Attachment 2 Quality Assurance Surveilliance Plan Qasp 28 Jan.docx

ATTACHMENT 2

QUALITY ASSURANCE SURVEILLANCE PLAN

FOR

HEALTHCARE HOUSEKEEPING SERVICES

AT

KIMBROUGH AMBULATORY CARE CENTER

2480 LLEWELLYN AVENUE

FORT GEORGE G MEADE, MD 20755

THIS QUALITY ASSURANCE SURVEILLANCE PLAN IS NEITHER PART OF THE REQUEST FOR PROPOSAL, NOR PART OF ANY RESULTING CONTRACT.

TABLE OF CONTENTS

PARAGRAPH TITLE PAGE

1 INTRODUCTION 3

2 ROLES AND RESPONSIBILITIES 3

3 REQUIRED PERFORMANCE STANDARDS/QUALITY LEVELS 5

4 PERFORMING QUALITY ASSURANCE 6

5 INSPECTION PROCEDURES 7

6 ANALYSIS OF CONTRACT PERFORMANCE 8

7 SURVEILLANCE LEVELS 9

8 SAMPLING GUIDES AND CHECKLISTS 10

FIGURE TITLE

1 SAMPLE SIZE TABLE FOR RANDOM SAMPLING 29

2 ACCEPTANCE AND REJECT LEVELS (NORMAL SURVEILLANCE) 30

3 ACCEPTANCE AND REJECT LEVELS (TIGHTENED SURVEILLANCE) 31

4 ACCEPTANCE AND REJECT LEVELS (REDUCED SURVEILLANCE) 32

QUALITY ASSURANCE SURVEILLANCE PLAN

1. INTRODUCTION

1.1. This Quality Assurance Surveillance Plan (QASP) has been developed to evaluate contractor actions while implementing this Performance Work Statement (PWS). It is designed to provide an effective surveillance method of monitoring contractor performance for each listed objective on the Performance Requirement Summary (PRS) in the support contract.

1.1.1. The QASP is based on the premise the government desires to maintain quality and standards. The contractor shall at all times, including during shift change, maintain an adequate work force to ensure the uninterrupted performance of all tasks defined within this PWS.

1.1.2. The contractor is responsible for management and quality control actions to meet the terms of the contract. The role of the government’s quality assurance (QA) is to ensure contract standards are met.

1.1.3. In this contract the quality control program is the mechanism for evaluating product quality. The contractor is required to develop a comprehensive program of inspections and monitoring actions.

1.1.4. Once the quality control program is accepted, careful application of the process and standards presented in the remainder of this document shall ensure a robust quality assurance program.

1.1.5. The QASP is a tool for use in government administration of the PWS and remains subject to revision at any time by the government throughout the contract performance period. Revisions to this surveillance plan are the responsibility of the Contracting Officer’s Representative (COR). Changes may be made unilaterally and need not be announced to the contractor; the Government may provide informal copies to the contractor at its option.

1.1.6. It is expected that during the start of the contract, all operational procedures and quality control measures will be tested and implemented. As the performance period progresses, the levels of surveillance may be altered for service areas in cases where performance is either consistently excellent or consistently unsatisfactory. If inspections reveal consistently good performance, then the amount of surveillance may be reduced. If inspections reveal consistent deficiencies, increased surveillance may be implemented.

2. ROLES AND RESPONSIBILITIES

2.1. The purpose of QA is to ensure that the customers are satisfied with the products and services received from the contractor and to ensure that the contractor is meeting its obligations to the government. The roles and responsibilities of the stakeholders involved in QA are described below.

2.1.1. Contracting Officer (KO). The KO has the authority to administer the contract. The KO may delegate many of the day-to-day contract administration duties to the COR. However, certain contractual actions such as negotiation and issuance of contract modifications, resolution of contract claims, and disputes, issuance of cure notices, issuance of show-cause letters, termination of the contract, and contract close-out functions are retained by the KO. Administrative actions such as invoice approval and issuance of contractor deficiency reports may be, and normally shall be, delegated by the KO to the COR. All communication regarding questions or issues related to QA and inspections will be directed to the KO or the COR. The KO shall approve any revisions to the QASP process or standards.

2.1.2. Contracting Officer’s Representative (COR). The COR shall serve as the first line manager of all tasks and/or subtasks issued under this Contract. The COR represents the KO and therefore is the contractor’s initial point of contact with the government. In turn, the COR will work with the Quality Assurance Evaluators (QAEs) to execute some administrative duties in order to ensure that the QA function is properly executed. If modifications to the contract are necessary, the KO will prepare and negotiate the modifications. If there are problems with the contractor performance, the COR will inform the contractor of the problems and recommend to the KO that adverse contractual actions are appropriate (e.g., issuance of a cure notice) if the contractor fails to correct the problem. Also, the COR must refer differences of contract interpretation to the KO.

2.1.3. Quality Assurance Evaluators (QAE). Government QAEs play a key role in contract administration. They provide technical assistance to the COR. They perform the actual contract surveillance and report to the COR. The COR is considered a QAE in this document when performing surveillance. Some of the key contract administration duties of the QAE include:

2.1.3.1. Evaluating and documenting the contractor’s performance in accordance with the QASP;

2.1.3.2. Making recommendations to the COR for the validation of satisfactorily completed work and for equitable adjustment reductions and other administrative actions based on unsatisfactory or non-performed work;

2.1.3.3. Assisting the COR in identifying necessary changes to the contract, preparing government estimates, conducting QA meetings, approving submittals, maintaining work files; and,

2.1.3.4. Promptly furnishing the COR with any requests for changes, deviations, or waivers to the contract (whether generated by Government personnel or contractor personnel).

