ATTACHMENT ONE- QASP.docx

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Attached to
Substance Use Disorder Program (SUDP) Federal contract opportunity
Solicitation number
36C26121Q1183
Issued by
Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 21

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File Type Posted
RFQ 36C26121Q1183.pdf PDF
ATTACHMWNT TWO- WD 2015-5610 R12 20200702.pdf PDF

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Quality Assurance Surveillance Plan (QASP) Project Title: Clean and Sober Living Contract Contract Number:

Contract Description: VA Central California Health Care System will provide clean and sober living for Veterans enrolled in outpatient Substance Abuse Dependency Program (SUDP). The goal of the SUDP is to place Veterans in a community-based, residential environment with sufficient therapeutic services to meet the needs of the Veteran.

Contractor’s Name:

1. PURPOSE

This Quality Assurance Surveillance Plan (QASP) provides a systematic method to evaluate performance for the stated contract. This QASP explains the following:

· What will be monitored

· How monitoring will take place

· Who will conduct the monitoring

· How monitoring efforts and results will be documented This QASP does not detail how the contractor accomplishes the work. Rather, the QASP is created with the premise that the contractor is responsible for management and quality control actions to meet the terms of the contract. It is the Government’s responsibility to be objective, fair, and consistent in evaluating performance.

The QASP is a “living document” and the Government may review and revise it on a regular basis. However, the Government shall coordinate changes with the contractor. Copies of the original QASP and revisions shall be provided to the contractor and Government officials implementing surveillance activities.

2. GOVERNMENT ROLES AND RESPONSIBILITIES

The following personnel shall oversee and coordinate surveillance activities:

a. Contracting Officer (CO) – The CO shall ensure performance of all necessary actions for effective contracting, ensure compliance with the contract terms, and shall safeguard the interests of the United States in the contractual relationship. The CO shall also assure that the contractor receives impartial, fair, and equitable treatment under this contract. The CO is ultimately responsible for the final determination of the adequacy of the contractor’s performance.

Assigned CO:

Organization or Agency: Department of Veterans Affairs, Office of Acquisition and Material Management

b. Contracting Officer’s Technical Representative (COTR) – The COTR is responsible for technical administration of the contract and shall assure proper Government surveillance of the contractor’s performance. The COTR shall keep a quality assurance file. The COTR is not empowered to make any contractual commitments or to authorize any contractual changes on the Governments behalf.

Assigned COTR: Linda Hayes

c. Other Key Government Personnel –

3. CONTRACTOR REPRESENTATIVES

The following employees of the contractor serve as the contractor’s program manager for this contract.

a. Program Manager

b. Other Contractor Personnel Title:

4. PERFORMANCE STANDARDS

Performance standards define desired services. The Government performs surveillance to determine if the contractor exceeds, meets or does not meet these standards.

The Performance Requirements Summary Matrix, includes performance standards. The Government shall use these standards to determine contractor performance and shall compare contractor performance to the Acceptable Quality Level (AQL).

Task #
Task
Performance Indicator
Standards
Acceptable Quality Level
Score (85, 95, 100%)
Surveillance Method
1
Occupancy
Program will maintain minimum acceptable level of occupancy through collaboration with VA and independent outreach efforts.
85% of occupancy reports shall demonstrate an occupancy rate of 80% or higher for a given month.
95%

Periodic Inspection

2
Admission Protocol
Program will follow established protocol for proper admission of clients, including obtaining ROI prior authorization from VA, completion and submission of the Homes.
90% if veterans admitted will have signed ROI and prior approval by VA staff documented in the case management file.
95%

Direct Observation

Periodic Inspection

Random Sampling

3
Case Management
Program will submit at the end of each month a summary of the case management activities and the veteran’s progress toward the goals outlined in the SUDP
75% of veterans will have a monthly summary submitted to the VA representative of progress
85%

Periodic Inspection

Random Sampling

4
Discharge Protocol
The program will follow protocol for handling and documentation of veteran discharge as established by the Scope of Work. This shall include notifying the identified VA liaison or designee within 24 business hours and providing supporting SUDP discharge documentation with 72 business hours.
85% of the veteran discharges shall be reported to VA liaison within 24 business hours
90%

Direct Observation

Periodic Inspection

Random Sampling

5
Reporting and Consumer Satisfaction
Upon completion of the program Eligible Veterans will complete a questions and submit to VA reprehensive
80% of the veterans who have resided in the program for longer than 30 days will complete a scarification survey and submit to VA SUD reprehensive
90%

Random Sampling

6
Veterans Safety
Program shall follow established protocol for ensuring appropriate emergency responses are initiated when indicated and that the identified VA Representative is notified as soon as possible and that a formal written report concerning all adverse incidents involving veterans is provided within 24 business hours. Reportable critical adverse incidents are defined as: Assault, sexual assault, abuse or neglect, fire-veteran involved, medical emergency, hospitalization suicide attempt, completed suicide, homicide, death, infectious control, active substance use, possession of weapons, and falls. All staff must be certified in First Aid and CPR
90% of reportable critical adverse incidents are reported within 24 business hours
95%

