Amendment_0001-GP-SF-30.pdf

(x)

TFSAAFRG15CI0003

x x

1 copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted ; or (c) By separate letter or telegram which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGEMENT TO BE RECEIVED AT

THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted , such change may be made by telegram or letter, provided each telegram or letter makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

x

Parkersburg WV 26101 200 Third Street

FSA-PARKERSBURG

Avery 5F Administration Branch Division of Procurement Bureau of the Fiscal Service

Parkersburg WV 26101 Attn: M. Coplin

FSA-MCOPLIN

200 Third Street Avery 5F Division of Procurement Bureau of the Fiscal Service

04/16/2015000001

13. THIS ITEM ONLY APPLIES TO MODIFICATION OF CONTRACTS/ORDERS. IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

12. ACCOUNTING AND APPROPRIATION DATA (If required) is not extended.is extended, Items 8 and 15, and returning

Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended , by one of the following methods: (a) By completing

The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

FACILITY CODE CODE

10B. DATED (SEE ITEM 13)

10A. MODIFICATION OF CONTRACT/ORDER NO.

9B. DATED (SEE ITEM 11)

9A. AMENDMENT OF SOLICITATION NO.

CODE

8. NAME AND ADDRESS OF CONTRACTOR (No., street, county, State and ZIP Code)

7. ADMINISTERED BY (If other than Item 6)CODE 6. ISSUED BY

PAGE OF PAGES

4. REQUISITION/PURCHASE REQ. NO.3. EFFECTIVE DATE2. AMENDMENT/MODIFICATION NO. 5. PROJECT NO. (If applicable)

1. CONTRACT ID CODE

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

03/30/2015

CHECK ONE A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes in paying office, C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER (Specify type of modification and authority) appropriation date, etc.) SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

E. IMPORTANT: Contractor is not, is required to sign this document and return __________________ copies to the issuing office.

ORDER NO. IN ITEM 10A.

14. DESCRIPTION OF AMENDMENT/MODIFICATION (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

The Purpose of this amendment is as follows:

1) Answer Solicitation Questions (See Attached)

2) Include Updated PWS: Sections 5.3, 5.10, 5.10.1, 5.12, 7.1 and 8.1. No other changes to the clauses have been made.

3) Attachment A - Pricing Sheet- Updated (Attached)

4) Attachment C - IPP Waiver - Separate pdf (Attached)

5) Attachment E - Past Performance - Separate pdf (Attached)

6) Attachment G - 2 Week SnapShot - New Attachment (Attached)

16A. NAME AND TITLE OF CONTRACTING OFFICER (Type or print)15A. NAME AND TITLE OF SIGNER (Type or print)

15C. DATE SIGNED 16B. UNITED STATES OF AMERICA 15B. CONTRACTOR/OFFEROR 16C. DATE SIGNED

(Signature of person authorized to sign) (Signature of Contracting Officer)

GINA N. HUFFMAN

STANDARD FORM 30 (REV. 10-83)

Prescribed by GSA

FAR (48 CFR) 53.243

NSN 7540-01-152-8070

Previous edition unusable

Except as provided herein, all terms and conditions of the document referenced in Item 9 A or 10A, as heretofore changed, remains unchanged and in full force and effect .

GULFPORT, MS NURSING SERVICES

PERFORMANCE WORK STATEMENT

1. Background. The Armed Forces Retirement Home (AFRH) a Continuing Care Retirement Community (CCRC) has been providing retired soldier’s airmen and sailors a place to call home for more than a century and a half. The mission of our staff is to meet the needs of the Nation's veterans today and in the future while providing services and care in the most efficient manner possible. The United States Congress established the Armed Forces Retirement Home (AFRH) as a separate Federal Agency in 1991 when it enacted the Defense Authorization Act, Public Law 101-

510. The AFRH is comprised of the Armed Forces Retirement Home Washington, DC (AFRH-W) and the Armed Forces Retirement Home Gulfport, MS (AFRH-G). AFRH is the only Federal agency that does not receive appropriated (tax payer) funds for its operation. The Agency’s income flows from enlisted men and women serving in the U.S. Armed Forces and in a trust fund that has operated since the Home’s beginning. Each site offers Independent Living, Independent Living Plus, Assisted Living, Long Term Care, and Memory Support options for its residents. Each site is maintained as a separate establishment of the AFRH for administrative purposes.

Both campuses make up the Armed Forces Retirement Home which has the high honor of providing exceptional care to our Nation’s defenders. The population at each facility will be approximately 600 residents.

2. Purpose. The AFRH-G has a requirement for nursing services and enhancing continuity of resident care.

Contractor provided services that include, but are not limited to, an innovative service model designed to control, support for nursing services at AFRH including Nurse Practitioner (NP), Registered Nurse (RN), Licensed Practical/Vocational Nurse (LPN/LVN) & Certified Nursing Assistant (CNA). The contractor shall perform in accordance with the terms and conditions stated in this Performance Work Statement (PWS).

3. Contract Term. Contract consists of a base and two option periods, as illustrated below:

Base Period: Months 1 through 12 Option Period I: Months 13 through 24 Option Period II Months 25 through 36

Contract term shall not exceed thirty-six (36) months.