2.1.3.5. The QAE has no authority to allow deviations from contract requirements. The QAE has no authority to direct or interfere with the methods of performance by the contractor or to issue modifications directly to any of the contractor's personnel unless methods being used are unsafe.

2.2. QAE Standards of Behavior. QAEs must conduct himself/herself at all times in a manner commensurate with the responsible position he/she occupies. QAEs must be honest in their official dealings and treat others in a fair and courteous manner. Integrity is a fundamental requisite. QAEs should be especially careful in dealing with contractor personnel. QAEs should maintain good working relationships with the contractor's personnel but he or she must guard against undue friendliness or intimate social association with the contractor's personnel. When possible, the QAE should work only with the contractor's designated official representative at the site. Sometimes the QAE will also have to work with various subordinates and subcontractors' representatives. The QAE must make sure that all such contacts are made with the full knowledge and consent of the contractor's representative, who is in effect delegating his own authority in such cases.

2.2.1. QAEs should establish cordial but professional relations with the contractor's representative and endeavor to establish a good mutual understanding at the start of the work. The QAE should make clear the following:

2.2.2. That he/she intends to be strict about compliance with the contract but reasonable in interpretation of subjectively judged requirements;

2.2.3. That although he/she intends to maintain a good working relationship between contractor's personnel and the QAE staff, the QAE cannot let anything divert him/her from faithful protection of the government's interest; and,

2.2.4. That although initially the QAE places full confidence in the contractor's representative, continuation of that confidence must be earned by demonstrated performance.

2.2.5. QAEs, as well as other government employees, are prohibited by law from accepting any gratuities or favor of any nature whatsoever, directly or indirectly, from any contractor. This law must be obeyed without exception. The contractor should also be aware of the pertinent statues and legal action that can be taken against him/her for violations.

3. REQUIRED PERFRMANCE STANDARDS/QUALITY LEVELS

3.1. The objective of surveillance is to monitor contractor performance to ensure compliance with the terms and conditions of the contract. The procurement of commercial services under FAR Part 12, Acquisition of Commercial Items, provides the basis for quality assurance. Pursuant to FAR Clause 52.212-4, Contract Terms and Conditions-Commercial Items, (a) Inspection/Acceptance:

“The contractor shall only tender for acceptance those items that conform to the requirements of this contract. The government reserves the right to inspect or test any supplies or services that have been tendered for acceptance. The government may require repair or replacement of nonconforming supplies or re-performance of nonconforming services at no increase in contract price. If repair/re-performance will not correct the defects or is not possible, the government may seek an equitable price reduction or adequate consideration for acceptance of nonconforming supplies or services. The government must exercise its post-acceptance rights-

(1) Within a reasonable time after the defect was discovered or should have been discovered; and

(2) Before any substantial change occurs in the condition of the item, unless the change is due to the defect in the item.”

3.2. The PRS is key to developing the QASP since it lists the required services, contract reference, the Acceptable Quality Level (AQL), the planned method of surveillance and performance incentives/remedial action. Because the PRS is a part of the contractual agreement with the contractor, these parameters cannot be changed during the performance of the contract unless a formal modification of the contract is undertaken.

3.2.1. The following performance requirements are used to measure the performance of the contractor. Sampling Guides are provided for each service listed on the PRS.

Paragraph

Disincentives

5.6., 5.12., 5.13., 5.14

5.7., 5.12., 5.13., 5.14.

5.8., 5.12., 5.13., 5.14.

5.9., 5.12., 5.13., 5.14.

5.10. ,

5.12. , 5.13.

5.11., 5.12., 5.13.

4. PERFORMING QUALITY ASSURANCE

4.1. All inspections will be performed as specified in the appropriate sampling guide for the particular service. For example, Sample Guide 1 gives instructions for performing random sampling inspections of Type I Services. It instructs the COR on how to determine lot size, sample size, rejection level, select random numbers, evaluate findings and determine if performance is acceptable or unacceptable.

4.2. Documentation. Thorough documentation of unperformed or poorly performed work is essential for tracking contractor performance throughout the period of performance. The governments QA surveillance is documented using checklists included with the sampling guides in this QASP. The checklists, when completed, will document the government’s assessment of the contractor’s performance under the contract. The COR will retain a copy of all completed checklists in the contract file for the duration of the contract.

4.3. Random Sampling. Random sampling evaluation is a QA method wherein a sample consisting of one or more, but not all, services is selected at random from the lot and examined for one or more quality characteristics. The government's use of random sampling methodology is based on procedural concepts established in American National Standards Institute/American Society for Quality Control (ANSI/ASQC) ANSI/ASQC Z14. Random Sampling is usually the most practical and economical means for determining the conformance or nonconformance of services to specified quality requirements. Using random sampling, any occurrence of a service is as likely to be evaluated as any other occurrence. With this type of surveillance, the contractor is unable to second-guess which occurrences of work are most likely to be evaluated. The government's (i.e., QAE’s) bias does not affect the specific occurrences of work selected to be monitored, and all occurrences of an item of work are assumed to be equally important. Random sampling requires that a surveillance schedule be prepared prior to evaluation for those services that are scheduled for performance.

