Attachment D1 - QASP.pdf

QUALITY ASSURANCE SURVEILLANCE PLAN (QASP)

FACILITY AND QTR: Click or tap here to enter text.

Performance standards define desired services. The Government performs surveillance to determine if the Contractor exceeds, meets, or does not meet these standards. The Performance Requirements Summary Matrix is incorporated within this QASP to include performance standards and disincentives. The Government shall use these standards to determine Contractor performance and shall compare Contractor performance to the Acceptable Quality Level (AQL) defined below for each performance requirement.

Task Standard

Performance Threshold/ Acceptable

Quality Level

Method of Surveillance

Performance Acceptable/

Unacceptable

Emergency Housing Facilities & Management:

1. Facilities meet fire and safety code imposed by the State law, and the Life Safety Code of the National Fire and Protection Association.

2. Facilities meet the Americans with Disabilities Act (ADA) guidelines for accessible accommodations for Veterans with physical limitations or impairments.

3. Facilities are licensed as required for the setting under State or Federal authority, and must meet all applicable local, state, and Federal requirements concerning licensing and health codes.

4. Facilities ensure the safety and privacy of Veterans and/or Veteran families with a clean and comfortable environment of care.

Facility provides: a.) a designated bed that is used exclusively by the individual Veteran from the time of admission to the time of discharge; situated in a room that affords the Veteran safety, privacy and security; b.) a safe and secure place for each Veteran to store his/her belongings that is readily accessible to the Veteran (such as a locking closet, a locking armoire, a locker, etc.); c.) laundry facilities for Veterans to do their own laundry at no cost to the Veteran.

5. Facility provides a safe and sober environment for all residents.

100% during annual rating period

Annual VA team inspection.

The Government may, at its discretion, choose any time, announced or unannounced, to have VA personnel inspect the contractor’s facility.

YES ☐

NO ☐

6. Facility provides appetizing, nutritionally adequate meals three times per day in a setting that encourages social interaction and nutritious snacks between meals and at bedtime must be available for those requiring or desiring additional food, when it is not medically contraindicated. All food is stored, handled and served in a safe and sanitary manner that meets accepted industry standards and guidelines.

Staffing & Supportive Services:

1. Contractor staffing provides:

a. A full-time administrative staff member on duty or residing at the residence and available for emergencies 24 hours a day, 7 days a week. Note: security staff alone, whether employed directly by the contractor or subcontracted by the contractor, is not sufficient to meet this requirement.

b. A Director of the program and/or facility on call and available for emergencies 24 hours a day, 7 days a week.

c. A professionally credentialed clinical supervisor available to make regular onsite visits and provide ongoing supervision of cases to case management personnel. The clinical supervisor must be on call and available for emergencies 24 hours a day, 7 days a week.

d. Sufficient case management personnel to provide the necessary therapeutic interventions and activities and to ensure a meaningful integration of these efforts with those provided in the residential setting. Each Veteran must have an assigned case manager responsible for coordinating and providing the supportive

95% of referred cases

Quarterly record review.

The Government may, at its discretion, choose any time, announced or unannounced, to have VA personnel inspect the contractor’s records.

services specified in the contract.

e. Security staff onsite 24 hours a day, 7 days a week. Security staff must be sufficient to ensure a safe and secure environment for all residents.

f. At least one staff or security member with Cardio-Pulmonary Resuscitation (CPR) certification on site and available in an emergency during each shift, 24 hours per day.

2. Contractor provides coordinated case management to include psychosocial assessment and individual service planning;

assisting Veterans with appointments, paperwork and linkages to needed resources;

transportation to appointments;

medication management.

3. Contractor provides daily structured groups and activities to promote skills building and healthy lifestyle.

Records and Reports: 1. Contractor provides daily sign-in sheets signed by Veterans to verify services and invoicing.

2. Contractor maintains individual client records to include:

a. Initial psychosocial assessment

b. Individual Service Plan

c. Progress notes for each client contact

d. Documentation of Veteran participation in daily group activities

e. Updated Individual Service Plans

f. Discharge summaries

3. Timely entry of data into HMIS

95% during quarterly rating period

Quarterly Veteran record review.

The Government may, at its discretion, choose any time, announced or unannounced, to have VA personnel inspect the contractor’s records.

Quarterly

Mandatory Training 1. Contractor shall complete all required training on time per

VAMC policy. All staff shall be certified in CPR/Heart Saver, VA Privacy Training, Psychological First Aid and received training on verbal de-escalation. Certificates of completion are to be forwarded to the designated COR by email.

2. All Contractor employees shall take, Talent Management System (TMS) Item #3873736, Records Management for Records Officers and Liaisons or the equivalent.

100% Annually YES ☐

Housing Placement: A. Positive discharges as defined in the Performance Work Statement

(PWS)

B. Administrative discharges as defined in the Performance Work Statement (PWS)

C. Negative discharges as defined in the Performance Work Statement

(PWS)

D. Unacceptable discharges as defined in the Performance Work Statement (PWS)

A. 85% or greater of Veterans admitted to the facility;

B. Not more than 10% of Veterans admitted facility

C. Not more than 5% of Veterans admitted facility

D. Zero (0) instances during the rating period

Semi-annual record review from the date of contract award.

The Government may, at its discretion, choose any time, announced or unannounced, to have VA personnel inspect the contractor’s files

Signature of Contracting Officer Representative

CONTRACT DISCREPANCY REPORT

1. CONTRACT NUMBER 2. REPORT NUMBER FOR THIS DISCREPANCY

3. TO: (Contracting Officer) 4. FROM: (Name of COR)

5. DATES

a. CDR PREPARED

b. RETURNED BY CONTRACTOR: c. ACTION COMPLETE

6. DISCREPANCY OR PROBLEM (Describe in detail. Include reference to PWS Directive; attach continuation sheet if necessary.)

7. SIGNATURE OF COR Date:

8. SIGNATURE OF CONTRACTING OFFICER Date:

9a. TO (Contracting Officer) 9a. FROM (Contractor)

10. CONTRACTOR RESPONSE AS TO CAUSE, CORRECTIVE ACTION AND ACTIONS TO PREVENT RECURRENCE. (Cite applicable quality control program procedures or new procedures. Attach continuation sheet(s) if necessary.)

11. SIGNATURE OF CONTRACTOR REPRESENTATIVE Date:

12. GOVERNMENT EVALUATION. (Acceptance, partial acceptance, reflection. Attach continuation sheet(s) if necessary.)

13. GOVERNMENT ACTIONS (Acceptance, partial acceptance, reflection. Attach continuation sheet(s) if necessary.)

14. CLOSE OUT

NAME TITLE SIGNATURE DATE

CONTRACTOR

NOTIFIED

COR

CONTRACTING

OFFICER