4. GENERAL DESCRIPTION.

4.1 Resident Population. Resident population includes Independent Living, Independent Living Plus, Long Term Care (LTCU), Assisted Living (ALU), Memory Support Units (MSU), and Independent Living. Total estimated population at the Gulfport Facility is listed below.

FY 2015 FY 2016 FY 2017

Independent Living 432-442 432-442 432-442 Independent Living Plus 50-60 50-60 50-60 Assisted Living 20-24 20-24 20-24 Memory Support 20-24 20-24 20-24 Long Term Care 20-24 20-24 20-24 Total 542-574 542-574 542-574

4.2 AFRH Scheduling Process. AFRH has an established Staffing House Snapshot and Daily Staffing Sheet that is based directly off a schedule. AFRH submits a two (2) week snapshot to the Nurse Staffing Agency in accordance with the designated timeline. The Nurse staffing Agency electronically enters their staffing into the available shifts and returns the adjusted sheet to AFRH as per the submission timeline (see 7.1).

The average number of hours per year for each category will be approximately:

CNAs 2,700 – 2,900 LPN’s 5,300 – 6,500 RN’s 1,500 – 1,800 NP’s 1,800 – 2,080

5. Required Nursing Services.

5.1 Nursing Services. The Contractor shall provide the full range of nursing care, comprehensive professional and clinical services for a geriatric population in accordance with the PWS. Contractor shall provide Nurse Practitioners (NP), Registered Nurses (RN), license practical/vocational nurses (LPN/LVN) and Certified Nursing Assistants (CNA) to work eight-twelve (8-12) hour shifts (days, evenings, nights, weekends and holidays) as needed by AFRH.

Contractor staff may be assigned to work in any unit identified by AFRH including Long Term Care Unit, Memory

TFSAAFRG15CI0003 Page 2

Support Unit, Assisted Living, Independent Living Plus and the Wellness Center. It should be noted that we may have a need to have transport CNA’s work a shift of a minimum of 4 hours to accompany residents to medical appointments.

The Contractor’s personnel performing work under this PWS shall remain employees of the Contractor and shall not be considered employees of the Government.

5.2 Compliance. The Contractor shall:

• Complete all work in accordance with all applicable federal, state, and local laws, regulations, nursing and industry standards, AFRH policy and directives.

• Comply with the standards established by the Commission of Accreditations of Rehabilitation Facilities (CARF), the Joint Commission and those accepted as best practices under nursing standards.

• Provide all certified nursing services as prescribed by their professional and licensure codes.

• Adhere to all requirements, regulations, ethical practices, standards and licensing requirements for Nurse

Practitioners (NP), Registered Nurses (RN), Licensed Practical/ Vocational Nurses (LPN/LVN), and Certified Nursing Assistants (CNA) in good standing under regulatory agency or agencies and all governing laws.

• Provide copies during phase in stage of all applicable licensure and credentialing documentation for Contractor employees. Any change in licensure status shall require immediate notification of the Contracting Officer’s Representative (COR).

• Ensure resident safety while maintaining excellence in provision of care.

• Comply with all AFRH SOPS covering Dress and Appearance Standards.

• Contractor employees working under this contract shall be citizens of the United States and possess the ability to fluently read, speak, write, and understand the English language.

• Shall successfully complete Informatics Technology computer security requirements.

• Shall complete annual Information Technology Security Awareness training.

5.3 Credentials. Contractor shall provide:

• NPs, RNs, LPN/LVNs, and CNAs active license in accordance with federal and state regulations.

• Resume’, current competency, licensure, legal, Continuing Education Unit (CEU), insurance and liability documentation. Contractor shall respond within 2 hours of a routine request for documentation and immediately when requested by a regulatory source or survey.

• For CNAs with certifications for providing specialized care, the Contractor shall make available to COR a copy of license or certification before authorization of the skills can be approved by the Director of Nursing (or designee) or the House Supervisor.

• Proof that all necessary requirements for licensure are adhered to for an NP, RN, LPN/LVN, or CNA and all shall be in good standing for and licensed or certified in the state of Mississippi. Contractor employee's competency information, CEU, and annual tuberculosis (TB) tests shall be kept current. Any positive results of TB tests shall require chest X-Ray and evidence that the Contractor employee is free of active TB. The costs of all testing shall be the responsibility of the Contractor. Any change in Contractor employee legal status, liability or licensure issues shall be reported to the COR and CO immediately.

• Current CPR certification to include cognitive and skills evaluation.

5.4 Advanced Nurse Practitioner (NP) (Registered Nurse III):

Contractor shall provide a Nurse Practitioner to provide a full range of medical care to a population of geriatric Residents. Provides both In-patient and out-patient care in a Wellness Center, Assisted Living, Long Term Care, and Memory support environment.

• Unit Assignment:

• Examines, diagnoses and treats unit Residents representing a wide range of medical case difficulty and complexity.

• Makes unit rounds observing Resident physical conditions, writes progress notes, ordering seclusions and restraints as appropriate, discussing patient problems with Unit staff, prescribing treatment, and administering treatment as required. Observes Unit conditions and nursing care program.

• Instructs Unit staff, on care requirements. Selects and utilizes laboratory, x-ray, EKG, and other auxiliary diagnostic methods.

