Amendment 2 36C26123Q1032 0002.pdf

5. PROJECT NUMBER (if applicable)

CODE 7. ADMINISTERED BY

2. AMENDMENT/MODIFICATION NUMBER

CODE

6. ISSUED BY

8. NAME AND ADDRESS OF CONTRACTOR

4. REQUISITION/PURCHASE REQ. NUMBER 3. EFFECTIVE DATE

9A. AMENDMENT OF SOLICITATION NUMBER

9B. DATED

PAGE OF PAGES

10A. MODIFICATION OF CONTRACT/ORDER NUMBER

10B. DATED

BPA NO. 1. CONTRACT ID CODE

FACILITY CODE CODE

Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods:

The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers

E. IMPORTANT:

is extended,

(a) By completing Items 8 and 15, and returning __________ copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted; or (c) By separate letter or electronic communication which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY is not extended.

12. ACCOUNTING AND APPROPRIATION DATA

(REV. 11/2016)

is required to sign this document and return ___________ copies to the issuing office. is not, A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT ORDER NO. IN ITEM 10A.

15C. DATE SIGNED

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by letter or electronic communication, provided each letter or electronic communication makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER

Contractor

16C. DATE SIGNED

14. DESCRIPTION OF AMENDMENT/MODIFICATION

16B. UNITED STATES OF AMERICA

Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.

15A. NAME AND TITLE OF SIGNER 16A. NAME AND TITLE OF CONTRACTING OFFICER

15B. CONTRACTOR/OFFEROR

STANDARD FORM 30 PREVIOUS EDITION NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.243

(Type or print) (Type or print)

(Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

(Number, street, county, State and ZIP Code)

(If other than Item 6)

(Specify type of modification and authority)

(such as changes in paying office, appropriation date, etc.)

(If required)

(SEE ITEM 11)

(SEE ITEM 13)

(X)

CHECK

ONE

13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS,

IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

(Signature of person authorized to sign) (Signature of Contracting Officer)

1 34

0002 10-19-2023 640-24-1-344-0003 None

612MCP

Department of Veterans Affairs

Network Contracting Office (NCO) 21 3237 Peacekeeper Way, Bldg 200 Suite 204 McClellan Park CA 95652

612MCP

Department of Veterans Affairs

Network Contracting Office (NCO) 21 3237 Peacekeeper Way, Bldg 200 Suite 204 McClellan CA 95652

To all Offerors/Bidders 36C26123Q1032

08-08-2023 X

X 1

The purpose of this amendment is to include the Question and Answer (QA) response below and updates section 7.1.1 and section 7.2.1 of the Performance Work Statement (PWS). The sections changed in the PWS have been highlighted.

All other terms and conditions remain unchanged.

Tim Smith Contracting Officer

Question and Answer

1. Is it okay if the Veterans are housed in a residential home?

VA Response - As long as the persons with the residential home are able to provide all services outlined in the Performance Work Statement and there is no conflict with their landlord etc., it should not be a problem.

2. Are there any specifics for this requirement that are not listed in the solicitation?

VA Response - No, the solicitation contains all the information needed to fulfill this requirement.

3. What are the education, experience and licensure requirements for the following Key Personnel positions: Case Manager Supervisor and the Night/Weekend Manager.

VA Response - The contract requires an LVN to be the main case manager and an on call LVN for night and weekends. The supervisor and night and weekend manager is not required to have these credentials however they are required to be familiar with the medical respite program rules and regulations as they may differ from other shelter programs. They are also required to have the trainings as listed in the contract.

4. Do you have historical data pertaining to the current incumbent for this requirement and Past Contract Award.

VA Response - Only questions regarding the current solicitation will be answered.

5. Can you please provide the NFPA 101 Facility inspection sheet data information for this requirement pertaining to Small Board and Care with less than Eight (8) people.

VA Response – An example of the inspection sheet is located below.

6. What is the maximum number of Veterans allowed to sleep in One (1) bedroom for this requirement.

VA Response - There is no maximum, however if the number of Veterans in one room is impeding Veterans ability to navigate with assistive devices (wheelchairs, walkers, and canes) or safety or hygiene or any other in any way impedes the duties described in the Performance Work Statement, this would affect the number of Veterans in a room. Recommendation is 1 per room for small rooms and 2 per room for larger but it is not specifically outlined.

7. What is the current "Fair market” Daily all-inclusive per diem rate for this requirement.

VA Response - The vendor is expected to determine the “fair market” value based on the requirements found in the Performance Work Statement.

8. What is the anticipated start date for this requirement.

VA Response – 12/1/2023

9. The RFQ document states that at least Fifty percent (50%) of the beds will be wheelchair accessible.

Will the VA provide the Awarded Contractor with this type of REQUIRED durable medical equipment (e.g Hospital/Handicap bed).

VA Response – The agency awarded this contract will be expected to communicate with VA and Non VA providers on the needs of the Veterans. Not all Veterans will need medical equipment, and if medically determined AND if a Veteran is agreeable to care and receiving care with VAPAHCS and the equipment is approved, it can be provided by the VA. Otherwise, the provider will be working with the Veteran on the required devices. Normally this can be worked around, but there have been cases where Veterans are declining VA healthcare services or the Veteran is refusing to use medical equipment.