Direct Observation

Periodic Inspection Random Sampling

7
VA Coordination
The program is expected to collaborate regularly with the identified VA liaison and other VA staff as necessary to ensure proper coordination of VA care, services and resources for the benefit of both individual veterans and the program in general.
75% of veteran charts reviewed will demonstrate evidence of collaboration with VA staff/clinics.
80%

Periodic Inspection

8
Invoicing
The program will follow the protocol for accurate and timely invoicing established in the SOW. Final invoice shall be submitted to the Financial Services Center by the 10th of the following month for certification and payments.
80% of mostly invoices will be submitted to the Financial Service Center by the 10th of the following month
95%

Direct Observation

5. METHODS OF QA SURVEILLANCE

Various methods exist to monitor performance. The COTR shall use the surveillance methods listed below in the administration of this QASP.

a. DIRECT OBSERVATION. (Can be performed periodically or through 100% surveillance.)

Admission Protocol Improvement of Financial Group Activities Discharge Protocol Veteran Safety Invoicing

b. PERIODIC INSPECTION. (Evaluates outcomes on a periodic basis. Inspections may be scheduled [Daily, Weekly, Monthly, Quarterly, or annually] or unscheduled, as required.)

Occupancy Admission Protocol Care Planning Group Activities Discharge Planning Discharge Protocol Outcomes VA Coordination

c. USER SERVEY. (Combines elements of validated user complaints and sampling. Survey is conducted to solicit user satisfaction. May also generate inspections.

Reporting and Consumer Satisfaction

d. PERIODIC SAMPLING. (Variation of random sampling. However, sample is only taken when a problem/deficiency is suspected. Sample results are applicable only for the specific work inspected. Since sample is not entirely random, it cannot be applied to total activity performance.)

Veteran Safety

e. RANDOM SAMPLING. (Designed to evaluate performance by randomly selecting and inspecting a sample of cases.

Admission Protocol Care Planning Group Activities Discharge Planning Discharge Protocol VA Coordination

f. Analysis of contractor’s progress reports.

Outcomes

6. RATINGS

Metrics and methods are designed to determine if performance exceeds, meets, or does not meet a given standard and acceptable quality level. A rating scale shall be used to determine a positive, neutral, or negative outcome. The following ratings shall be used.

90%
Positive Performance
85%
Neutral Performance
80%
Negative Performance

7. DOCUMENTING PERFORMANCE

a. ACCEPTABLE PERFORMANCE (90% Rating) The Government shall document positive performance. Any report may become a part of the supporting documentation for any contractual action.

b. UNACCEPTABLE PERFORMANCE (70% Rating) When unacceptable performance occurs, the COTR shall inform the contractor. This will normally be in writing unless circumstances necessitate verbal communication. In any case the COTR shall document the discussion and place it in the COTR file.

When the COTR determines formal written communication is required, the COTR shall prepare a Contract Discrepancy Report (CDR), and present it to the contractor’s program manager.

The contractor shall acknowledge receipt of the CDR in writing. The CDR will specify if the contractor is required to prepare a corrective action plan to document how the contractor shall correct the unacceptable performance and avoid a recurrence. The CDR will also state how long after receipt the contractor has to present this corrective action plan to the COTR. The Government shall review the contractor’s corrective action plan to determine acceptability.

Any CDRs may become a part of the supporting documentation for any contractual action deemed necessary by the CO.

8. FREQUENCY OF MEASUREMENT

a. Frequency of Measurement.

During contract performance, the COTR will periodically analyze whether the negotiated frequency of surveillance is appropriate for the work being performed.

b. Frequency of Performance Assessment Meetings.

The CORT shall meet with the contractor quarterly to assess performance and shall provide a written assessment.

Signature – Contractor Program Manager

Signature – Contracting Officer’s Technical Representative

Attachments:

1. Contract Performance Report
2. Contract Discrepancy Report

Attachment 1 Contract Performance Report

1. Contract Number:

2. Prepared by: Linda Hayes

3. Date and time of observation:

4. Observation:

· Method of surveillance

· How frequently you conducted surveillance

· Surveillance results

· Number of observation

5. Performance Rating (in accordance with QASP, paragraph6):

___________________________________________________________________________
Signature – Contracting Officer’s Technical RepresentativeDate

Attachment 2 Contract Discrepancy Report (CDR) TO: (Contractor Program Manager or onsite representative) FROM: Linda Hayes

1. Contract Number:

2. Date and time observed discrepancy:

3. Discrepancy/Problem/Issue:

4. Corrective action plan:

5. A written corrective action plan (is/is not) required. If a written corrective action plan is required include the following. (The written Corrective Action Plan will be provided to the undersigned no later than (# of days after receipt of this CDR)

___________________________________________________________________________
Signature – Contracting Officer’s Technical RepresentativeDate

Received by:

___________________________________________________________________________
Signature – Contracting Program Manager or Onsite RepresentativeDate

Distribution:

(Name and Title – Contracting Officer) The COTR may initiate a CDR at any time, including whenever the number of monthly recorded defects for a performance standard exceeds the allowable number of defects; anytime unacceptable performance is determined critical in nature and requires formal corrective action; and whenever an unfavorable trend is detected in contractor performance.

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