• Prescribes appropriate drug therapies and make appropriate adjustments as needed.

• Determines the necessity for seeking advice or referring cases to specialists as appropriate. Observes clinical course of patients, and upon sufficient recovery, orders discharge from health care.

• In case of Resident death, makes appropriate report for the record and contacts the next-of-kin when appropriate.

TFSAAFRG15CI0003 Page 3

• In medical emergencies takes immediate and appropriate action.

• Reviews clinical records, interviews relatives and other appropriate persons, or through correspondence, obtains medical history of patient.

• Shares information when necessary, mindful of medico-legal entitlement.

• Obtains clearance for special examinations or treatments, and makes reports for hospital records or to city health authorizes as required.

5.4.1 Outpatient Medical Assignment:

• Practices in and examines Residents reporting to the Ambulatory Care clinic.

• Collects and records medical histories.

• Orders laboratory tests and x-rays necessary to complete medical evaluations such as blood counts, urinalysis, chest x-rays, etc.

• Writes instructions and prescriptions for Residents as necessary. Writes referrals for Residents to specialists or consultants of other clinical facilities when necessary.

5.4.2 Documentation:

• Ability to document an electronic record upon completion of orientation training.

• Maintains and ensures an accurate recording of evaluations, assessments, diagnosis, treatment and referrals in the electronic medical record.

5.4.3 Medical Qualifications:

• Must be a graduate of a nationally recognized college or university certified by the National League of Nursing. Must be currently licensed and credentialed as a Nurse Practitioner in the state of Mississippi.

Must maintain current, unrestricted nursing licensure.

• Certified as a Nurse Practitioner in Geriatrics.

• CPR Certification

• Effective oral and written communication in the English language.

• Contractor employee shall possess a current Federal Drug Enforcement agency (DEA) registration.

5.4.4 Other Requirements

• The Contractor Nurse Practitioner is considered key and essential personnel. As such, personnel shall be present and available to perform their medical role during all periods of severe inclement weather and other potential emergencies.

• The Nurse Practitioner will be assigned to a Disaster Team function and may be required to be on board in a working status before, during and immediately following any natural disaster. The Nurse Practitioner shall remain on board until relieved by the supervising physician or the Chief Medical Officer.

5.4.5 Supervision. This person will work under the direction of the Chief Medical Officer or their designee

5.5 Registered Nurses I (RN). Contractor employees shall:

• Provide professional nursing duties while overseeing the care of geriatric residents. Provide professional, comprehensive nursing care to residents based on the provider’s medical plan and the physical and psychosocial needs. Follow all evidenced-based practices of nursing standards and the Nurse Practice Act.

Use evidence-based practice in nursing standards related to care, judgment, documentation, assessment and all aspects regarding ethical, practical, and performance related to nursing. Observe and assess residents’ clinical condition; recognize, identify and interpret serious situations and immediately decide proper action for example: continual observation, notify the provider and/or initiate appropriate emergency measures such as resuscitation in case of cardiac or respiratory arrest. Respond to cardiac, respiratory and choking emergencies and perform neuro-checks.

• Serve as a member of a nursing team with an assignment for a defined group of residents requiring special and/or complex care. Contractor employees are responsible for residents from admission to discharge and possess the knowledge, skills and experience for providing necessary care. Demonstrate self-motivation to carry out direct and indirect care assignments.

• Observe changing conditions and participate in revising care plans throughout a shift, consistent with recognized nursing standards, in accordance with appropriate nursing care and prescribed medical treatment while adhering to all legal, ethical, nursing, and evidence-based practice guidelines.

• Document outcomes and follow-up for interventions, treatments, and medication administration within legal guidelines and nursing standards for continuity of care.

• Support the resident and/or family members in the integration of the care plan toward the achievement of discharge and maintenance objectives.

TFSAAFRG15CI0003 Page 4

• Restate instructions to the resident on preoperative and postoperative procedures that were previously provided by a provider or nurse. After return to AFRH from a surgical procedure, assist and instruct resident on how to keep lungs clear or other appropriate preventative care treatments or procedures.

• Instruct resident on how equipment is used (oxygen, suction, ostomies, etc.) and other direct care, information or teaching as required and within the RN nursing standards. Instruct resident and/or family on use of prescribed medications, contradictions of medications and proper follow-up self-care. Assist residents with restorative and preventive programming, care and equipment.

• Perform a range of treatment and diagnostic support duties per licensure and training qualifications including administrative and direct care measures. Act as liaison with other healthcare professionals to ensure continuity of care or to take medical orders. Document and follow up accordingly.

• Observe and document all pertinent data regarding the physical and emotional status of residents. Promptly assess and take actions to alleviate problems reflected in subtle changes in condition. Make careful observations to assure that nursing procedures and treatments are not causing additional distress.

Communicate information effectively and timely.

• Provide assessment and documentation on change of condition, transfers (in house and external to AFRH) and admissions or discharges.

• Shall have one-year practical experience in geriatric care.

5.5.1 Clinical Duties:

• Obtain initial health history on new residents, coordinate health care needs through appointments or other health care facilities, screen visits, and manage chronic and minor health problems as directed by the physician. Monitor, respond and perform continuity of care. Perform all necessary assessments.

