W81K04-20-R-0016 Amendment 0001 28 JAN 2020.pdf

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

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

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

30-105-04EXCEPTION TO SF 30

APPROVED BY OIRM 11-84

STANDARD FORM 30 (Rev. 10-83) Prescribed by GSA

FAR (48 CFR) 53.243

SEE SECTION SF 30 BLOCK 14 CONTINUATION PAGE-SUMMARY OF CHANGES

1. CONTRACT ID CODE PAGE OF PAGES

J 1 86

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

16C. DATE SIGNED

BY 28-Jan-2020

16B. UNITED STATES OF AMERICA15C. DATE SIGNED15B. CONTRACTOR/OFFEROR

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

8. NAME AND ADDRESS OF CONTRACTOR (No., Street, County, State and Zip Code) X W81K0420R0016

X 9B. DATED (SEE ITEM 11)

03-Jan-2020

10B. DATED (SEE ITEM 13)

9A. AMENDMENT OF SOLICITATION NO.

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

X The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offer X is extended, is not extended.

Offer 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 Items 8 and 15, and returning 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 ACKNOWLEDGMENT 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.

12. ACCOUNTING AND APPROPRIATION DATA (If required)

13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS.

IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

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

CONTRACT ORDER NO. IN ITEM 10A.

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes in paying office, appropriation date, etc.) SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(B).

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER (Specify type of modification and authority)

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

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

10A. MOD. OF CONTRACT/ORDER NO.

2. AMENDMENT/MODIFICATION NO. 5. PROJECT NO.(If applicable)

6. ISSUED BY

3. EFFECTIVE DATE

28-Jan-2020

CODE

W40M USA HLTH CONTRACTING ACT

CTR FOR HEALTH CARE CONTR

2199 STORAGE ST BLDG 4197 STE 68

JBSA FT SAM HOUSTON TX 78234-5074

W81K04 7. ADMINISTERED BY (If other than item 6)

4. REQUISITION/PURCHASE REQ. NO.

CODE

See Item 6

FACILITY CODECODE

EMAIL:TEL:

W81K0420R0016

SECTION SF 30 BLOCK 14 CONTINUATION PAGE

SUMMARY OF CHANGES

SECTION SF 30 - BLOCK 14 CONTINUATION PAGE

The following have been added by full text:

SUMMARY OF CHANGES

The purpose for this amendment is:

A. Post Pre-Proposal Conference Slides from the Pre-Proposal Conference and Site Visit held on 15 January 2020 at Irwin Army Community Hospital, Fort Riley, KS for Healthcare Housekeeping Services, Pre-Proposal Conference Questions and Answers, Minutes, Site Visit Tour Document, Contractor and Government Sign-In Sheets and Questions from Contractors.

B. Change Block 8 Standard Form 1449 Offer Due Date/Local Time, from 12:00 PM 03 Feb 2020 to 12:00 PM 14 Feb 2020.

C. Add FAR clause 52.236-13, Accident Prevention.

D. Replace PWS in its entirety with “Revision 1” dated 22 January 2020. Changes are highlighted in red.

E. Updated Exhibit B; changes are highlighted in red.

F. Replaced Exhibit C in its entirety with "Revision 1" dated 23 January 2020. Changes are highlighted in red.

G. Updated Exhibit D, with "Revision 1" dated 23 January 2020. Changes are highlighted in red.

H. Updated Exhibit J CBA Addendum dated 2 January 2020.

I. Replaced Attachment 1 MTF Description in its entirety with “Revision 1” dated 27 January 2020. Changes are highlighted in red.

J. Updated Attachment 2 QASP table under 3.2.1. Changes are highlighted in red.

K. Updated Attachment 3 Price Matrix “Revision 1” CLINs 0002, 0003, 0004, 0005, 0008, 0010, 0012, 0013.

L. All other terms and conditions remain unchanged. The POC for this amendment is Juanita Garza at tel: 210-

221-5963.

SECTION SF 1449 - CONTINUATION SHEET

SOLICITATION/CONTRACT FORM

The required response date/time has changed from 03-Feb-2020 12:00 PM to 14-Feb-2020 12:00 PM.

The following have been added by reference:

52.236-13 Alt I Accident Prevention (Nov 1991) - Alternate I NOV 1991

The following have been modified:

ATTACHMENT 1

Medical Treatment Facility Description and Workload Data

1. General Description: Irwin Army Community Hospital (IACH) is part of the Defense Health Agency (DHA).

IACH is located at 650 Heubner Road on the Main Post of Fort Riley, Kansas. Fort Riley is a United States Army facility located in Geary County and Riley County, Kansas, Fort Riley is located in the Flint Hills Region of central Kansas. IACH provides a full-range of primary care (family practice, pediatrics and internal medicine) and specialty care services (behavioral health, orthopedics, general surgery, physical therapy, women’s health, optometry, radiology, pharmacy and laboratory services). IACH has an active ambulatory surgery program in orthopedics, podiatry, ear, nose, and throat, gynecological surgery and general surgery.