4.3.1. Establishing Lot and Determining the Lot Size. Lot and lot size are key to the inspection effort. A “lot” is the total number of operational periods for each space by Type Service in a month. The lot size is calculated by multiplying each space’s daily operational periods times the space’s operational days each month and summed by Type Service. Once the lot is calculated, use the Sample Size Table (Figure 1) to determine how many services will be inspected during the month.

4.3.2. Sample Selection. Once the sample size has been determined, the actual services to be inspected can be selected from the lot. The services to be inspected are normally selected by computer.

4.4. Surveillance Schedule. Each Type Service to be monitored will have a surveillance schedule prepared by the last workday of the preceding month. Surveillance must cover all hours of operation. If the service being monitored requires work at nights, on weekends, and holidays inspections will be scheduled during those periods. Each Type Service inspection requirement is consolidated into a master inspection schedule. A master schedule listing all services to be inspected on any given day permit QAEs to plan their work in advance to eliminate potentially wasteful actions (e.g., excessive travel time between inspections.). Use of the consolidated schedule also allows the QAE to prioritize inspections and identify when the inspection workload exceeds the availability of QAEs.

4.4.1. Mark the surveillance schedule "FOR OFFICIAL USE ONLY", and do not show it to the contractor to protect the anonymity of the inspection procedures. If the schedule is shown to the contractor, they will have advance warning of the areas scheduled for inspection and may use this information to skew their performance. A copy of the surveillance schedule is submitted to the KO for his/her information and review.

4.4.2. Any changes to the surveillance schedule must be explained and documented. A copy of the revised schedule is sent to the KO. Actual surveillance, as recorded on the Inspection Checklist, must be comparable to the monthly schedule.

5. INSPECTION PROCEDURES.

5.1. Inspection checklists are prepared for each sampling guide. Inspection checklists will be used to record information on inspections and deficiencies. Each inspection in the sampling will be recorded on the inspection checklists.

5.1.1. All selected random sample work occurrences should be inspected during the evaluation period. If a work occurrence is included in the sample but not inspected, the occurrence must be considered as satisfactory and documented as not inspected with an explanation of why. It is important to inspect the work as it is being done or as soon as possible after completion. This allows the contractor to correct or re-perform (rework) the work if a problem is encountered. It is more important to have the work performed correctly and completely than it is to deduct from the contractor for not performing the work. If the contractor satisfactorily re-performs the work, the inspection is considered satisfactory. However, some aspects of the work occurrence may not be able to be re-performed such as responding within contract required times when the allowable time has already elapsed. All re-performed work must be re-inspected and the re-inspection results documented.

5.1.2. The number of re-performances (reworks) should be identified for the analysis of the inspection results. A significant number of “reworks” reflect a situation where the contractor is relying on the government QA to insure quality rather than his own QC program and should be addressed to the KO for correction.

5.1.3. Substantially Complete. Service contracts deal with service outputs that are evaluated using subjective values (e.g. excellent, satisfactory, and unsatisfactory). The criteria for acceptable performance and for defects must be defined for these service outputs. The concept of “substantially complete” should be the basis for inspections based on subjective scales.

5.1.3.1. Work is considered “substantially complete” where there has been no significant departure from the terms of the contract and no omission of essential work. In addition, the contractor has performed the work required to the best of its ability and the only variance consists of minor omissions or defects.

5.1.4. Non-performance. Non-performance occurs when the contractor’s performance does not meet or exceed the prescribed performance standards for a given requirement. Requirements may contain multiple performance elements, and therefore, deficiencies may occur in one or more aspects of performance (e.g. timeliness, accuracy, completeness, etc.) or subject areas of effort.

5.1.4.1. When surveillance indicates that the contractor’s service output is not in compliance with the contract requirements, the QAE must determine whether the contractor or the government caused the deficiency. If the cause of the defect rests with the government, corrective action must be taken through government channels. If the cause of the defect is due to action or inaction by the contractor, the contractor is responsible for correction of the problem at no additional expense to the government.

5.1.4.2. Unsatisfactory contractor performance will be documented on the inspection checklist. The contractor shall be notified and required to sign the inspection checklist. The date and time the contractor was notified of the discrepancy shall be annotated on the inspection checklist.

5.1.5. It is extremely important the QAEs document any missed inspections, explaining the reasons. An inspection that was scheduled and not done is the same as no inspection at all in terms of the performance documentation. When no inspection activity is documented it is presumed that the contract requirements have been met. In other words, if the government cannot evidence non-conformance, conformance is assumed.

5.1.6. A running total of all inspections will be kept on a Monthly Tally Checklist. Tally checklists are maintained by the QAE for each sampling guide and will be used to tally information on inspection results. These documents will become a formal record for later reference. The tally of inspections and deficiencies will be compared to the acceptable number of deficiencies appearing in the relevant sampling guide at the end of the payment period. The following should be included on this form:

(1) Title of the service requirement being monitored.

(2) An identifier for each inspection recorded (e.g. date/room number)

(3) Inspection results (satisfactory/unsatisfactory)

5.2. INSPECTION OF NON-PRS ITEMS

5.2.1. For required tasks not shown on the PRS chart, the government still retains the right to inspect any item included in the contract in accordance with the inspection clauses of the contract. The results of these inspections are documented and, if necessary, provided to the COR/KO for corrective action.

6. ANALYSIS OF CONTRACTOR PERFORMANCE.

6.1 Lots of housekeeping services are either accepted or rejected depending upon the results of the inspection. It should be understood that the terms "accepted" and "rejected" indicate a statistical decision reached on the basis of the sampling methods used. This decision in itself does not dictate or guarantee final acceptance or rejection, since other contractual, administrative or technical considerations may be involved.