• Demonstrate proficiency in:

o Venipuncture. Ability to initiate and complete venipuncture procedures for laboratory tests; initiate peripheral intravenous access for emergency medication management and hydration.

o Administer oxygen, and prescribed oral, subcutaneous, intra-muscular, medications, and nebulizers.

o Counseling and minor treatment services for all residents. Assisting with emergencies throughout AFRH.

o Set up and use of specialized equipment such as defibrillator, feeding pumps, and suctioning equipment.

o Managing nasal-pharyngeal, tracheal and gastric suction along with a variety of other drainage tubes.

o Simple and complex wound care, including specialized equipment and therapies. Example: compression dressings; wound irrigations; wound measurements and application of authorized wound treatment products.

o Contact precautions and isolation set-up; documentation and discontinuance.

o Ensure compliance with Infection Control Standards.

5.5.2 Documentation:

• Maintain and ensure accurate recording of information in medical records, treatment forms, and official logbooks.

• Ability to document an electronic record upon completion of orientation training.

• Develop and implement care plans, medication administration, charge nurse duties, coordination and prioritization of care activities.

5.5.3 Leadership:

• Perform in the capacity of charge nurse with full responsibility and accountability for ensuring that all nursing policies and procedures are adhered to, especially in the areas of: medications, valuables, care, and counseling and mentoring of assigned AFRH or contracted staff. Maintain open communication of staffing needs with appropriate shift supervision.

• Direct and supervise various skill levels of nursing personnel. Ensure timely notification to appropriate supervisor when issues arise in accordance with facility policy.

• Provide excellent customer service, proactive anticipation and response to needs.

• Monitor stock and prepare requisition lists for drugs and medical supplies. Ensure timely replenishment of medications and supplies in accordance with local SOP. Monitor appropriate supply utilization.

• Ensure security of health care environment at all times.

5.5.4 Problem Solving and Delegation:

• Provide instruction, clarification and guidance to all levels of nursing personnel regarding direct care requirements, treatment and special needs.

• Work cooperatively with other disciplines to effectively problem solve issues related to resident care; unit workflow, equipment and medication needs.

• Give assistance in resolving resident and employee complaints and disputes.

TFSAAFRG15CI0003 Page 5

• Promote all aspects of resident rights and responsibilities; example: the right to make personal choices and right to be free from abuse.

• Provide assessment and documentation on change of condition, transfers (in house and external to AFRH) and admissions or discharges.

5.5.5 Resident Health Education and Staff:

• Provide health education to residents, significant others, families and AFRH staff.

• Participate in the orientation of newly assigned nursing staff.

• Adhere to nursing standards, facility policies and protocols, HIPAA (Health Insurance Portability and

Accountability Act), OSHA (Occupational Health and Safety Administration), CDC (Center for Disease Control), CARF, CCAC (Continuing Care Accreditation Commission), legal and ethical guidelines and regulations.

• Contractor employees shall keep skills current, maintain licensure in good standing; perform care appropriately, safely and within fiduciary capabilities; discharge preparation and planning, including medication management; life-style modifications; equipment use and disease management.

5.4.5 Supervision.

This person will work under the direction of the Clinical Supervisor or their designee and serves as member of a nursing team with a written assignment.

5.6 Licensed Practical/Vocational Nurse I (LPN/LVN). Contractor employees shall demonstrate proficiency in:

• Venipuncture - demonstrate ability to initiate and complete venipuncture procedures for laboratory tests.

• Monitor residents with specialized respiratory therapy such as Bi-Pap and C-Pap.

• Ability to document an electronic record upon completion of orientation training.

• Shall have one-year practical experience in geriatric care.

• Medication administration competency.

5.6.1 Duties:

• Observe resident’s changing condition and participate in revising care plans throughout a shift, consistent with recognized nursing standards in accordance with appropriate nursing care and prescribed medical treatment while adhering to all legal, ethical, nursing, and evidence-based practice guidelines.

• Assess and record information regarding the resident’s condition and establish a plan of action to carry out nursing care.

• Support the resident and/or family members in the integration of the care plan toward the achievement of stated goals.

• Provide to the resident communication and teaching information and education, before and after procedures, treatments, medication administration.

• Administer prescribed medications (oral, topical, and intramuscular injection), and monitor for any physical or emotional contradictions to the medications. Proper certification for IVs by LPN/LVNs is required.

• Perform a range of diagnostic support duties which includes: taking vital signs, obtaining specimens, venipuncture (if certified) calling the laboratory for lab reports, recording lab reports given over the telephone, and assisting the physician in a variety of diagnostic examinations. Follow up on resident care and acts as a liaison with other healthcare professionals regarding residents’ needs for continuity of care.

• Perform a range of treatment procedures that include but are not limited to, using hot and cold packs, extensive sterile dressing changes, giving enemas, inserting urinary catheters, passing medications, caring for residents in isolation, setting up and giving treatments that require auxiliary equipment such as oxygen and suction.

• Complies with all Infection Control protocols and standards.

5.6.2 Documentation:

• Observe and document all pertinent data regarding the physical and emotional status of residents. Promptly assesses and takes action to alleviate problems reflected in subtle changes in the condition such as dizziness or slight rise in temperature. Makes careful observations to assure that nursing procedures and treatments are not causing additional distress.

