Attachment+D+-+Monthly+Activity+Report.docx
DOCX document 32 KB Posted
- Attached to
- Recovery Center - Mental Health
- Solicitation number
- 325-25-970-080
- Issued by
- Burleigh County, North Dakota
About this file
This is a monthly activity report template and compliance checklist for Recovery Centers operating under a state contract agreement with the Health and Substance abuse Consortium (HSC). The document outlines mandatory operational requirements and activities that Recovery Center vendors must complete to maintain compliance with their service agreements. Required compliance items include maintaining 40 hours per week of operations, operating as a drop-in facility, filling designated positions (Recovery Center Director and Certified Peer Support Specialist Coordinator), maintaining tobacco-free environments, and providing staff guidance on recovery-oriented care models. Vendors must also complete required activities including hosting peer support groups and recovery education groups at least weekly, conducting structured social activities daily, holding monthly member meetings, providing computer and internet access, utilizing social media marketing, and submitting weekly statistical reports. The Recovery Center must follow the state's Recovery Center Handbook and SAMHSA-endorsed Consumer-Operated Services model in its operations.
Failure to maintain compliance with Section 1 requirements results in a letter of warning with a 30-day correction period; non-correction leads to disciplinary action up to termination. Failure to complete Section 2 required activities may result in reduced monthly payments, with three consecutive months of non-completion triggering a warning letter. Additional reporting requirements include quarterly compliance reports due by the 15th of the subsequent quarter months, an annual compliance report due by August 1st, and an annual consumer satisfaction survey to be conducted in May with results submitted by June 30th. The local HSC Liaison conducts routine facility reviews and provides improvement recommendations. The document was last updated on October 17, 2022.
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Other files
| File | Type | Posted |
|---|---|---|
| Attachment+G+-+Cost+Proposal.docx | DOCX document | |
| Attachment+H+-+Evaluation+Tool.docx | DOCX document | |
| Attachment+F+-+Business+Associate+Agreement.docx | DOCX document | |
| RFP+325-25-970-080.docx | DOCX document | |
| Attachment+E+-+Sample+POS+Agreement.docx | DOCX document | |
| Attachment+C+-+Annual+Compliance+Report.docx | DOCX document | |
| Attachment+B+-+Quarterly+Compliance+Report.docx | DOCX document | |
| Attachment+A+-+Recovery+Center+Handbook.docx | DOCX document |
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Text version
ATTACHMENT D
Recovery Center Monthly Activity Report
Instructions: Please complete this checklist each month when you meet with the Recovery Center Director. After completion, provide the Recovery Center Director with a copy, and retain the original for your records. Discuss results locally at QM Meeting each month.
Date:
Location of Meeting:
Attendees:
Section 1 - The items in are required by Vendor to remain compliant with the Agreement. Failure to adhere to expectations in this section shall result in a letter of warning requiring immediate correction. Failure to correct identified non-compliance within 30 days of receiving the letter of warning shall result in disciplinary action up to and including termination of the Agreement.
| Activity |
| If No, Action Plan must be included |
| Comments; including Action Plans needed to address any concerns. |
All members of the Recovery Center meet the following eligibility guidelines
Yes or No
Recovery Center was open 40 hours per week each week of the month.
Recovery Center operated as a drop-in, meaning members were able to casually come and go.
| If there were changes this month; changes in policy/procedure were submitted to HSC. |
| Yes or No |
N/A
The Recovery Center utilizes the State’s Recovery Center Handbook.
| If there were changes this month; updated organizational chart was submitted to HSC. |
| Yes or No |
N/A
Recovery Center Director position is filled.
Recovery Center Coordinator position is filled, and Recovery Center Coordinator is a Certified Peer Support Specialist.
Job descriptions and background checks are completed and maintained in employee file.
Recovery Center followed State’s policies for state vehicle during the past month.
Over the last month, was guidance and education provided to the staff of the Recovery Center on the Rehab Philosophy, person-centered and skills-based services, and the recovery-oriented model of care?
If yes, who provided the guidance/education?
What was the topic of this month’s education?
Recovery Center maintains a tobacco-free environment.
Section 2 - These items are required activities of the Recovery Center. Vendor shall fulfill the following activities as part of the Agreement; payment is contingent upon completion of these items. Payment structure is included. Failure to complete an activity may result in reduced payment for the month. Failure to complete activities 3+ months in a row shall lead to a letter of warning requiring immediate correction. Failure to correct identified non-compliance within 30 days of receiving the letter of warning shall result in disciplinary action up to and including termination of the Agreement.
| Activities |
| Yes or No; if No, Action Plan must be included |
| Comments; including Action Plans needed to address any concerns. |
Activity Calendar emailed to HSC Liaison at least 10 days before the end of the previous month?
Peer Support Group was held at least once per week; documentation reviewed by Liaison.
Recovery Education Group held at least once per week; documentation reviewed by Liaison.
Structured social activity held at least once per day; documentation reviewed by Liaison.
Member Meeting held this month; documentation reviewed by Liaison.
Computers, email, and internet access available for staff and members.
Social media marketing tools were used and updated this month.
Weekly statistical reports were submitted in a complete and timely manner. (Confirm with Alicia Torfin)
Additional Notes/Comments:
Additional items to review during the monthly meetings:
a. Quarterly Compliance Reports are due by the 15th of the subsequent month (January 15th, April 15th, July 15th, and October 15th). Recovery Center Director is expected to email the completed report to the local HSC Liaison by the due date. The local HSC Liaison will review report in local QM Meeting, and provide a copy to local leadership.
b. Annual Compliance Report is due each year by August 1st. Recovery Center Director is expected to email the completed report to the local HSC Liaison. The local HSC Liaison will review report in local QM Meeting, and provide a copy to local leadership.
c. Annual consumer satisfaction survey is to be conducted during the month of May each year, and results are to be submitted to local HSC by June 30th of each year. Recovery Center Director is expected to email the completed report to the local HSC Liaison. The local HSC Liaison will review report in local QM Meeting, and provide a copy to local leadership.
d. The Recovery Center will use the SAMHSA-endorsed Consumer-Operated Services model in the philosophy and operations of the Recovery Center. The Recovery Center will collaborate with the local HSC. The local HSC will conduct routine reviews of the facility and provide recommendations for improvement.
· https://store.samhsa.gov/product/Consumer-Operated-Services-Evidence-Based-Practices-EBP-KIT/SMA11-4633 Last Updated: 10.17.2022
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