6.2. Determining the Sample Acceptance and Reject Level. The acceptance and reject levels for numerous AQLs are found in ANSI/ASQC Z1.4, Tables II-A, B, or C based on the sampling level (normal, tightened, or reduced). A condensed version of these with the most frequently used AQLs is found in Table 2, Table 3, and Table 4 of this guide. Find the table that corresponds to the level of surveillance. Select the row of the table corresponding to the sample size and go across to the column that corresponds to the AQL as shown for the contract requirement in the PRS. The numbers in the appropriate row and column are the acceptance and reject level for the sample.

6.2.1. The acceptance number is the maximum number of defects or unsatisfactory inspections in the sample that will permit acceptance of the lot.

6.2.2 The reject number is the minimum number of defects in the sample that will cause rejection of the lot represented by the sample.

6.2.3 The reduced surveillance table has the unusual feature of a gap between the acceptances and reject numbers. The rule is that if the observed number of defects is equal to the acceptance number or less, the lot is accepted and reduced inspection is continued (provided that other conditions do not call for normal inspection). If the rejection number is reached or exceeded, the lot is rejected and normal inspection begins with the next lot. If, however, the result falls in the gap between the acceptance and rejection numbers, the lot is accepted but normal inspection must be restored.

6.3. Review the documentation for all the inspections of the contract requirement performed during the surveillance period (usually one month). Identify the number of defects (unsatisfactory inspections). Compare the number of defects during the surveillance period for the contract requirement to the sample reject level for the appropriate level of sampling and AQL. If the number of defects equals or exceeds the reject level, the contractor’s quality control and contract performance is unsatisfactory for the contract requirement and the contractor must be notified. In addition, the tightened level of surveillance should be instituted for the following surveillance period. If the observed defect rate is equal to or less than the AQL, the contractor's overall level of performance for the item evaluated is classified as satisfactory.

EXAMPLE:

NOTE: When using random sampling solely for performance evaluation, a second method of inspection may also be used, such as validated customer complaints. Information collected using other evaluation methods can never be combined with information gathered by random sampling for purposes of performance evaluation. In the example above, if there were 21 observed defects in the lot sampled, the contractor’s performance for the service is satisfactory. Two additional validated customer complaints during the same period do not make the contractor’s overall performance for the service unsatisfactory. Evaluation results collected by other methods serve only as supportive data.

7. SURVEILLANCE LEVELS.

7.1 If the result of a COR's surveillance shows consistently acceptable performance, the amount of surveillance can be decreased. Conversely, when the contractor's performance consistently falls below the prescribed standards, the frequency of government inspections may be tightened for the services concerned

7.2. Reduced Sampling Inspection. Inspection can be reduced from normal size when the following conditions have been met for a sampling guide.

7.2.1.1. The preceding four lots (i.e. last four consecutive months) have all been acceptable.

7.2.1.2. The number of deficiencies in each of the preceding four lots is 50 percent or less of the acceptance numbers. For example, with an AQL of 6.5 percent and a sample size of 32, the acceptable number is 5. If two or less deficiencies were found in each of the last four lots, reduced inspection could be used.

7.2.1.3. The COR and the KO agree to use reduced inspection.

7.2.2. Reduced Sample Size and Acceptance or Rejection Numbers. Reduced inspection decreases the sample size, as shown in Figure 2. In addition, the acceptance and rejection numbers change, as shown in Figure 4. To make the changes to the existing sampling guide, take the following steps:

7.2.3. Ensure that the original sampling guide was used for the normal sample size. To determine this, see Figure 3 (normal size) and compare the lot size with the sample size in the sampling guide.

7.2.4. Find the new sample size by using Figure 2 (reduced size). Take the lot size and find the new reduced sample size.

7.2.5. Using the AQL in the sampling guide and the new reduced sample size, see Figure 4 for the new acceptance numbers. Note that there is a gap between the rejection numbers (for example, sample size 32 and the AQL is 6.5 percent, accept is 5 and reject is 8). This means that the lot would not be rejected unless eight deficiencies were found and would be accepted if five or fewer deficiencies were found. However, a number of deficiencies greater than five will be cause for returning to normal inspection (i.e., return to the sample size and acceptance and rejection numbers used in the original sampling guide).

7.2.6. Returning to Normal Inspection. When reduced inspection is in effect, returning to normal inspection the next month will happen under the following conditions.

7.2.6.1. When the number of deficiencies exceeds the acceptance number under reduced sampling.

7.2.6.2. The COR and the KO deem it necessary to return to normal inspection.

7.2.7. Returning to Reduced Inspection. If during the first month of the return to normal inspection the number of deficiencies found is again 50 percent or less of the acceptance level, a return to reduced inspection may be done the next month. If the number of deficiencies found exceeds 50 percent, then normal sampling must be accomplished until four consecutive months of 50 percent or less of acceptance level deficiencies are found.

8. SAMPLING GUIDES AND CHECKLISTS

8.1. The following pages contain sampling guides and checklists for performing quality assurance surveillance inspections of contractor performance. Follow the instructions carefully. You will need to refer to the appropriate standards (provided in the PWS) for each output.