5.6.3 Supervision.

This person will work under the direction of the RN and serves as member of a nursing team with a written assignment.

TFSAAFRG15CI0003 Page 6

5.7 Certified Nursing Assistant I (CNA). Contract employees shall demonstrate proficiency in:

• Vital signs- taking and recording blood pressure; peripheral heart rate, respirations, pulse oximetry.

• Knowledge of a condition which contributes to skin impairment issues and performs principles of skin care and pressure ulcer prevention for example: turning and repositioning; assuring nutritional supplements are provided and assists residents to the toilet and/or provides timely incontinence care.

• Safe resident transfer; lifting and turning techniques.

• Gait belt assisted transfers.

• Collection and preparation of urine and stool specimens for laboratory analysis.

• Care and management of gastro-intestinal tube feedings.

• Documentation of observations of psychosocial needs.

• Upon training orientation, escort residents to appointments to outside agencies, keep residents’ environment neat, set up equipment, store and move supplies and assist with some procedures.

• Shall have one-year experience in a geriatric setting.

5.7.1 Duties. Provide comprehensive care appropriate to CNA training and licensure qualifications to residents based on physician’s medical plan, nursing care plan and the physical and psychosocial needs. Utilizes evidence-based practice in CNA standards related to care, judgment, documentation, assessment and all aspects regarding ethical and practical performance related to provision of care. RN provides oversight and CNA often assists LPN/LVNs. Answer call bells, deliver messages, serve meals, make beds, and assist with eating, dressing and bathing; reposition residents, take temperatures, pulse, respiration, and blood pressure; assist with transfers.

Direct Care:

• Taking and recording routine and special vital signs.

• Record care delivered based on AFRH standardized documentation. Example: practice and methodology for recording Activities of Daily Living (ADL) prior to the completion of shift along with reporting findings to the charge nurse.

• Measuring and recording intake and output.

• Collecting and testing of urine and stool specimens.

• Applying simple bandages.

• Providing personal care including bathing, feeding, shaving, and oral hygiene.

• Reporting results from enema administration by licensed nursing staff.

• Collecting and transporting dirty linen.

• Retrieving clean linen supplies.

• Adhere to defined AFRH nursing policies and advanced procedures such as:

o Observe resident’s condition; recognizes, identifies and notifies appropriate supervisor or nurse of potentially serious situations.

o ADL skills training including re-feeding program, re-ambulation, bowel and bladder toileting.

o Measures and records vital signs and other body measurements.

o Report to nurse signs and symptoms demonstrated by the resident with a tracheotomy, sterile dressing care, pressure ulcers.

o Participates in the Interdisciplinary Care Plan (IPC) conference.

o Complete dementia training and implements re-motivation and reminiscence validation strategies.

o Assists with group and individual recreational activities.

o Works in all assignment areas within the AFRH including: Ambulatory Care, Assisted Living Unit (ALU), Dementia, and Long Term Care Unit (LTCU) areas.

o Personifies the basic principles of best practices of dementia care as evidenced by appropriate demeanor, use of tools learned to be proactive with dementia behaviors, de-escalate situations, demonstrate re-direction, validation and reminiscing techniques. Use appropriate techniques in verbal and non-verbal dementia related care.

• Monitor stock inventories and documents utilization appropriately.

• Attend and participate in orientation and training.

• Adhere to care plans, document appropriately, and communicate effectively.

• Provide customer service and proactive anticipation and response to needs.

• Serve as member of a healthcare team. Contractor employees have considerable knowledge, experience and skill for concentrated effort and self-motivation to carry out care assignments.

• Support the resident and family members in the integration of the care plan toward the achievement of objectives.

TFSAAFRG15CI0003 Page 7

• Assist in restorative and prevention programs and in problem solving related to identified needs. Includes safety and ADL.

• Communicate with a wide variety of individuals including those with psychiatric issues or dementia, requiring specialized techniques.

• Escort residents to appointments off the AFRH campus as required for medical appointments and/or treatments as necessary. Transportation will be provided by AFRH. CNA may be responsible for transporting resident’s medical records and must remain with the resident at all times.

• Adheres to all Infection Control protocols and standards.

5.7.2 Supervision.

This person will work under the direction of the RN and LPN and serves as member of a nursing team with a written assignment.

5.7.3 RNs, LPN/LVNs and CNAs Requirements:

• Keep charge nurse informed of any changes identified in the resident’s condition such as: hemorrhages, fevers, respiratory distress, and change in activity or cognitive level.

• Assist the charge nurse in obtaining and maintaining supplies and equipment while ensuring the safety and cleanliness of the facility.

• Maintain positive relationships with residents, visitors and government personnel.

• Utilize positive customer service skills while interacting with residents, government personnel, visitors and community members.

• Utilize all forms of appropriate communication techniques: verbal, non-verbal, and written.

• Utilize the computer in appropriate manner to ensure compliance with AFRH directives.

• Access to printed and electronic files that contain sensitive resident and operational data shall be protected under the provisions of the Privacy Act of 1974 and other applicable laws, federal regulations and AFRH directives.

• Responsible for (1) protecting data from unauthorized release, loss, alteration, or unauthorized deletion, and

(2) following applicable regulations and instructions regarding access to files.

• Maintain and ensure accurate recording of information in medical records, treatment forms, and official logbooks.