10. Please clarify the statement found under the Therapeutic and Rehabilitative Services Section 3.1.9.2 which says the following:

“While the contractor is not expected to offer licensed level care, the contractor will support Veterans who show a decline in daily functioning. As such, the administrator for this agency must be RCFE administrator certified. Whereas, a RCFE Administrator certification is an actual Eighty (80) hour “license” program overseen by the California Department of Social Services (CDSS). Why would a prospective contractor be REQUIRED to have this type of licensed certification if they are not expected to offer licensed level care, as stated in Section (2.1).”

VA Response - In order to understand the needs of the population expected to be served and to provide an exceptional quality of care, RCFE Administrator certification provides this education. Many of our providers will want the Geriatric contract without any knowledge of the needs of a geriatric population or the expectation of the services or how to manage those services.

11. Section 6.1.3 - Can you please clarify what is the education and or licensure requirement for the role of a “Certified Medical Technician”.

VA Response - There is no education requirement for the certification of medication assistance. Below are some examples of locations they can acquire this training (not endorsed by VA):

CEU providers provided by CDSS that can provide the medication monitoring training for staff.

https://www.cdss.ca.gov/Portals/9/CCL/ACP/2023/RCFEceu.pdf?ver=2023-10-03-103634-667

Examples of the medication monitoring training https://admh.academy.reliaslearning.com/Medication-Documentation-for-California--REL-PAC-0- MDC.aspx https://careersmart.com/shop/medication-training-for-facilities-of-15-or-less-capacity-california-required-rcfe/ https://reliasacademy.com/rls/store/browse/productDetailSingleSku.jsp?productId=p317033 https://careersmart.com/shop/annual-medication-training/

RCFE Administrator Training links to acquire or get information on that training https://www.cdss.ca.gov/inforesources/community-care/administrator-certification/administrator-information/list-of-approved-vendors https://assistedlivingeducation.com/product/rcfe-administrator-certification-training/ . (RCFE)

12. Section 7 Description and Standards of Facilities - There appears to be a contradiction between the total time allowed for the prospective Contractor to PASS the initial facility inspection for Contract Award. Is the time allotted Sixty (60) days (7.1.1) or Ninety (90) days (7.2.1).

VA Response – 90 days.

13. Is it a very “realistic” metrics goal to expect that this unhoused “special” population will be successfully permanently housed within the initial Sixty (60) day time period by the prospective Contractor, based upon historical/statistical data which clearly does not support this desired outcome due to low-income housing resource scarcity in the area and other prevailing factors that may exist beyond the contractors control.

VA Response - The HCHV contracts are emergency shelter contracts, and the geriatric contract is also emergency shelter. The expectation is that housing placement and/or housing discussions are occurring from day one. Extensions can be made after the 60 day time period up to but no more than 6 months to assist with the housing plan set in place by the agency. Although the goal is to get housing in 60 days, it is understood with our geriatric populations we may have between 60 days to 6 months to achieve that goal depending on wait lists etc.

Existing Lodging and Rooming Houses

Safety Inspection Report Example VA Community Placement Program

(All Code References are NFPA 101-2012 unless otherwise noted)

This checklist {current as of: 11/9/2011} is a summation of the requirements found in Chapter 26, Lodging or Rooming Houses of the Life Safety Code. The user is cautioned to consult the code prior to answering the following questions.

Lodging, Rooming Houses, or Buildings that provide sleeping accommodations for 16 or fewer persons on either a transient or permanent basis, with or without meals, but without separate cooking facilities for individual occupants.

Facility Name/Address:

Number of Residents:

Building Sprinklered:

Number of Stories:

Year Built:

Square Feet:

Recommended Action:

Approved with no recommendations

Approved contingent upon resolution of recommendations

Rejection

Inspected Title:

Date:

Existing Lodging and Rooming Houses

Item Standard Reference Yes No N/A

Section 1: Minimum Construction Requirements

1-1

Does the building construction meet the basic requirements of

NFPA 101, paragraph 26.1.6? (No special Requirements)

26.1.6 X

Section 2: Occupant Load

2-1 Are their 16 or fewer persons on either a transient or permanent basis?

26.1.7 X

Section 3: Egress - Means of Escape Requirement

3-1

In units with two rooms or more – does every sleeping room and every living area have not less than one primary means of escape and one secondary means of escape?

EXCEPTION: A secondary route is not required if the door leads directly outside of the building at or to grade level or the unit is protected throughout by an approved automatic sprinkler system.

24.2.2.1.1

24.2.2.2 X

3-2

Is the primary means of escape a door, stairway, or ramp providing a means of unobstructed and safe travel to the outside of the dwelling unit at street or ground level?

24.2.2.2 X

3-3

If the primary means of escape above or below the level of exit discharge is the primary means of escape an interior stair, an exterior stair, a horizontal exit or an exiting fire escape stair in accordance with other sections of chapter 7 and 26?

26.2.1.1.2

Existing Lodging and Rooming Houses

67667

Item Standard Reference Yes No N/A

3-4 If a secondary means of escape is required is it in compliance with

24.2.2 and 26.2.1.1?

26.2.1.2

X

3-5

The building does not require two primary means of escape because it:

1. Is existing

2. Protected by sprinklers

3. Every story is less than 2000 Sq Ft. or the travel distance to the primary means of escape is less than 75 ft.

If any of the above is true answer yes, otherwise the building requires two primary exits.