· Type 1 – one deficiency fails room

· Type 2 – two deficiencies fails room

· Type 3 and 4 – three deficiencies fails room

· Type 5 and 6 – four deficiencies fails room

SAMPLING GUIDE #1

PRS OUTPUT FOR TYPE I SERVICES: Provide healthcare housekeeping services in the Operating Room, Labor & Delivery, scrub rooms and central sterile supply. Type I Services shall be performed in accordance with the HRP requirement and AHE Practice Guidance for Healthcare Environmental Cleaning.

1. METHOD OF SURVEILLANCE: Random Sampling

2. ACCEPTABLE QUALITY LEVEL (AQL): 1.0% maximum deviation is acceptable.

3. LOT SIZE FOR SAMPLING: Lot size is _____. The lot size is calculated by multiplying each space’s daily operational periods times the space’s operational days each month and summed by Type Service.

4. SAMPLE SIZE: Sample size is _____. The reference sources are Tables I, II-A, II-B, and II-C, Sampling Procedures and Tables for Inspection by Attributes, ANSI/ASQC Z1.4.

5. SAMPLING PROCEDURES: Schedules must be prepared by the last workday of the month preceding inspection. The objective in deciding how the sample will be drawn is to ensure that the sample is random (that is, that all services have an equal chance of being selected). To achieve random selection an automated program will be used for selecting the rooms/areas and the dates of inspection. When selecting samples, the number of selections should exceed the required sample size by at least 10 percent to allow for situations where a selected sample cannot be evaluated.

6. EVALUATION PROCEDURES: On the day the areas are to be inspected review the contractor’s work schedule and determine when the work will be done. This can be done ahead of time, if the QAE desires, since the contractor’s schedule is known. Check the area as soon as possible after performance so that evidence of the work performed is not destroyed by building traffic.

Before beginning any inspection, the QAE will prepare an Inspection Checklist listing the date and space numbers of each space to be inspected. The QAE will complete the form on site, grading all work as satisfactory (S) or unsatisfactory (U) based on substantial compliance with the requirement. If a “U” is indicated, make sure that there was no probability that the task failed because some outside action soiled the area after cleaning was done. For every “U”, indicate under “Remarks” or on the back of the checklist the specific reason why the “U” was given. If rework is ordered all pertinent data such as date the contractor was informed of the problem, action taken, and date of acceptance will be recorded on the original inspection checklist.

The following is a typical inspection procedure: The QAE will enter the space about two paces. The QAE first looks at the main floor area, then the nearby walls, next any nearby fixtures. Now the QAE moves to the center of the space, again inspecting the floor, sidewalls, fixtures, and windows. The QAE will next inspect any bathrooms, closets, and bathroom windows. Each work requirement must be evaluated by the QAE to determine if there has been substantial compliance with the specification requirements. It is only upon leaving the space that the QAE marks each of the work requirements on the Checklist as "satisfactory" or "unsatisfactory." All appropriate blocks on the Checklist must be completed. Total inspection time per space will average three to four minutes, of which the fixture inspection should take approximately half.

7. PERFORMANCE CRITERIA:

a. Performance is acceptable if 1.0% or less sample items were rated unacceptable during the month.

b. Performance is unacceptable if 1.01% or more sample items were rated unacceptable during the month. Even if the number of unacceptable sample items meets or exceed the reject level, all scheduled inspections of the service requirement should be accomplished.

TOTAL DISINFECTION CLEANING OF TYPE I AREAS

For use of this form, see QASP for Healthcare Housekeeping Services

PRS I – Provide Cleaning of Type I Areas

Accepted Rejected

REQUIRED SERVICES

REMARKS – (Continue on page 2 if more space is needed

1. Hard Floors – To include corners and edges

1a. Interior Sweeping

1b. Wet Mop/Vacuuming

1d. Floor Care (Strip/Buff/Finishing)

3. Carpeted Floors

3a. Vacuuming

3b. Extraction/Shampooing

3c. Spot Removal, Including Gum

4. Walls/Wall Guards - Damp Wiped/ Washed

5. Light Fixtures/Light Covers/ Surgical Lights, Surgical Reflectors, Light Arms

6. Glass Cleaning

7. Furniture and Furnishings

7a. Damp Wipe

7b. Extraction/Shampooing

7c. Bed Made – Clean & Serviceable Linen

7d. Empty, Disinfect and Reline Linen Hamper

8. Metal Surfaces – Clean

9. Waste Removal – General and RMW

9a. Empty Waste Receptacles

9b. Clean and Disinfect Receptacles Inside and Out

9c. Reline Trash Receptacles

10. General Cleaning

10a. Clean and Disinfect Sinks , Toilet, Urinal, Showers, Tubs and Fixtures

10b. Clean and Disinfect Mirrors

10c. Clean and Disinfect Woodwork, Doors and Partitions

10d. Clean and Disinfect Baseboards

10e. Clean, Disinfect and Supply Dispensers

10f. Clean and Disinfect Telephones, Microwaves, Refrigerators and Televisions

10g. Clean and Disinfect Ducts/Louvers/Grills and Radiators

10h. Change Cubicle Curtains/Drapes

10i. Clean and Disinfect Venetian Blinds

10j. Vacuum Window Drapes

11. Ceilings – Damp Wipe/ Wash

12. Approved Chemicals/Clean Equipment/Supplies

12a. Using Approved Chemicals/ Supplies

12b. Healthcare Housekeeping Equipment Cleaned

REMARKS (QAE/COR)

SAMPLING GUIDE #2

PRS OUTPUT FOR TYPE II SERVICES: Provide healthcare housekeeping services in Inpatient rooms, nursery, and trauma rooms areas. Type II Services shall be performed in accordance with HRP requirement and AHE Practice Guidance for Healthcare Environmental Cleaning.