5.8 Contractor’s Primary Point of Contact. The Contractor shall name a primary point of contact. Substitution of the primary point of contact shall require prior written notification (including a justification for the change) to the CO.

CO and COR approval is required prior to any change or substitution in the Contractor's primary point of contact. The primary point of contact must be available within one hour to resolve any contract / personnel issues.

5.9 Continuity of Services. The Contractor shall provide full coverage for the performance hours stated in Section 6.

Hours of Operation. The Contractor shall provide back-up coverage for absences of Contractor employees (Section

7.2 and 7.3) scheduled for work at AFRH and shall provide back-up coverage for the absences of AFRH Government employed nursing staff as requested by AFRH.

5.10 Contractor Personnel Education Orientation for NP Credentialing & Privileging AFRH will not begin the credentialing/privileging process for a nurse practitioner until there is a need. When the Government determines a need for a NP, the Contractor shall identify a candidate and the candidate shall submit all required credentialing documentation in the AFRH electronic credential/verification system within five (5) business days. The NP shall not perform duties under this contract until the NP is credentialed and privileged.

Upon validation of the NP credentialing and privileging, the NP shall attend a sixteen (16) hour orientation session prior to working any shift at AFRH. The contractor is responsible for paying its employees for attending the first day of orientation – an invoice for time spent at the orientation will not be paid by AFRH. AFRH will pay for the second day of orientation.

5.10.1 Contractor Personnel Education Orientation. All Contractor personnel who provide RN, LPN and CNA services shall attend a sixteen (16) hour orientation session prior to working any shifts at AFRH. The contractor is responsible for paying its employees for attending the first day of orientation – an invoice for time spent at the orientation will not be paid by AFRH. AFRH will pay for the second day of orientation. Two (2) weeks prior to the orientation session, the contractor shall forward complete licensure packages (refer to Section 5.3 of the Performance Work Statement) and a copy of the security investigation summary (refer to Section 11.1 of the Performance Work Statement) to the Healthcare Educator for review. Any information which is omitted or determined by AFRH to be unacceptable will result in the rejection of the licensure package. The contractor employee may also be rejected based on the results of the background check.

TFSAAFRG15CI0003 Page 8

The contractor shall send employees during the day shift for orientation. At this time, orientation takes place on the third Tuesday of each month. If necessary orientations will be held more often and may be scheduled without the two week notice to ensure adequate contractor personnel to meet AFRH staffing requirement. AFRH shall conduct additional orientation sessions during the initial startup time period to ensure an adequate number of contractor employees complete the orientation.

• No less than five (5) business days prior to the orientation, the Healthcare Educator shall inform the contractor which licensure packages are acceptable and which ones were rejected. Only contractor employees with accepted packages will be permitted to attend the orientation.

• Any contractor employee that fails to work at least 40 hours within 60 days of orientation will be required to re-orientate at the expense of the contractor.

• AFRH will not reimburse the contractor for the 2nd day Employee orientation for an employee who doesn’t work a minimum of 40 hours within 60 days of orientation

Contractor shall ensure that packets are completed and graded prior to arrival on day of orientation. Incomplete packets will not be accepted and employees will not be allowed to proceed with orientation. The Healthcare Staff Orientation: Competency Review Checklist must be returned thirty (30) days after personnel are scheduled.

First Orientation Session consists of the following:

1) Security Presentation – Chief of Security

2) Badges Made – Nurse Educator escort

3) Nursing Orientation

4) Safety Briefing – Safety Officer

Second Orientation Session consists of:

Shadowing a government employee for and eight (8) hour shift in order to learn and better understand the process, systems and required medical record documentation.

Orientation: 7:30 am – 4:00 pm

1) Will be scheduled at least fifteen (15) days in advance. This is to allow all parties ample time to prepare. (EX:

to be placed on the nursing education calendar, Security notified, etc.)

2) Candidate’s completed licensure packets shall be received by AFRH from the Contractor at least one (1) week prior to the scheduled orientation date.

5.10.2 Continuing Education. All Contractor personnel shall attend AFRH annual training to remain current on AFRH policies, procedures, and directives. Contractor employees shall attend 6 – 8 hours of annual training at no additional cost to the AFRH. Annual training will be conducted by AFRH personnel during each shift and will include but not be limited to the following:

• Ethics

• Campus Security

• Dementia

• HIPAA

• Infection Control

• Person Centered Care

• Resident Abuse

• Respect, Privacy, & Dignity

• Rights & Responsibility

• Safety

• Suicide Prevention

• Security Awareness

5.11 Standards. This is not a personal service contract. However, the Contractor, although in fact not a Government employee, shall comply with acceptable Standards of Ethical conduct to include but not limited to:

• Give a full day’s work for a full day’s pay.

• Give to the performance of your duties in a professional manner throughout the workday, and treat the residents with care, dignity, respect, and dedication.

• Respond promptly to, and fully comply with, all legal directions instructions from supervisors or management officials.

• Report to work on time and fit for duty (i.e., free from any effects of alcohol and/or drugs, and in a mentally alert condition to perform the duties of your position).

TFSAAFRG15CI0003 Page 9

• Maintain a clean and neat personal appearance during working hours, and dress appropriately for your duties and responsibilities.