26.2.1.3 X

3-6 Does the building comply with two primary exits? 26.2.1.3 X 3-7 Means of egress shall have signs in accordance with Section 7.10 7.10 X

3-8 Are signs with a directional indicator showing the direction of travel in every location where the direction of travel to reach the nearest exit is not apparent.

7.10.1.5.1 /

7.10.2.1 X

3-9

Are any doors, passages, or stairways that is neither an exit nor a way of exit access and that is located or arranged so that it is likely to be mistaken for an exit shall be identified by a sign that reads as follows:

NO EXIT

7.10.8.3 /

7.10.8.3.1 X

3-10 Means of egress shall be continuously maintained free of all obstructions or impediments to full instant use in the case of fire or other emergency.

7.1.10.1 X

Section 4: Stairways

4-1 Do all stairways comply with the code in chapter 26 Section 26.3.1.1.2? 26.2.2 X

Section 5: Doors

5-1

Are all doors in a means of escape are not less the 28 inches?

Exception: bathroom doors shall not be less the 24 inches.

26.2.3.1 26.2.3.2

X

5-2

Can all closet doors be readily opened from the inside in case of emergency?

26.2.3.3 X

5-3

Can all bathroom doors be opened from the outside during an emergency when locked?

26.2.3.3 X

5-4

Are all doors in any means of escape kept unlocked against egress when the building is occupied?

26.2.3.5.1 26.2.3.5.2

67667

Note: Delayed-egress locks complying with 7.2.1.6.1 shall be permitted, provided that not more than one such device is located in any one escape path.

Note: Doors serving a single dwelling unit shall be permitted to be provided with a lock in accordance with 7.2.1.5.6.

Item Standard Reference Yes No N/A Section 6: Protection – Smoke Barriers

6-1

Are all vertical openings protected so that no primary escape route is exposed to an unprotected vertical opening?

Note: the vertical opening shall be considered protected if the opening is cut off and enclosed in a manner that provides a smoke and fire-resisting capability of not less than ½ hour.

Note: any doors or openings shall have a smoke and fire-resisting capability equivalent to that of the enclosure and shall be automatic-closing on detection of smoke or shall be self-closing.

26.3.1.1.1 X

6-2 Are exterior stairs protected against blockage caused by fire within the building? 26.3.1.2 X

6-3 Contents and furnishings shall not be required to comply with Section

10.3.

26.7.1.2

10.3.2.1* X

6-4 Opening Protective’s. Every opening in a fire barrier shall be protected to limit the spread of fire and restrict the movement of smoke from one side of the fire barrier to the other

LSC 101,

Section

8.3.4.1 X

6-5

Limited quantities of combustible commodities, as defined in NFPA 13, Standard for the Installation of Sprinkler Systems, shall be permitted to be stored in liquid storage areas if the ordinary combustibles, other than those used for packaging the liquids, are separated from the liquids in storage by a minimum of 8 ft (2.4 m) horizontally, either by aisles or by open racks, and if protection is provided in accordance with Chapter 16.

NFPA 30,

Section 3.9 X

6-6

Are hazardous areas protected with a 1 hour fire resistance barrier or provided with an automatic extinguishing system. In accordance with

8.7.1?

8.7.1

X

Item Standard Reference Yes No N/A Section 7: Interior Finish

7-1 Are interior finishes in accordance with section 26.3.3.2?

Note: Interior wall and ceiling finish materials complying with Section

10.2 shall be Class A, Class B, or Class C.

26.3.3.2 X

Fire Protection Features- Sprinkler - Fire Alarm – Kitchen -Extinguishers Section 8: Detection, Alarm, and Communications Systems Is the lodging and rooming house equipped with a fire alarm system in accordance with section 9.6 or is it an existing lodging and rooming house with existing smoke detection system with not less than one manual fire alarm box per floor arranged to initiate the smoke detection alarm?

8-1 Note: Approved single-station smoke alarms, other than existing smoke alarms shall be installed in accordance with 9.6.2.10 in every sleeping room. Existing battery-powered smoke alarms, rather than house electric-powered smoke

26.3.4.1.2 /

26.3.3.3 X

alarms, shall be permitted where the facility has demonstrated to the AHJ that the testing, maintenance, and battery replacement programs will ensure reliability of power to the smoke alarms.

Note: The smoke alarms shall not be required to be interconnected.

67667

8-2 Is initiation of the required fire alarm system by manual means or by extinguishing system operation in building protected throughout by an approved automatic sprinkler system?

26.3.3.2

8-3 Manual fire alarm boxes shall be installed so that they are conspicuous, unobstructed, and accessible.

NFPA 72-2010 X

Sprinklers

8-4 Is a minimum of 18 inches clearance maintained between the top of all storage and ceiling sprinkler deflectors?

NFPA 13-2010

8.6.5.3.1

X

8-5 Any required sprinkler system shall be in accordance with Section 9.7. 17.3.5.1

NFPA 13

8-6 Single-station or multiple-station smoke alarms or smoke detectors shall be provided in all rooms used for sleeping in accordance with

9.6.2.10

9.6.2.10

Fire Extinguishers

8-7 Are Fire extinguishers conspicuously located where they are readily accessible and immediately available in the event of fire?

NFPA 10

6.1.3.1

X

8-8 Are Fire extinguishers located along normal paths of travel, including exits from areas?