1. METHOD OF SURVEILLANCE: Random Sampling

2. ACCEPTABLE QUALITY LEVEL (AQL): 1.5% maximum deviation is acceptable.

3. LOT SIZE FOR SAMPLING: Lot size is ____. The lot size is calculated by multiplying each space’s daily operational periods times the space’s operational days each month and summed by Type Service.

4. SAMPLE SIZE: Sample size is _____. The reference sources are Tables I, II-A, II-B, and II-C, Sampling Procedures and Tables for Inspection by Attributes, ANSI/ASQC Z1.4.

5. SAMPLING PROCEDURES: Schedules must be prepared by the last workday of the month preceding inspection. The objective in deciding how the sample will be drawn is to ensure that the sample is random (that is, that all services have an equal chance of being selected). To achieve random selection an automated program will be used for selecting the rooms/areas and the dates of inspection. When selecting samples, the number of selections should exceed the required sample size by at least 10 percent to allow for situations where a selected sample cannot be evaluated.

6. EVALUATION PROCEDURES: On the day the areas are to be inspected review the contractor’s work schedule and determine when the work will be done. This can be done ahead of time, if the QAE desires, since the contractor’s schedule is known. Check the area as soon as possible after performance so that evidence of the work performed is not destroyed by building traffic.

Before beginning any inspection, the QAE will prepare an Inspection Checklist listing the date and space numbers of each space to be inspected. The QAE will complete the form on site, grading all work as satisfactory (S) or unsatisfactory (U) based on substantial compliance with the requirement. If a “U” is indicated, make sure that there was no probability that the task failed because some outside action soiled the area after cleaning was done. For every “U”, indicate under “Remarks” or on the back of the checklist the specific reason why the “U” was given. If rework is ordered all pertinent data such as date the contractor was informed of the problem, action taken, and date of acceptance will be recorded on the original inspection checklist.

The following is a typical inspection procedure: The QAE will enter the space about two paces. The QAE first looks at the main floor area, then the nearby walls, next any nearby fixtures. Now the QAE moves to the center of the space, again inspecting the floor, sidewalls, fixtures, and windows. The QAE will next inspect any bathrooms, closets, and bathroom windows. Each work requirement must be evaluated by the QAE to determine if there has been substantial compliance with the specification requirements. It is only upon leaving the space that the QAE marks each of the work requirements on the Checklist as "satisfactory" or "unsatisfactory." All appropriate blocks on the Checklist must be completed. Total inspection time per space will average three to four minutes, of which the fixture inspection should take approximately half.

7. PERFORMANCE CRITERIA:

a. Performance is acceptable if 1.5% or less sample items were rated unacceptable during the month.

b. Performance is unacceptable if 1.6% or more sample items were rated unacceptable during the month. Even if the number of unacceptable sample items meets or exceed the reject level, all scheduled inspections of the service requirement should be accomplished.

TOTAL DISINFECTION CLEANING OF TYPE II AREAS

For use of this form, see QASP for Healthcare Housekeeping Services

PRS II – Provide Cleaning of Type II Areas

Accepted Rejected

REQUIRED SERVICES

REMARKS – (Continue on page 2 if more space is needed

1. Hard Floors – To include corners and edges

1a. Interior Sweeping

1b. Wet Mop/Vacuuming

1d. Floor Care (Strip/Buff/Finishing)

3. Carpeted Floors

3a. Vacuuming

3b. Extraction/Shampooing

3c. Spot Removal, Including Gum

4. Walls/Wall Guards - Damp Wiped/ Washed

5. Light Fixtures/Light Covers/ Surgical Lights, Surgical Reflectors, Light Arms

6. Glass Cleaning

7. Furniture and Furnishings

7a. Damp Wipe

7b. Extraction/Shampooing

7c. Bed Made – Clean & Serviceable Linen

7d. Empty, Disinfect and Reline Linen Hamper

8. Metal Surfaces – Clean

9. Waste Removal – General and RMW

9a. Empty Waste Receptacles

9b. Clean and Disinfect Receptacles Inside and Out

9c. Reline Trash Receptacles

10. General Cleaning

10a. Clean and Disinfect Sinks , Toilet, Urinal, Showers, Tubs and Fixtures

10b. Clean and Disinfect Mirror

10c. Clean and Disinfect Woodwork, Doors and Partitions

10d. Clean and Disinfect Baseboards

10e. Clean, Disinfect and Supply Dispensers

10f. Clean and Disinfect Telephones, Microwaves, Refrigerators and Televisions

10g. Clean and Disinfect Ducts/Louvers/Grills and Radiators

10h. Change Cubicle Curtains/Drapes

10i. Clean and Disinfect Venetian Blinds

10j. Vacuum Window Drapes

11. Ceilings – Damp Wipe/ Wash

12. Approved Chemicals/Clean Equipment/Supplies

12a. Using Approved Chemicals/ Supplies

12b. Healthcare housekeeping Equipment Cleaned

REMARKS (QAE/COR)

SAMPLING GUIDE #3

PRS OUTPUT FOR TYPE III SERVICES: Provide healthcare housekeeping services in restrooms, showers and locker rooms. Type III Services shall be required in accordance with HRP requirement and AHE Practice Guidance for Healthcare Environmental Cleaning.