• Perform your duties with honesty and integrity.

Additionally, the Contractor shall comply with all safety practices, vehicle registration, speed limits and any other AFRH regulation and policy applicable to conduct and patient care.

5.12 Status Reports. By the fifth business day of each month, the Contractor shall provide via a cloud service, an updated report to the COR, identify any problem areas that would prevent successful completion of the contract requirements, fill rates and recommend problem resolution.

5.13 Regulations. The Contractor shall meet all state and federal regulations and AFRH policies. (Note: See Attachment B for applicable documents).

5.14 Deliverables.

No. Deliverable Title Required PWS Reference

1 Status Reports Not later than the 5th business day of each month following contract award. Para. 5.12

2 HIPAA Compliance Plan Initial at start of performance. Updates as required. Para. 10

3 Quality Control Program Not later than the 5th business day following contract award. Updates as required.

Para. 12

6. Hours of Operation. Contractor shall be available to provide nursing services on an "on-call" basis, 7 days a week, 24 hour hours a day, and 365 calendar days a year. Nursing staff schedule:

Eight Hour Schedules:

• Day shift 7:00 am – 3:30 pm CT;

• Evening shift 3:00 pm – 11:30 pm CT; and

• Night shift 11:00 pm – 7:30 am CT.

Twelve Hour Schedules:

• Day shift 7:00 am – 7:30 pm CT;

• Night shift 7:00 pm – 7:00 am CT.

CNA 4-Hour Transportation Shifts: 7:00 am – 6:30 pm CT.

Contractor employees are entitled to holiday pay for the holidays designated by the Department of Labor Wage Grade Determination most recent revision. The Contractors employees must work the holiday to receive holiday pay.

During reviews, surveys and inspections by external groups or organizations, the Contractor and primary point of contact shall accommodate the reviewers' schedules at the facility or via phone conference.

Contractor employees shall sign in at the unit they are working, and on their time sheets for accountability and verification of hours and day’s services provided at the AFRH. Contractor shall assure that staff assigned to work at AFRH will work no more than 12 hours in any 24-hour period regardless of work locale.

7. Standard Operating Procedures for Scheduling of Nurse Staff

7.1 Scheduling

• The schedule for Government nursing staff is prepared on a monthly basis. The COR or designee will provide this schedule to the Contractors no later than two (2) weeks prior to the first day of the schedule. The vacant shifts shall be highlighted.

• The Contractor shall respond within three (3) business days by email to the COR and designee with the names of the Contractor personnel scheduled to fill the vacant shifts. The Contractor shall have ample staff to cover all vacant shifts with personnel working no more than 12 hours within any 24 hour period. If the COR and designee does not receive the revised schedule within the required timeframe, the COR or designee shall follow up with a phone call/e-mail to the Contractor scheduling point of contact for the Contractor and copy the Bureau of the Fiscal Services. The Contractor will receive a disincentive for all vacant shifts which cannot be filled. Additionally, if the Contractor meets all AFRH scheduling request as stated above for six

TFSAAFRG15CI0003 Page 10 consecutive invoice periods, AFRH will provide the Contractor with a .5% incentive for the six scheduling periods where all shifts are covered and all employees report for assigned shifts. (See Section 7.8)

7.2 Call Offs/Late Notice AFRH Requests

• When a Contractor employee is unable to work a shift at AFRH for which they are scheduled, that employee shall inform the Contractor’s scheduling point of contact. It is then the responsibility of the Contractor to schedule a replacement and inform the COR or designee and House Supervisor of the change. The Contractor must find a replacement employee and that employee must report to the AFRH for work within one

(1) hour of the beginning of the shift. If the Contractor cannot fill the shift, the COR, designee and House Supervisor designee shall be informed immediately and a disincentive will be applied (See Section 7.8). The Contractor replacement employee will only be paid for the amount of time worked, not for the entire shift. The Contractor employees shall not contact any AFRH employee to inform them of their absence; they shall only report their absence to their scheduling point of contact. After three (3) call-offs, within a 12 month period, the Contractor employee shall be moved to the "do-not return" list and shall no longer be scheduled to work at AFRH after discussing with the COR.

• In the event a Government nursing staff employee reports off and AFRH decides to fill the vacancy with a contract employee, the COR, House Supervisor or designee will contact the Contractor for a replacement.

Within two (2) hours, the Contractor must find a replacement employee and that employee must report to the AFRH for work. The Contractor employee shall only be paid for the amount of time worked, not for the entire shift. The AFRH will not contact any contract employee directly and ask them to fill vacant shifts. If the Contractor cannot fill late requirements which do not exceed 10% of the total requests, a disincentive will be applied (See section 7.8).

7.3 No Shows

• When a Contractor employee is scheduled to work a shift at AFRH and does not show up for work and does not call off, the AFRH will inform the appropriate scheduling point of contact. The Contractor shall schedule a replacement and inform the COR, Designee or House Supervisor of the change. Within one hour of notification by the AFRH, the Contractor must find a replacement employee and that employee must report to the AFRH for work. If the Contractor cannot fill the shift, the COR, Designee or House Supervisor shall be informed immediately and penalty shall be applied (See Section 7.8). The replacement Contractor employee will only be paid for the amount of time worked, not for the entire shift. Contractor employees shall not contact any AFRH employee to inform them of their absence; they shall only report it to their scheduling point of contact. The AFRH shall not contact any contract employee directly and ask them to fill vacant shifts.