NFPA 10

6.1.3.2

Item Standard Reference Yes No N/A

8-9 Are Fire extinguishers unobstructed or un-obscured from view? NFPA 10

6.1.3.3.1

8-10 In large rooms and in certain locations where visual obstructions cannot be completely avoided, is signage provided to indicate the extinguisher location.

NFPA 10

6.1.3.3.2*

8-11 Are portable fire extinguishers maintained in a fully charged and operable condition and shall be kept in their designated places at all times when they are not being used?

6.1.2

8-12 Are fire extinguishers having a gross weight not exceeding 40 lb (18.14

kg) shall be installed so that the top of the fire extinguisher is not more than 5 ft (1.53 m) above the floor?

6.1.3.8.1

8-13 Fire extinguishers shall be inspected either manually or by means of an electronic monitoring device/system at a minimum of 30-day intervals.

7.2.1.2*

8-14 Where at least monthly manual inspections are conducted, the date the manual inspection was performed and the initials of the person performing the inspection shall be recorded.

7.2.4.3

Section 9: Separation of Sleeping Rooms

9-1 Are all sleeping rooms separated from escape route corridors by smoke partitions in accordance with section 8.4?

26.3.4.1 X

9-2 Are there no louvers or operable transoms in corridor walls? 26.3.4.2 X

9-3

Are there no air passages penetrating the corridor walls?

Note: Permitted if properly installed heating and utility installations other than transfer grilles.

26.3.4.3

9-4 Are there no transfer grilles in corridor walls?

26.3.4.4

9-5 Do doors have latches or other mechanisms suitable for keeping the doors closed?

26.3.4.5 X

9-6 Can occupants close the doors? Note: The doors cannot be arranged to prevent the occupant from closing the door.

26.3.4.6 X

9-7

Are doors self-closing or automatic-closing upon detection of smoke?

Note: not required in buildings protected by approved, automatic sprinkler system

26.3.5

67667

9-8

Evacuation Diagram. Where a posted floor evacuation diagram is required in Chapters 11 through 43, floor evacuation diagrams reflecting the actual floor arrangement and exit locations shall be posted and oriented in a location and manner acceptable to the authority having jurisdiction.

LSC 101,

Section

7.10.8.5* X

Section 10 - General Maintenance

10-1 Are doors and associated hardware in good repair? 4.6.12.1 X

10-2

Whenever or wherever any device, equipment, system, condition, arrangement, level of protection, or any other feature is required for compliance with the provisions of this Code, such device, equipment, system, condition, arrangement, level of protection, or other feature shall thereafter be maintained, unless the Code exempts such maintenance.

4.5.8 X

Section 11 - Utilities

11-1 Do utilities comply with the provisions of Section 9.1.2” Guarding of

Live Parts. A Live Part(s) Guarded Against Accidental Contact”.

LSC 101 / 9.1.2

NFPA 70

Section 110.27 X

11-2 Do utilities comply with the provisions of Section 9.1

NFPA70-2011

/ 9.1 X

11-3

Equipment using gas and related gas piping shall be in accordance with

NFPA 54, National Fuel Gas Code, or NFPA 58, Liquefied Petroleum

Gas Code, unless such installations are approved existing installations, which shall be permitted to be continued in service.

LSC 101 / 9.1.1

NFPA 54

X

Item Standard Reference Yes No N/A

Section 12: Heating, Ventilating, and Air Conditioning

12-1 Do heating, ventilating and air conditioning comply with the provisions of Section 9.2?

NFPA 101

Section 9.2

X

12-2 Are un-vented fuel heaters prohibited? 26.5.2.2 X

Section 13 - Inspection and Testing Requirements

13-1 For battery-powered emergency lights, are they tested monthly for thirty

(30) seconds; and, are they functionally tested annually for not less than

1½ hours?

7.9.3 X

13-2 Are sprinkler system main drain tests performed annually, and are records maintained?

NFPA 25-2011

2.2.6 X

13-3 Are sprinkler water flow alarms and valve supervisory tamper switches tested semi-annually?

NFPA 72-2010,

Table 10.4.4

(15) X

13-4 Are fire pumps churn-tested weekly and flow tested annually?

NFPA 25-2011

Table 8.1 X

13-5 Is the automatic fire extinguishing system protecting cooking equipment inspected and serviced by a properly trained and qualified company on at least a semi-annual basis?

NFPA 96-2011

11.2.1 X

13-6 Does the fire alarm system automatically transmit an alarm to the municipal fire department?

NFPA 72

X

13-7 If a generator is utilized for emergency power, is it inspected weekly and tested under load, for at least 30 minutes, on a monthly basis?

NFPA 110-

2005; 8.3.2.1 and 8.4.1

67667

Section 14: Administration

14-1 Smoking regulations shall be adopted by the administration

LSC 101,

Section

32.7.4.1* X

14-3 Are Emergency plans provided?

LSC 101

Section 4.8 X

14-4

Are Emergency egress and relocation drills being conducted in sufficient frequency to familiarize occupants with the drill procedure and to establish conduct of the drill as a matter of routine? Drills shall include suitable procedures to ensure that all persons subject to the drill participate. Fire drills are done monthly.