1.2. IACH consists of thirteen buildings to include Irwin Army Community Hospital.

1.2.1. Irwin Army Community Hospital (building 650) is comprised of one, Five-story building constructed in 2014 which opened in October 2016. The building houses family practice clinics, labor and delivery (LDRP), medical surgical units (MEDSURG), operating rooms (OR), the full range of radiology to include mammography, MRI and CT, physical therapy, occupational therapy, orthopedics, dental surgery center (DC #1) and nutrition care.

Additionally, the building houses patient service activities such as outpatient records, pharmacy, laboratory, administrative and logistical support functions to the 1st Infantry Division and subordinate units.

1.2.2. Dental Clinic #2 (602) constructed in 1981and had minor renovations in 2010; this facility provides dental care to active-duty service members. DC2 is located at 602 Huebner road.

1.2.3. Dental Clinic #3 (7670) constructed in 1978 and underwent a total renovation in 2011, this facility provides dental care to active-duty service members. DC3 is located at 7670 Estes road on Fort Riley

1.2.4. Dental Clinic #4 (4010) constructed in 1989 and underwent a total renovation in 2015, this facility provides dental care to active-duty service members. DC4 is located at 4010 1st Division Road on Fort Riley.

1.2.5. Dental Headquarters (228) constructed in 1908 with a minor renovation in 2012, this facility provides administrative and logistical support to the 1st Infantry Division and subordinate units. DCHQ is located at 228 Custer Ave, Fort Riley.

1.2.6. The Veterinary Clinic (226). This building was constructed in 1905 and was currently remodeled with an expected completion date of February 2018. The Foster Veterinary Treatment Facility provides full service health care for military working dogs and other government owned animals; preventive health care for privately-owned animals to include routine vaccinations, internal and external parasite testing and control, limited sick-call to treat communicable/zoonotic diseases (diseases transmittable to man), registration of dogs and cats on post, and issuance of health certificates required for travel. Foster VTF is located at 226 Custer Ave, Fort Riley.

1.2.7. Farrelly Health Clinic (8072) constructed in 2010. Farrelly Health Clinic (FHC) is a two story building that provides medical support through sick call services, Pharmacy, Laboratory, radiology and Physical/Occupational Therapy clinics to the 1st Infantry Division and subordinate units. FHC is located at 8072 Normandy Drive, Fort Riley.

1.2.8. Custer Hill Health Clinic (7672) constructed in 2003. Custer Hill Health Clinic (CHHC) is a single story building that provides sick call services, Pharmacy, radiology and behavioral health services to the 1st Infantry Division and subordinate units. CHHC is located at 7672 Estes Road, Fort Riley.

1.2.9. ANAM Facility (7671) Automated Neuropsychological Assessment Metric Facility constructed in 2010. The ANAM facility provides TBI assessment services to the 1st Infantry Division and subordinate units. The ANAM facility is located at 7671 Estes Road, Fort Riley.

1.2.10. Caldwell Clinic (7665) constructed in 1966 with a minor renovation in 2014. The Caldwell Clinic provides services though our Public and Environmental Health Department of Irwin Army Community Hospital, Caldwell Clinic is located at 7665 Normandy Drive, Fort Riley.

1.2.11. Novsell Aviation Clinic (814) is located on Marshall Army Airfield on the southern side of Fort Riley. And provides clinical services to the aviation brigade providing basic sick call services and patient records, no other services are provided at this facility. Novsell Aviation Clinic was built in 1993.

1.2.12. PX Pharmacy (building 2210) is located in the Main Post Exchange providing access to pharmaceuticals to our beneficiaries.

1.2.13. Flint Hills Medical Home located off installations in Junction City, Kansas to serve active duty, retirees and their family members.

