing and Observation Exercise of supportive services free daily 100% and random Option from religious inspection. Periods.

Safety discrimination.

Observation Exercise of

Compliant with the

At all times 100% and random Option NFPA life safety code. insoection. Periods.

Acceptable Method of

Task ID Indicator Standard Quality Surveillance

Incentive Level

Exercise of Option Period and past

Compliant with the Observation performance

11 American with At all times 100% and random and/or any

Disabilities Act. inspection.

other incentive that was proposed in your solution.>

Provide each Veteran Observation Exercise of appropriate space and

At all times 100% and random Option security for themselves and their belonging.

inspection. Periods.

Provide sufficient sanitary facilities to resident that are in proper operational condition, may be used in privacy, and are

Observation Exercise of p adequate personal

At all times 100% and random Option cleanliness and disposal of human inspection. Periods.

waste. Provides adequate heating and or cooling of facility and electrical sources for use.

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 observation, periq_dic in�pecti'oris, a�d progress meeting�.

·a. DIRECT OBSERVATION. (Can 'be perf�rme� perfodical!t or through 100% surveillance.)

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b. PERIODIC INSPECT.ION. (Evaluates putcomes on. a pe·riodic basi·s. lnsp�ctioa� may be scheduled [Daily, Weekly: Monthly, Qua,rterly, or annu�ll'y] or unsct,�d\Jled, as required.)

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d. PROGRESS MEETINGS.

Monthly meeting .)lllith Contracting staff .and Veterans.

3 & 6

8. RA,TINGS

Metrics and methods are designed to.determine if performance exceeds, me'ets, or does not meet a given standard and acc�ptable quality level. A rating sqal8.c shall be used to determine a positive, neutral, or negative outcome. The following rating,s··shall be �sed:

Quarterly Reports will be used to reflect the rating of ''exce�ds, meets, or does not meet a given standard. These ·reports·will be combined to incorporate ·into the anr,ual inspection assessment.

9. DOCUMENTING PERFO'RMANCE,

a. ACCEPTABLE PERFORMANCE ,, Tfie Government shall documenfpositive pei:formance. Any re'p.ort may be·come a part of the supporting documentation for any contracfu�I action.

b.UNACCEPTABLE�ERFQR�ANCE

When.unacceptable performance occurs·, ·the COR 'shall inform the contra"ctor. This will normally be in writing unless cifcumsta,nces ne�essitate.vei-Qal coryimunication. In any case the COR shall document the discussion-ijnd place it in the COR file.

vyhen the COR dete_rmines formal writteh communicatior:i is required, the. COR shall prepare a Contract Discrep�ncy Report (CD�). an� present it to the contractor's program manager.

The contractor shall acknowlec;lge receipt of the CDR in writing. The CDR'yvil,I specify if the contractor is required to prepare a corrective action plan to aocument how the,qontractor shall correct the unacceptable performance and avoid• a recurrenc�. The CDR will also state how long· after receipt' the cqntractor: has to present �his corrective action ,plan to the COR. The Government shall review the contractor's corr�ctive action plan to determine acc�ptability.

Any CDRs may become a part .of the supporting documentation for ·any contr�ciual action deemed n�ce�sary by the CO.

10 .. FREQUENCY OF- MEASUREMENT

a. Frequency of M_easurement.

During contract performance, the CORWill peciodically analyze whether the negotiated freqtJency of surveillance is appropriate for tt)e work being performed.

b. Frequency of Performance Assessment fvleetings.

The COR shall meet with the contractor as needed to assess f'.)erforl'lianee and shall provide a written assessment.

Signature - Contracting Qffic�r