LSC 101,

Section 4.7.2

Item Standard Reference Yes No N/A

PERFORMANCE WORK STATEMENT

CONTRACT EMERGENCY RESIDENTIAL SERVICES BEDS

1. PURPOSE

1.1. The Department of Veterans Affairs Palo Alto Health Care System (VAPAHCS) located at 795 Willow Rd. Menlo Park, CA 94025 requires a contractor to provide services as part of its Community Based Health Care for Homeless Veterans (HCHV) program. The goal of the HCHV program is to remove homeless Veterans from the street or habitation unfit for Veterans and place them in community-based, residential environments with sufficient supportive services to meet their needs and ultimately facilitate the improvement of their housing situation. This contract represents a Firm Fixed-Priced, Indefinite Delivery-Indefinite Quantity contract. Costs not incorporated into the Contractor’s price will NOT be reimbursed by the Government. This contract is specifically for the geriatric population which has additional requirements as outlined below.

2. BACKGROUND

2.1. Through the HCHV program, VA provides supportive services to Veterans and facilitates their access to a broad range of medical, mental health, and rehabilitative services. The purpose of this solicitation is to obtain offers from Contractors in San Mateo and Santa Clara Counties who can provide housing, and supportive services to geriatric Homeless Veterans that, in addition to community-based, the Contracted Emergency Residential Services (CERS) facilities will be stand-alone and have a home like environment.

Geriatric is defined as a veteran who is 50 years of age or older. However, exceptions to this age requirement of admission can be made on a case-by-case basis. These facilities will offer a safe and secure environment that supports the goal of recovery from homelessness. The Contractor will be required to provide a low-barrier therapeutic and rehabilitative milieu and attendant services targeting the underlying factors contributing to homelessness within the geriatric population. The Contractor will not be required to provide detoxification or other hospital level or licensed care treatment.

3. SERVICES TO BE PROVIDED

3.1. The Contractor shall provide all labor, supervision, housing, material and supplies necessary to provide emergency residential treatment, rehabilitative and supportive services. Services will be provided on-site at the Contractor’s facility, in accordance with all terms and conditions, provisions and requirements listed herein. The prices provided in the Price Schedule shall be inclusive of all “basic services” as may be necessary in the treatment of the Veteran. “Basic Services” shall be defined in the Performance Work Statement.

3.1.1. Residential Room and Board: Room and Board shall be accessible to the Veteran 7 days a week and 24 hours per day.

3.1.1.1. One single bed and personal linens (towels, pillows, blankets, and bed sheets, etc.)

3.1.1.2. Furnishings such as a dresser, storage locker and lock or designated locked secured space. Storage space will accommodate two bags of belongings and all prescribed medical equipment. The Contractor will allow Veteran to store personal belongings for at least 72 hours after formal HCHV discharge. Should a Veteran abandon his/her belongings, the contractor will make three documented attempts to contact the Veteran before disposing Veterans items.

At least three nutritious meals, 7 days a week will be provided for the Veteran.

At least 50% of the beds will be wheelchair accessible and will have access to ADA accessible entryways and restrooms.

3.1.2. Dietetic Services: Three meals a day and snacks of nourishing quality (e.g., fruits, vegetables, protein sources, etc.), between meals and bedtime for those requiring or desiring additional food, even when it is not medically indicated. There will not be more than a 14-hour span between evening meal and breakfast of the following day.

Contractor will provide alternative meals for Veterans with dietary restrictions if medically indicated (e.g., diabetic, renal, and soft mechanical diets) and reasonable accommodation for Veterans with cultural/religious preferences around food (e.g., Kosher, Halal, etc.). Food shall be prepared, served, and stored under sanitary conditions. The facility shall provide storage space in an onsite refrigerator for Veterans to store and freely access personal food. The facility shall establish and maintain sanitary procedures for washing dishes, cleaning equipment and work areas, and disposing of waste. In addition, for locations where food is provided via food pantry, Veterans will have access to the pantry at least three times a day to access foods. All foods shall be stored and maintained in sanitary conditions following all health and safety regulations. Veterans will be offered food of nourishing quality and variety (fresh fruits, vegetables, grains, breads, and proteins).

3.1.3. Laundry Facilities: Laundry facilities and necessary detergent free of charge shall be available for residents to do their own laundry or to have laundry done at minimum one time per week. Should a Veteran have difficulty doing his or her own laundry, the facility will provide guidance. Should a Veteran refuse to wash his or her clothes, this will not be grounds for discharge but rather be addressed as a therapeutic opportunity.

3.1.4. Case Management Services: This contract requires that the Contractor will maintain a minimum staffing ratio of one dedicated, full time, on-site medical case manager per 12 Veterans. (For further information on staffing requirements please see Section 6: Personnel) Exceptions may be granted in writing by the VA. Staff is defined as a paid professional and does not include interns. The VA requires that case managers working with Veterans do not engage in any outside duties that do not pertain to the HCHV program which includes, case management of or group facilitation of non-Veteran populations unless a waiver has been granted by the VA Liaison (or Designee). Each VA Liaison (or Designee) will have no more than two POC’s per program. Additionally, the Case Manager shall provide the following:

3.1.4.1. Intake Packets: All Veterans must receive an intake packet within 72 business hours which includes, at minimum, the following information:

1. Description of the Contractors services

2. Grievance Policy

3. Emergency procedures

4. Patient rights and Reasonable Accommodation

3.1.4.2. A thorough assessment of Veteran’s psychosocial needs and written Individualized Care Plan (ICP) will be developed within 72 business hours of admission for each Veteran. Information from the assessment will be integrated into the Veterans’ Individual Care Plan. Care Plans will also include an assessment of possible crisis for the Veteran such as harm to self, verbal abuse or acts of violence or any other medical or psychiatric crisis. Staff will take proactive measures to prevent these instances to avert crisis to keep these incidents at a minimum. Contractors will be proactive to ensure staff are trained in de-escalation techniques.

