Attachment 2 - HCHV CRS Quarterly Review Tool.pdf

VA HCHV CONTRACTED RESIDENTIAL SERVICES

Quarterly REVIEW TOOL

I. CRS Program and CASE IDENTIFICATION CRS Program Reviewed

VA Staff Present

FY & QTR reviewed

Unannounced Date of Review

(First/Last initials and last four)

OPEN CASES CLOSED CASES

II. Clinical Review standards per HCHV Annual Inspection form and Contract Statement of Work (Type an X in the ONE Appropriate Box)

Criteria Met Not Met N/A

1. Provider meets or exceeds the performance measures (exits to permanent housing and negative exits) noted (quarterly) and if not the Liaison works with the provider to put together a plan for improvement (B.3.3.7)

2. Quarterly report provided to COR is a detail report of program data to include at a minimum: Total number of veterans served, percent of veterans discharged to independent housing, percent of negative discharges, and other information contracts feels pertinent (Contract Deliverables B.3.22.15)

3. Ensures records kept on veterans are kept confidential (B.3.11.3)

4. The Physical structure of the facility, program policies and procedures are appropriate in ensuring the safety, security and privacy of the individuals in the facility (B.3.28)

5. Care Planning- Engage veteran in collaborate assessment of needs, including barriers to stable housing, and create initial plan of care to address concerns within 14 days of admission (B.3.10.2)

6. Case Management- Provide individual case management sessions at least three times per month (preferably weekly) (B.3.10.3)

7. Case Management Sessions focus on housing search and stabilization, increasing income, coordination of ongoing participation in care provided by VA/ community medical and/or mental health providers, and ongoing discharge planning at a minimum (B.3.10.3)

8. Records should contain at a minimum: Reason for referral, pertinent demographic information, copies of any medical prescriptions/orders issues by physicians, case management/ treatment notes, critical indent notes and a final summary that includes reason(s) for leaving, the veterans known future plans and follow-up locator information, when available (B.3.11.3)

9. Homeless Management Information system (HMIS) Data reporting- Enter the /Universal Data elements from the HMIS Data Standards;

signed ROI for the Continuum of Care (CoC) (B.3.11.4)

10. Participant’s case records include at a minimum: family status, verification of veteran’s status, Education, Employment History, and marketable skills/ licenses/ credentials (B.3.15)

11. Ensures that an individual treatment plan is maintained in the case management record for each individual participating and Quarterly ISP review or update (B.3.11.3)

12. The Individual treatment plan contains: assessment of barriers, service needs, strengths, specific services provided including duration and outcomes, documentation of referrals, benefits achieved as result of program participation (B.3.10.2)

13. Types of services available to residents include at a minimum: Case Management, Care Coordination, Vocational, Independent living and Benefits services, Permanent/Transitional housing search support (B.3.7.3)

III. Program Requirements identified by Contract Performance Work statement & Quality Assurance Surveillance Plan (QASP)

Program Documentation Met Not Met N/A

1. Daily Census Sign- in sheet (B.3.11.5)

2. Incident Reporting maintained in the veterans record and Liaison notified within 24 hrs. (B.3.11.6)

3. Extension Request Documentation (over 60 days – HCHV Liaison approval documented) (B.3.11.7)

4. Discharge Reporting (Notify HCHV Liaison within 1 business day and provide needed documentation for HOMES within 48 hours) (B.3.11.9)

5. Documentation of authorized absences to further treatment plan goals (B.3.24)

6. Travel - Assist veteran with arranging local transportation to scheduled VA meetings and/or appointments. Assist with identifying potential alternative modes of transportation. Assist veteran with understanding and utilizing public transportation. When the veterans do not have financial means, provide a bus pass or other transportation assistance. (B.3.28)

7. Monthly Satisfaction Surveys (B.3.11.8)

8. Invoices submitted to Tungsten Network (Due to Liaison by the 5th of the month; due in Tungsten Network by the 10th of the month immediately following the billing period in question. (B.3.21)

IV. Facilities, Nutrition, Security and Medication Review identified by HCHV Annual Inspection (to be reviewed randomly)

Program Documentation Met Not Met N/A

1. Facility Exits/Entries capable of egress in case of fire (B.3.29.1.2)

2. Space provided to secure belongings (B.3.9.8)

3. Refrigeration and dry food storage are maintained and monitored

(B.3.31.10)

4. Sufficient lighting around perimeter and indoor (B.3.29.1.10)

5. Residential Supervision 24/7 (B.3.9.5) (B.3.12.2.1)

6. Emergency contacts posted: Medical, Law enforcement, Fire (B.3.29.1.8)

7. Medication Management, Medication Monitoring or Individual Storage Control System (B.3.10.4)

Contractor Strengths:

Best Practice Recommendations:

Deficiencies Noted:

Actions Taken:

o Agency informed verbally and in writing. Include name of staff and method of written communication o Agency staff notified in writing of problems. Include name of staff and method of written communication o Agency given ___ days for correction Agency to provide a corrective action plan by Other:

Next Steps:

o Liaison to review at next visit o Subject Matter Expert to inspect o Other:

Follow-up Needed o Weekly visits by Liaison until corrected o Program admissions to be placed on hold o Veterans to be removed from program o N/A- No Deficiencies Noted

HCHV Liaison

Contracting Officer Representative