1. METHOD OF SURVEILLANCE: Random Sampling

2. ACCEPTABLE QUALITY LEVEL (AQL): 1.5% maximum deviation is acceptable.

3. LOT SIZE FOR SAMPLING: Lot size is _______. The lot size is calculated by multiplying each space’s daily operational periods times the space’s operational days each month and summed by Type Service.

4. SAMPLE SIZE: Sample size is ________. The reference sources are Tables I, II-A, II-B, and II-C, Sampling Procedures and Tables for Inspection by Attributes, ANSI/ASQC Z1.4.

5. SAMPLING PROCEDURES: Schedules must be prepared by the last workday of the month preceding inspection. The objective in deciding how the sample will be drawn is to ensure that the sample is random (that is, that all services have an equal chance of being selected). To achieve random selection an automated program will be used for selecting the rooms/areas and the dates of inspection. When selecting samples, the number of selections should exceed the required sample size by at least 10 percent to allow for situations where a selected sample cannot be evaluated.

6. EVALUATION PROCEDURES: On the day the areas are to be inspected review the contractor’s work schedule and determine when the work will be done. This can be done ahead of time, if the QAE desires, since the contractor’s schedule is known. Check the area as soon as possible after performance so that evidence of the work performed is not destroyed by building traffic.

Before beginning any inspection, the QAE will prepare an Inspection Checklist listing the date and space numbers of each space to be inspected. The QAE will complete the form on site, grading all work as satisfactory (S) or unsatisfactory (U) based on substantial compliance with the requirement. If a “U” is indicated, make sure that there was no probability that the task failed because some outside action soiled the area after cleaning was done. For every “U”, indicate under “Remarks” or on the back of the checklist the specific reason why the “U” was given. If rework is ordered all pertinent data such as date the Contractor was informed of the problem, action taken, and date of acceptance will be recorded on the original inspection checklist.

The following is a typical inspection procedure: The QAE will enter the space about two paces. The QAE first looks at the main floor area, then the nearby walls, next any nearby fixtures. Now the QAE moves to the center of the space, again inspecting the floor, sidewalls, fixtures, and windows. The QAE will next inspect any bathrooms, closets, and bathroom windows. Each work requirement must be evaluated by the QAE to determine if there has been substantial compliance with the specification requirements. It is only upon leaving the space that the QAE marks each of the work requirements on the Checklist as "satisfactory" or "unsatisfactory." All appropriate blocks on the Checklist must be completed. Total inspection time per space will average three to four minutes, of which the fixture inspection should take approximately half.

7. PERFORMANCE CRITERIA:

a. Performance is acceptable if 1.5% or less sample items were rated unacceptable during the month.

b. Performance is unacceptable if 1.6% or more sample items were rated unacceptable during the month. Even if the number of unacceptable sample items meets or exceed the reject level, all scheduled inspections of the service requirement should be accomplished.

TOTAL DISINFECTION CLEANING OF TYPE III AREAS

For use of this form, see QASP for Healthcare housekeeping Services

PRS III – Provide Cleaning of Type III Areas

Accepted Rejected

REQUIRED SERVICES

REMARKS – (Continue on page 2 if more space is needed

1. Hard Floors – To include corners and edges

1a. Interior Sweeping

1b. Wet Mop/Vacuuming

1d. Floor Care (Strip/Buff/Finishing)

3. Carpeted Floors

3a. Vacuuming

3b. Extraction/Shampooing

3c. Spot Removal, Including Gum

4. Walls/Wall Guards - Damp Wiped/ Washed

5. Light Fixtures/Light Covers/ Surgical Lights, Surgical Reflectors, Light Arms

6. Glass Cleaning

7. Furniture and Furnishings

7a. Damp Wipe

7b. Extraction/Shampooing

7c. Bed Made – Clean & Serviceable Linen

7d. Empty, Disinfect and Reline Linen Hamper

8. Metal Surfaces – Clean

9. Waste Removal – General and RMW

9a. Empty Waste Receptacles

9b. Clean and Disinfect Receptacles Inside and Out

9c. Reline Trash Receptacles

10. General Cleaning

10a. Clean and Disinfect Sinks , Toilet, Urinal, Showers, Tubs and Fixtures

10b. Clean and Disinfect Mirrors

10c. Clean and Disinfect Woodwork, Doors and Partitions

10d. Clean and Disinfect Baseboards

10e. Clean, Disinfect and Supply Dispensers

10f. Clean and Disinfect Telephones, Microwaves, Refrigerators and Televisions

10g. Clean and Disinfect Ducts/Louvers/Grills and Radiators

10h. Change Cubicle Curtains/Drapes

10i. Clean and Disinfect Venetian Blinds

10j. Vacuum Window Drapes

11. Ceilings – Damp Wipe/ Wash

12. Approved Chemicals/Clean Equipment/Supplies

12a. Using Approved Chemicals/ Supplies

12b. Healthcare housekeeping Equipment Cleaned

REMARKS (QAE/COR)

SIGNATURE (QAE/COR)

DATE

SAMPLING GUIDE #4

PRS OUTPUT FOR TYPE IV SERVICES: Provide healthcare housekeeping services in Clinics, Laboratories, Veterinary facilities, Radiology, Therapy Areas, and Dental facilities.

1. METHOD OF SURVEILLANCE: Random Sampling

2. ACCEPTABLE QUALITY LEVEL (AQL): 2.5% maximum deviation is acceptable.

3. LOT SIZE FOR SAMPLING: Lot size is _______. The lot size is calculated by multiplying each space’s daily operational periods times the space’s operational days each month and summed by Type Service.