3.1.4.3. Case Manager will provide structured individual case management, at minimum, weekly including counseling on self-care skills, adaptive coping skills, financial planning, permanent housing search, written care plan, referral for financial benefits.

3.1.4.4. For Santa Clara County locations, in addition to their standard documentation, the case manager(s) will also be expected to update HMIS on all admissions, discharges and enter at least one transaction in HMIS at per month.

3.1.4.5. Collaboration and coordination with VA program staff, as needed, will include coordination of supportive psychosocial services. Coordinated efforts must be made with the Liaison around medical, mental health, admission and discharge needs. Contractor is expected to coordinate all appointments including, but not limited to chemotherapy appointments, dialysis appointments, and wound care appointments. Contractors will be expected to accompany Veterans to their appointments when medically, cognitively, or psychiatrically indicated per the liaison and/or the contractor’s clinical judgement. Contractor staff will make active effort to establish relationships with key stakeholders, providers, and partners in the VA Health Care and Benefits Administration Systems to work closely and collaboratively with the interdisciplinary treatment team.

3.1.4.6. Ongoing Care Plan Coordination will be expected between the Case Manager and VA Liaison (or Designee). The Case Manager will be expected to coordinate with the VA Liaison (or Designee) to ensure Veterans’ goals, as expressed in both the agency and VA Liaison’s (or Designee’s) intake, are reflected in the ICP’s.

3.1.4.7. Every 60 Days the Case Managers will also coordinate a meeting with the Veteran and the VA Liaison (or Designee) for bi-monthly ICP update meetings.

The Care Plan meeting may be used by the Liaison (or Designee) as the main factor to determine if any Veteran extension requests may be approved or denied.

3.1.4.8. Meet with the VA Liaison (or Designee) for case management update meetings every 30 days. All Contractors will provide proper documentation verifying services and case management efforts by all team members including, but not limited to housing, benefit and employment specialists, and program management staff. There will be an expectation that notes are written professionally in a format that utilizes the clear settings of goals and documents progress towards those goals (e.g., SNAP, SOAP, or SMART notes).

3.1.4.9. Special attention will be made to address High Suicide Risk (HSR) Veterans as identified by the VA Liaison (or Designee), VA Mental Health Staff and/or the contracted Case Manager. Contractor will avail themselves to be contacted by the suicide prevention coordinator immediately should a Veteran miss an appointment and his/her safety must be verified. On a weekly basis the contracted case manager will be required to update the VA Liaison (or Designee) on Veteran progress and/or safety concerns for HSR Veterans.

Contracted case manager will review the HSR Safety Plans with the Veteran on a bi-weekly basis. HSR Safety plan reviews and a copy of the Veteran’s Safety Plan will be documented in the chart. All Veterans will be referred to VA for

Primary Care and Mental Health appointments and Contractors will support Veterans in making initial and subsequent appointments. Efforts will be made for Veterans who are identified by Liaison to be highly acute. Efforts will be documented in the Veterans ICP and reviewed by the VA Liaison (or Designee), at least monthly.

3.1.4.10. If the Contractor determines a Veteran who has not been identified as an HSR Veteran to have expressed suicidal ideation, the Contractor will be expected to follow their agency and VA incident and safety protocols. If the identified Veteran does not have a safety plan, the agency will create an agency safety plan with the Veteran and make increased efforts to connect the Veteran to mental health services. The agency safety plan will be forwarded to the VA Liaison (or Designee) as well as information on all efforts to connect Veteran to mental health services. As above, all procedures applied to HSR Veterans will then be followed for the non-flagged HSR Veteran until the Veteran can be evaluated by a MH provider and/or Suicide Prevention Coordinator.

3.1.4.11. Contractors must be in close communication with the liaison for any missing Veterans due to the high acuity of the target population. The contractor must file missing person’s report should the Veteran be considered at risk.

3.1.4.12. Contractor staff will treat liaisons with respect and will work with assigned liaisons to resolve issues around quality of care and contract compliance with respect.

3.1.4.13. Medical Case Management Services: Provides support to patients in maintaining health and wellness in the Geriatric program. Assists veterans with scheduling medical and mental health appointments, provides customized education for medical diagnosis and medication management, and arranges appropriate transportation to and from all appointments. Makes referrals to community-based organizations when health and/or psychosocial condition(s) indicate need for appropriate referral(s) and make sure all medications prescribed are reconciled to prevent duplication of orders among providers.

Promotes clear communication amongst treating providers by ensuring awareness regarding veteran’s medical needs and prescribed medication.

Provides coordination of care by meeting with veterans and medical staff to determine goals and recovery targets for identified conditions. Assist veterans with medication management by monitoring Veterans’ compliance issues and providing extensive medication education to improve compliance. Teaches appropriate medical interventions regarding wound care, self-care, and management of medical diagnosis. Contractor is expected to offer cues to Veterans to facilitate self-care. Staff giving this education will be qualified professionals to offer this service and education to Veterans.