2. IACH Operating Hours: (Hours are subject to change with mission requirements)

Operating Rooms and Ambulatory Surgical Center 6:30am - 4:00pm Monday-Friday

Medical Homes 7:30am - 5:30pm Monday-Friday

Pharmacy 7:30am - 5:30pm Monday-Friday

Laboratory 7:30am - 5:00pm Monday-Friday

Radiology 7:30am - 6:00pm Monday-Friday

Mammography 7:30am - 6:00pm Monday-Friday

Preventive Medicine 7:30am - 4:00pm Monday-Friday

Behavioral Health Clinic 7:30am - 4:30pm Monday-Friday

Dental Clinic 7:30am - 4:30pm Monday-Friday

Veterinary Clinic 7:00am - 4:00pm Monday-Friday

Labor & Delivery 24hrs 7 days per week

Medical Surgical Unit 24hrs 7 days per week

Emergency Department 24hrs 7 days per week

Inpatient Behavioral Health 24hrs 7 days per week

3. IACH Healthcare System Staff: IACH and outlying buildings are staffed with military, civilian, contractor and volunteer employees. Approximate total number of IACH employees is approximately 1100. Staff is assigned as follows:

Department Staff Assigned

IACH (650) 1013

Dental Clinic #2 (602) 22

Dental Clinic #3 (7670) 34

Dental Clinic #4 (4010) 32

DENTAC HQs (228) 12

Veterinary Clinic (226) 10

Farrelly Health Clinic (8072) 94

Custer Hill Health Clinic (7672) 36

Caldwell Clinic (7665) 27

ANAM (7671) 5

Remote Pharmacy (2210) 3

Novsell Aviation Clinic (814) 27

Flint Hills Medical Home (Junction City KS) 26

4. Healthcare Statistics (Annually) 2017 2018 2019

IACH Outpatient Clinics 477,369 497,231 386,692

Emergency Department 29622 31534 23165

Radiology Visits 78482 80952 82651

Pharmacy Visits 383447 376681 357,967

Laboratory Visits 269846 299029 250,441

Behavioral Health and Assistance Clinic 48877 43371 41,073

Dental Clinic 46539 44552 unavailable

Veterinary Health Clinic 1887 1872 1756

Annual Surgeries 1964 2125 1879

Population Supported 45649 44,881 43,768

5. Environmental Services Statistics

Pounds of Linen Delivered (Daily): 1100

Pounds of RMW Collected (Weekly): 422

Dispensers Quantity Paper Towel Dispenser 646 Toilet Paper Dispenser 1 Roll 246 Toilet Paper Dispenser 2 Roll 448 Hand Sanitizer Dispenser 384 Hand Soap Dispensers 696

ATTACHMENT 2

QUALITY ASSURANCE SURVEILLANCE PLAN

FOR

HEALTHCARE HOUSEKEEPING SERVICES

At

Irwin Army Community Hospital

Fort Riley, Kansas

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 1

2 ROLES AND RESPONSIBILITIES 4

3 SURVEILLANCE APPROACH 6

4 SCOPE OF GOVERNMENT QUALITY ASSURANCE SURVEILLANCE 7

5 PERFORMING QUALITY ASSURANCE 8

6 PERFORMANCE REQUIREMENTS SUMMARY 10

7 DETERMINING CONTRACTOR PERFORMANCE 12

8 SAMPLING GUIDES AND CHECKLISTS 13

FIGURE TITLE

1 SAMPLE SIZE TABLE FOR RANDOM SAMPLING 44

2 ACCEPTANCE AND REJECT LEVELS (NORMAL SURVEILLANCE) 45

3 ACCEPTANCE AND REJECT LEVELS (TIGHTENED SURVEILLANCE) 46

4 ACCEPTANCE AND REJECT LEVELS (REDUCED SURVEILLANCE) 47

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 observations reveal consistently good performance, then the amount of surveillance may be reduced. If observations 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. 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). The 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 payment deductions 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 only has authority delegated by the KO. 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 him/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 PERFORMANCE 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.

Performance Objective

PWS

Paragraph

Acceptable Quality Level

(AQL)

Primary Surveillance Method

Incentives/ Disincentives

Provide healthcare housekeeping services in Type I areas

5.5.1.1., 5.6., 5.12., 5.13., 5.14., & 5.15.

1.0% Random Sampling

Re-Performance, Price Reduction for Substandard Performance, Favorable or unfavorable Contractor Performance Assessment Reporting System (CPAR)

Provide healthcare housekeeping services in Type II areas

5.5.1.2., 5.7., 5.12., 1.5% Random Sampling Re-Performance, Price Reduction for Substandard

5.13., 5.14., & 5.15.

Performance, Favorable or unfavorable CPAR

Provide healthcare housekeeping services in Type III areas

5.5.1.3., 5.8., 5.12., 5.13., 5.14., & 5.15.

1.5% Random Sampling

Re-Performance, Price Reduction for Substandard Performance, Favorable or unfavorable CPAR

Provide healthcare housekeeping services in Type IV areas

5.5.1.4., 5.9., 5.12., 5.13., 5.14., & 5.15.