4. SAMPLE SIZE: Sample size is ________. The reference sources are Tables I, II-A, II-B, and II-C, Sampling Procedures and Tables for Inspection by Attributes, ANSI/ASQC Z1.4.

5. SAMPLING PROCEDURES: Schedules must be prepared by the last workday of the month preceding inspection. The objective in deciding how the sample will be drawn is to ensure that the sample is random (that is, that all services have an equal chance of being selected). To achieve random selection an automated program will be used for selecting the rooms/areas and the dates of inspection. When selecting samples, the number of selections should exceed the required sample size by at least 10 percent to allow for situations where a selected sample cannot be evaluated.

6. EVALUATION PROCEDURES: On the day the areas are to be inspected review the contractor’s work schedule and determine when the work will be done. This can be done ahead of time, if the QAE desires, since the contractor’s schedule is known. Check the area as soon as possible after performance so that evidence of the work performed is not destroyed by building traffic.

Before beginning any inspection, the QAE will prepare an Inspection Checklist listing the date and space numbers of each space to be inspected. The QAE will complete the form on site, grading all work as satisfactory (S) or unsatisfactory (U) based on substantial compliance with the requirement. If a “U” is indicated, make sure that there was no probability that the task failed because some outside action soiled the area after cleaning was done. For every “U”, indicate under “Remarks” or on the back of the checklist the specific reason why the “U” was given. If rework is ordered all pertinent data such as date the contractor was informed of the problem, action taken, and date of acceptance will be recorded on the original inspection checklist.

The following is a typical inspection procedure: The QAE will enter the space about two paces. The QAE first looks at the main floor area, then the nearby walls, next any nearby fixtures. Now the QAE moves to the center of the space, again inspecting the floor, sidewalls, fixtures, and windows. The QAE will next inspect any bathrooms, closets, and bathroom windows. Each work requirement must be evaluated by the QAE to determine if there has been substantial compliance with the specification requirements. It is only upon leaving the space that the QAE marks each of the work requirements on the Checklist as "satisfactory" or "unsatisfactory." All appropriate blocks on the Checklist must be completed. Total inspection time per space will average three to four minutes, of which the fixture inspection should take approximately half.

7. PERFORMANCE CRITERIA:

a. Performance is acceptable if 2.5% or less sample items were rated unacceptable during the month.

b. Performance is unacceptable if 2.6% or more sample items were rated unacceptable during the month. Even if the number of unacceptable sample items meets or exceed the reject level, all scheduled inspections of the service requirement should be accomplished.

TOTAL DISINFECTION CLEANING OF TYPE IV AREAS

PRS IV – Provide Cleaning of Type IV Areas

Accepted Rejected

REQUIRED SERVICES

REMARKS – (Continue on page 2 if more space is needed

1. Hard Floors – To include corners and edges

1a. Interior Sweeping

1b. Wet Mop/Vacuuming

1d. Floor Care (Strip/Buff/Finishing)

3. Carpeted Floors

3a. Vacuuming

3b. Extraction/Shampooing

3c. Spot Removal, Including Gum

4. Walls/Wall Guards - Damp Wiped/ Washed

5. Light Fixtures/Light Covers/ Surgical Lights, Surgical Reflectors, Light Arms

6. Glass Cleaning

7. Furniture and Furnishings

7a. Damp Wipe

7b. Extraction/Shampooing

7c. Bed Made – Clean & Serviceable Linen

7d. Empty, Disinfect and Reline Linen Hamper

8. Metal Surfaces – Clean

9. Waste Removal – General and RMW

9a. Empty Waste Receptacles

9b. Clean and Disinfect Receptacles Inside and Out

9c. Reline Trash Receptacles

10. General Cleaning

10a. Clean and Disinfect Sinks , Toilet, Urinal, Showers, Tubs and Fixtures

10b. Clean and Disinfect Mirrors

10c. Clean and Disinfect Woodwork, Doors and Partitions

10d. Clean and Disinfect Baseboards

10e. Clean, Disinfect and Supply Dispensers

10f. Clean and Disinfect Telephones, Microwaves, Refrigerators and Televisions

10g. Clean and Disinfect Ducts/Louvers/Grills and Radiators

10h. Change Cubicle Curtains/Drapes

10i. Clean and Disinfect Venetian Blinds

10j. Vacuum Window Drapes

11. Ceilings – Damp Wipe/ Wash

12. Approved Chemicals/Clean Equipment/Supplies

12a. Using Approved Chemicals/ Supplies

12b. Healthcare housekeeping Equipment Cleaned

REMARKS (QAE/COR)

SAMPLING GUIDE #5

PRS OUTPUT FOR TYPE V SERVICES: Provide healthcare housekeeping services in administrative areas and offices.

1. METHOD OF SURVEILLANCE: Random Sampling

2. ACCEPTABLE QUALITY LEVEL (AQL): 2.5% maximum deviation is acceptable.

3. LOT SIZE FOR SAMPLING: Lot size is _______. The lot size is calculated by multiplying each space’s daily operational periods times the space’s operational days each month and summed by Type Service.

4. SAMPLE SIZE: Sample size is ________. The reference sources are Tables I, II-A, II-B, and II-C, Sampling Procedures and Tables for Inspection by Attributes, ANSI/ASQC Z1.4.

5. SAMPLING PROCEDURES: Schedules must be prepared by the last workday of the month preceding inspection. The objective in deciding how the sample will be drawn is to ensure that the sample is random (that is, that all services have an equal chance of being selected).