3.1.4.14. Permanent Housing Search: Programs are required to provide Veterans with direct and ongoing assistance in achieving permanent housing. Plans for Veterans’ transition to permanent housing placements must be clearly reflected in each ICP and in weekly case management notes. As part of this plan, Veterans’ housing history and needs must be assessed through a formal and thorough Housing Assessment completed within 72 business hours of program admission. Housing Assessments must identify Veterans’ housing history, strengths (i.e., positive prior rental history), and barriers (i.e., Unlawful Detainers). Should Veteran refuse to engage with program staff regarding plans for permanent housing transition, motivational interviewing and other therapeutic techniques will be used to address Veteran ambivalence. All efforts to engage Veteran regarding housing plans, options, and resources shall be clearly documented and include any therapeutic techniques utilized. Contractor staff must provide direct assistance to Veterans in developing permanent housing plans and accessing appropriate housing resources. These services shall be provided weekly through one-to-one case management. Examples of expected housing services include: 1) assistance obtaining and reviewing Veteran’s free credit report, identifying housing strengths and/or barriers associated with current credit status; 2) Creating a Tenant Portfolio with Veteran that contains all relevant documents required in the rental process, including a completed sample rental application for Veteran, income verification documents, identification, applicable subsidies, etc.; 3) Reviewing affordable housing rental options and Permanent Supportive Housing (PSH) program offerings, and assisting Veterans with making appropriate rental inquiries and submitting completed rental applications; 4) Conducting regular and individualized housing advocacy efforts, including transportation, assistance scheduling, meeting, and communicating with property managers and landlords, and engage in troubleshooting where rental barriers or denials occur in the housing search process 5) exploring housing option in low-rent areas 6) exploring appropriate level senior care facilities. All housing efforts by Contractor shall be documented clearly in case notes and presented to VA Liaison (or Designee) upon request. Mere communication with Veterans regarding housing, without subsequent Contractor staff action and follow-up, shall not on its own meet the above requirements. If housing placements or inpatient residential treatments have been approved and acquired, the support and case management around maintaining housing, future housing options, connecting to local resources, discussions on how to maintain/pay for housing over long term, adult day health referrals and other community long-term supports may be counted as a housing resource.

3.1.4.15. Financial Planning and Employment: Referral to and follow up on all potential financial resources the Veteran may be eligible for (e.g., SSI, SSDI, Food Stamps, NSC pension, GA, Medi-Cal, etc.). Case Managers will document in the case notes all structured activities that support Veteran in developing a short and long-term plan to understand and address their current financial situation and how to improve it. At minimum two financial planning activities appropriate to the Veterans individual circumstance must be documented monthly. All Veterans will be assessed for employment within 72 hours of admission. Veterans who report a desire to work will be provided referrals to all relevant employment opportunities the Veteran is eligible for and interested in and/or structured activities that support Veteran in applying for employment as appropriate based on needs of Veteran as identified in the assessment. Employment referrals and activities may be counted as a financial resource. The Case managers will document the assessment and all referrals and supportive activities in the case notes. Each Veteran must apply for Medi- Cal and Medi-Care if they do not have this benefit.

3.1.4.16. Group Activities: Structured group activities, as appropriate, shall occur two times per month – examples include group therapy, life skills training, social skills training, financial workshops, Alcoholics Anonymous, Narcotics Anonymous, vocational counseling, and physical activities as appropriate. For the purposes of this contract “House Meetings” and VA Housing Resource Groups may not be counted as a structured group activity should have a therapeutic value and facilitation shall be the responsibility of the Contractor.

Should a Veteran have mental health, medical, family and/or employment obligations which directly conflicts with this requirement alternate group activates will be arranged and/or the Contractor will clearly document in their case notes their efforts to accommodate the Veteran. Unwillingness to participate in these groups will not be considered grounds for program discharge.

3.1.4.17. Case manager will make referral to all relevant legal services which would further the Veteran’s efforts to get housed. Case managers will document all activities and education that support a Veteran’s legal needs.

3.1.4.18. Discharge Planning: Securing permanent housing will be the primary discharge goal for every Veteran, and resources will be coordinated for discharge to a successful community placement throughout the duration of the Veteran’s stay.

3.1.4.16.1. All Veterans must have a discharge plan within one week of admission which integrates items included in earlier sections of this document.

3.1.4.16.2. Veterans must also be in active search and/or apply for independent housing within the first month of admission. Compliance with all VA regulations regarding discharges and timeliness of reporting discharges is required by Contractor. Paperwork required for discharging a Veteran from any HCHV program is required via fax or secure email within 24 business hours from known discharge.

3.1.4.16.3. A negative discharge for undesirable behavior is a committee decision that must include the VA Liaison prior to discharge. All Veterans scheduled for discharge based on behavior must meet with the treatment team and work with team to determine most therapeutic option for Veteran.

This does not include violations for safety reasons. Please note: Profanity does not in and of itself constitute abuse and shall not exclusively be considered grounds for discharge. All actual or threatened violence will be grounds for discharge. Veterans may be discharged for safety reasons at any time. Safety concerns must be clear and obvious to both contractor and liaison. Parameters around safety violations and/ what constitutes reasonable threat must be established with liaison. All negative discharges will be subject to a full team debriefing, including VA Liaison, to look for opportunities missed to intervene sooner. All discharges are subject to the Contractors grievance procedures and must allow clients the opportunity to be represented by the VA Liaison in the grievance process. Reasonable efforts must be made to coordinate with the Liaison to schedule an appeal.