2.5% Random Sampling

Re-Performance, Price Reduction for Substandard Performance, Favorable or unfavorable CPAR

Provide healthcare housekeeping services in Type V areas

5.5.1.5.,

5.10. ,

5.12. ,

5.13. , 5.14., & 5.15

2.5% Random Sampling

Re-Performance, Price Reduction for Substandard Performance, Favorable or unfavorable CPAR

Provide healthcare housekeeping services in Type VI areas

5.5.1.6., 5.11., 5.12., 5.13., 5.14., & 5.15

2.5% Random Sampling

Re-Performance, Price Reduction for Substandard Performance, Favorable or unfavorable CPAR

4. SCOPE OF GOVERNMENT QUALITY ASSURANCE SURVEILLANCE

4.1. 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.”

4.2 Contractor performance requirements are policed by the Government using random sampling, customer complaint and 100% inspection. 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) Z1.4. A computer generated random sample inspection list will be used for all random sampling.

4.3. Customarily, the Government will require the Contractor to re-perform any services that are found to be nonconforming with Government standards. Under the Election of Remedies Provision, the Government may, in addition to requesting re-performance of nonconforming service, reduce the Contractor’s payment pursuant to the PWS in an amount which represents the reduced value of services called for by the contract. Deductions are calculated as shown in Section 8 of the QASP. The Election of Remedies Provision refers to the Government's rights under the Inspection of Services and Default or Termination Clauses to pursue deduction and/or other appropriate remedies for substandard performance by the Contractor.

4.4. The Government's remedies of re-performance and price reduction are applicable to all services outputs covered in the PWS. When the COR detects substandard performance for a particular service output, he/she will bring the deficiency to the immediate attention of the Contractor's Program Manager and request the Contractor correct the problem. The COR will then note the finding on his/her monthly tally sheet. If the number of deficiencies exceeds the level for satisfactory performance (i.e., AQL), the COR will render that service as unacceptable.

4.4.1. Any discrepancies created by the Government are not to be counted against the contractor's performance.

4.4.2 When the Contractor is responsible for exceeding the AQL, the COR will issue a Contract Discrepancy Report (CDR) with recommendations to the KO. The KO will determine the action deemed appropriate for the discrepancy. If the failure is serious enough, the KO will issue the CDR at the end of each month.

4.4.3. When a CDR is issued for a specific service output, the KO will deduct from the payment for the nonconforming service. The contractor will have two working days to respond to the CDR. Lack of a response will be considered as an agreement to CDR findings.

4.4.4. If the contractor does not achieve satisfactory performance in the specific service within the time allowed for corrective action, the KO will issue another CDR and deduct the appropriate amount from the contractor's payment.

4.4.5. If a third CDR must be issued, the KO will issue a Cure Notice (although a Cure Notice may be issued sooner if deemed necessary).

4.4.6. Depending on the contractor's overall performance, the Government may issue a Show Cause letter if the contractor’s response to the Cure Notice is either unsatisfactory or fails to bring about acceptable contractor performance. Ultimately, the KO will consider termination of the contract if necessary.

4.4.7. The contractor's routine performance is evaluated objectively against the performance based standards provided in the PWS. The performance oriented concept of contracting does allow for some flexibility in enforcement to encourage innovation by the contractor in achieving the desired results. Thus, when the contractor's performance consistently meets or exceeds the prescribed Government standards, the Government may reduce the frequency of its inspections for the pertinent services. Conversely, when the contractor's performance consistently falls below the prescribed standards, the frequency of Government inspections may be tightened for the services concerned. Surveillance based on customer complaint will not serve as a basis for taking deductions for any services which have not been found deficient by actual inspection. Complaints may indicate a need to increase inspection frequency by means of tightened random sampling inspection. Complaints, in themselves do not trigger any Government remedy, only actions taken by authorized Government personnel (COR, ACOR, e.g.) may trigger remedies such as re-performance or deductions. Such remedies would apply to the nonconforming services actually inspected during the complaint validation process. Deductions taken as a result of validated customer complaints are based on the Government's actual losses relative to the missed or nonconforming services. It is not appropriate to take deductions "across the board" based on isolated customer complaints alone.

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:

Service to be inspected (lot size) = 4,030

Sampling level = Normal Sample size requirement = 200 (Figure 1, Column 2, Normal Sample)

AQL = 6.5%

Unsatisfactory level = 22 or more defects (Figure 2, Normal Surveillance)

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

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 MTF requirement and AHE Practice Guidance for Healthcare Housekeeping Services.

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 PWS and QASP for Healthcare Housekeeping Services

PRS I – Provide Cleaning of Type I Areas

AREA Evaluator

DATE TIME INITIAL INSPECTION

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 #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 MTF requirement and AHE Practice Guidance for Healthcare Housekeeping Services.

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 ____. Lot is the minimum required frequency of cleanings scheduled for Type II Services, times the number of rooms/areas, times the number of days per month that service is required.

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.