• Unless the “no show” results from an extreme emergency situation which prevents the contract employee from notifying the Contractor, the Contractor shall immediately place any "no show" employee on the "do-not return" list and shall not schedule that employee for work at AFRH.

• In the event a Government nursing staff employee is a "no show" and AFRH determines to fill the vacancy with a contract employee, the COR, designee or House Supervisor will contact the Contractor for a replacement. Within two (2) hours, the Contractor must find a replacement employee and that employee must report to the AFRH for work or be subject to a disincentive (See Section 7.8).

7.4 Contractor Staff Overtime Scheduling and Payment. It is the responsibility of the Contractor to have adequate employees to meet AFRH needs without overtime and to track overtime of Contractor employees. The Contractor shall not schedule a Contractor employee to work a shift at the AFRH if that employee is in or will be in overtime status during the scheduled period. In the event that the only available Contractor employee is in overtime status, the Contractor may schedule the employee but AFRH will not pay overtime since the Contractor’s responsibility to have adequate staff available for scheduling. Overtime will only be paid for contract employees who work on Federal Holidays or who agree to replace late notice government requests. For the safety of AFRH Residents, contract employees shall not be scheduled for more than 12 hours in a 24 hour period beginning with their reporting time.

7.4.1 Invoicing. Invoicing shall be submitted every two weeks; the billing cycle is to begin Sundays at 12:00 am CT of the first week through Saturday 11:59 PM CT of the second week. Contractor shall submit proper invoices in accordance with the requirements identified in FAR 32.905(b) “Payment documentation and process” and applicable payment clause contained in this contract. In addition to requirements contained in FAR 32.905(b) invoices shall also include time sheets electronically signed by the AFRH Staffing Coordinator, Nurse Supervisor or designated personnel. Contractor shall ensure all electronic time sheets are signed prior to submission of invoices and time sheets into any invoice approval platform utilized by the AFRH, currently the Internet Payment Platform (IPP). Invoices shall include accurate disincentives for shifts which were not filled as requested or incentives if applicable. (Section 7.8)

TFSAAFRG15CI0003 Page 11

7.5 Inconvenience Pay. If a Contractor employee is scheduled to work and upon arrival is no longer needed (as determined by the Director of Nursing (or designee) the Contractor shall invoice AFRH for two (2) hours of inconvenience pay. In the event the Contractor employee is scheduled for a shift and prior to the shift it is determined that person is no longer needed, the AFRH will call the Contractor a minimum of two (2) hours before the start of the shift and inconvenience pay shall not be billed. It is the responsibility of the Contractor to contact the Contractor employee and give notice of the cancellation. Failure on the part of the Contractor to reach the Contractor employee shall not result in inconvenience pay.

7.6 After Hours/Weekend Access to Contractor. Contractors shall have a toll-free phone line manned 24 hours a day, 7 days a week with access to a Contractor representative (not an answering service) as a front line resource for emergency scheduling or other issues. In addition, there shall be back up access in the form of voice mail, answering service or pager with a maximum response time of 30 minutes via email or text.

7.7 Holiday Pay. Contractors shall be paid holiday pay in the event the employee works at AFRH on one of the Federal Holidays listed in the most recent Department of Labor WD.

7.8 Incentive/Disincentive. For the health and safety of AFRH residents, staffing requests shall be met 100% of the time for regularly scheduled shifts; 98% of the time for late notice government requests and 100% of the time for Contractor cancellations/no shows within the allowable period of replacement.

If the Contractor fails to meet these requirements during an invoice period, the following penalty rate shall be applied as a credit on the invoice:

• Regularly scheduled shifts – 3 hours of applicable labor rate (example: When Contractor cannot provide employee for a scheduled shift the penalty will be calculated as [Labor Rate$ x 3 hours] applied to each shift not filled).

• Late Notice Government Requests – 2 hours of applicable labor rate (example: When Contractor cannot provide employee for a Late Notice shift the penalty will be calculated as [Labor Rate$ x 2 hours] applied to each shift not filled).

• Contractor Cancellations/no shows – 3 hours of applicable labor rate (example: When Contractor cannot fill shifts resulting from cancellations/no shows the penalty will be calculated as [Labor Rate$ x 3 hours] applied to each shift not filled).

Additionally, if the Contractor meets all AFRH scheduling request as stated above for six consecutive invoice periods, AFRH will provide the Contractor with a .5% incentive for the six scheduling periods where all shifts are covered and all employees report for assigned shifts. Prior to including the incentive, the Contractor must meet with the COR and request payment for the incentive which will be included in the next invoice.

If the COR confirms the contractor has met staffing requirements for six consecutive invoice periods, the incentive will be calculated by adding the six invoices and multiplying the total sum by .5%. This amount will be added to the next invoice.

Once an incentive is approved, the requirement for six consecutive invoice periods of meeting staffing requirement is reset. If at any time during the six periods the staffing requirements are not met, the requirement for six consecutive invoices is reset.

8. Government Furnished Property, Materials & Supplies. The AFRH will provide a work area if requested by the Contractor for on-site supervisor.