In the case of no reasonable alternative housing arrangement, a target discharge date may be established by agency, no less than 7 calendar days of decision to discharge, to afford Veteran an opportunity to utilize VA Liaison advocacy.

3.1.4.16.4. Lastly, all TQI measures must be met to receive the highest past performance rating. These include the following:

• HCHV1 (DC to Ind. Housing) - > 55%

• HCHV2 (DC w/ Neg. Exits) - 20%

• Bed Occupancy > 85%

3.1.4.19. Extensions- It is understood that the Contractor will not be paid for care provided to a referred Veteran beyond the period authorized, unless an extension of the authorization is provided in writing by the VA. The initial stay for a Veteran is expected to be no longer than 60 days. Any extension of the stay after 60 days must be authorized by the VA Homeless Program Coordinator or Designee, if there is clear clinical indication and availability of funds. Only extraordinary circumstances will be considered to extend service periods up to and more than 6 months for individual Veterans and these must be authorized by the Medical Center Director or Designee.

3.1.5. Medication Management: Medications and narcotics shall be properly stored, controlled, issued, and recorded in compliance with physician’s orders. For Geriatric Contracts it is recommended that facilities utilize a Medication Management system for Veteran medications. (Copies of Inspection Packet requirements relating to medication management are available upon request).

3.1.5.1. Contractor shall establish procedures for insuring Veteran’s confidentiality in the storage of and keeping of records concerning medication.

3.1.5.2. Medication Assisted Treatment (MAT) cannot be used to rule out Veteran’s participation in an HCHV Program. This includes prescribed use of Vicodin, morphine, methadone, oxygen, etc.

3.1.5.3. Reasonable accommodation for individuals in MAT is required provided the requested accommodation does not require major financial or administrative commitments that would be considered an “undue burden.” Examples of reasonable accommodations include:

1. Arranging for the individual to take medication at their clinic, physician’s office, or another off-site location – when consistent with the individual’s treatment plan.

2. Storing an individual’s MAT medication in a lock box in the program and having the individual be personally responsible for it.

3. Arranging to have the housing facility keep MAT medications in a locked cabinet For Facilities that are providing Medication Management, there must also be staff identified for after hours and on weekends who are trained in medication management protocol who can provide medication to the Veterans as needed when the medical case manager is not on duty. This coverage must be and the certificate(s) of medication management training and the times/days and hours of the person(s) covering will be provided to the VA Liaison to keep on file. (Copies of Inspection Packet requirements relating to medication management are available upon request).

4. Arranging to have refrigerated medications stored in appropriate locked location which is only accessible to the Veteran or trained designee.

(Copies of Inspection Packet requirements relating to medication management are available upon request).

3.1.6. Grievance Procedures: Programs must have an internal grievance process that Veterans can use to resolve conflicts within the program. Programs must have written policies and procedures for resolving grievances, including a statement regarding the client’s right to request reasonable accommodation, and must post them in a place conspicuous and be accessible to clients. In addition, each client shall receive a copy of the grievance policies and procedures, upon intake and upon receiving a warning or discharge notice.

3.1.7. Timeliness of Response: Contractor is expected to have a dedicated phone line for

VA inquiries and Veteran self-referrals. Return calls from the program are expected within 4 hours during business hours Monday through Friday. Calls, referrals, emails, or other correspondence from, community agencies, VA staff, Veterans or VA Liaisons (or Designees), are also expected to be addressed within 4 business hours Monday through Friday. Admission determinations must be made within 24 hours of referral.

3.1.8. Critical Incident Reporting: All critical incidents will be reported within 24 hours. This includes the following:

o Falls o Assault (to Veteran or Staff) o Elderly/Dependent Adult Abuse or Neglect o Sexual Assault o Fire (Veteran Involved) o Medical/Psychiatric Emergency (911 Calls) o Hospitalization o Suicide or Suicide Attempt o Homicide o Death o Infectious Control (TB COVID, etc.)

o Active Substance Abuse on contractor property o Observation/ Possession of Weapons o Use of “cooling off” option within facility o Grave Disability

3.1.9. Therapeutic and Rehabilitative Services:

3.1.9.1. Milieu: The agency will cultivate a milieu of trust and safety. This includes a tolerance for relapses, regression, and personal unpredictability. In cases of documented verbal escalation with other program participants and/or Contractor staff, Contractor is permitted to request Veteran voluntarily relocate to “cooling off” area, as long as the area is within the physical boundaries of the Contractor’s HCHV facility. Veteran will be monitored in a clinically appropriate manner by Contractor’s staff, during any time within the aforementioned area. As a part of the engagement strategy, Veterans will be invited to participate in the activities of everyday life, including meals, chores, recreation activities, and socializing. These activities must maintain a therapeutic significance. Such opportunities will be offered, not required nor demanded and modeled by staff. Veteran’s resistance to participate in these activities will not be grounds for discharge. A Harm Reduction Model will be utilized. Fidelity to this model may be assessed at any time by the liaison.

3.1.9.2. For the Geriatric contract, it is expected that the contractor will assist with light self-care including, but not limited to, offering adult briefs, and providing daily cues for hygiene, self-care, medication, and eating.