Q--Phx Rapid Emergent Housing Program

Please provide an e-mail indicating your interest for this project to [email protected] PHOENIX VA HEALTH CARE SYSTEM PERFORMANCE WORK STATEMENT A. PURPOSE. The Department of Veteran Affairs, Phoenix VA Health Care System in, Phoenix, AZ requires contractors to provide services as part of its Community Based Health Care for Homeless Veterans (HCHV) program. The goal of the HCHV program is to remove homeless Veterans from the street or habitation unfit for Veterans and place them in community-based, residential environments with sufficient therapeutic services to meet the needs of those Veterans. Many transitional housing and other residential environments provide barriers to placement that may include maintaining a period of sobriety, no sexual offenders or other specific past felonies. The need for a homeless transitional program that provides direct 24/7 direct admission is essential to ending homeless. B. BACKGROUND. The Department of Veterans Affairs has established Health Care for Homeless Veterans (HCHV), in accordance with 38 USC 1720A and Public Law 101-237. The Department of Veterans Affairs is implementing programs to end homelessness for veterans within five years. Existing housing programs provide transitional and permanent housing. This program will provide immediate and emergent housing for homeless veterans. The targeted population is homeless veterans who are being discharged from a hospital, veterans who are seen in the PVAHCS Emergency Department, and/or homeless veterans seen through the HCHV clinic who do not require hospital level care, but require a level of care that is provided in a community program facility. Some veterans will be less than sober on admission, but will not be a danger to self, agency staff or property. Admissions will be accomplished on a 24/7 basis. The contractor will provide case management and supportive services in collaboration with the VA contract liaison. The contractor will provide beds in a free standing facility or complex facilities that provide domicile and health related services, supportive program staff, and personal and/or protective care for veterans with or without substance use disorders. Contractor staff shall communicate information pertinent to resident's treatment to VA clinical staff. Contractor staff will participate in staff meetings during which their input regarding treatment decisions may be solicited. Admission Criteria for Placement in Rapid Emergent Housing: The contractor provides, one time only, the following clinical information along with an appropriate signed release: 1. Homeless 2. Blood alcohol level of <.08 3. Not a danger to self, others or property 4. Capable of independently performing all activities of daily living (i.e. bathing, dressing, feeding one's self, managing any incontinence issues, etc.) 5. Functionally and cognitively able of fleeing an emergency situation if needed 6. Functionally and cognitively able to manage own medications 7. Functionally and cognitively able to manage own home oxygen 8. Medically cleared by the VA provider 9. Veterans cannot possess firearms or any other weapons on contract facility property. 10. Veterans need to be eligible for VA services and enrolled in HCHV with 72 hours of admission. If the veteran has been through contract housing in the past there may need to be a review of the veteran's former stay and current situation to determine eligibility. 11. Veterans must also be willing to abide by the rules of the agency, including observing curfews, participating in drug testing, attending mandatory group meetings, and refraining from drug and alcohol use. 12. Veterans must be willing to work toward resolving the barriers that stand between them and independent living, which may include finding employment, applying for disability benefits, or engaging in substance abuse or mental health treatment. 13. All Veterans must be willing to participate in developing a treatment plan outlining the steps they will take towards ending their homelessness with their case manager and the Contract Liaison no later than the sixth day of admission. Veterans who do not agree to a treatment plan within this time frame will be discharged after the sixth day of the initial period they enter the program. C. SERVICES TO BE PROVIDED BASIC SERVICES. The contractor shall furnish each Veteran referred for care under this contract with the following basic services: A. Treatment Planning 1. Case Management: consists of the development of an initial treatment plan in collaboration with the VA Liaison, Contracting Agency Staff and client. The treatment plan is client-driven with establish objectives to complete their transition goal within 90 days. Follow-up meetings will occur at least bi-weekly. Treatment plans will be revised when a life-altering event happens, and will consist of the provision of direct services, ongoing assessment and evaluation of goals and objectives that have been developed. 2. Once admitted veterans will be required to complete a physical and mental health or substance abuse appointment within the first 30 days (unless the veteran had a physical or mental/substance abuse appointment within the past 30 days- at the VA) to determine if the veteran may benefit from additional services at the Southern Arizona VA Health Care System. 3. The contracting agency shall adhere to the National VA Reporting requirements. VA reporting requirements include the following: veterans must have completed an Intake Form within 72 hours of entrance into the program. Veterans must complete additional VA reporting requirements as directed by National mandates. Further direction will be provided by the Contract Liaison. 4. The Contractor shall provide discharge planning reflecting a team assessment of health, social and vocational needs and the involvement of the veteran, the VA staff and appropriate community resources in resolving problems and setting goals. 5. Assessment of Treatment Outcomes: Assessment of treatment outcomes will be conducted by the Contract Liaison in collaboration with the contracting agency staff at periodic intervals before the 90 day program is completed. Veterans provided placement in Contract Facilities under this program will be evaluated for the length of stay in program, goals accomplished from the treatment plan, compliance with rules and regulations of the agency. Other information to be obtained will include follow-up activities, if appropriate, as part of the continuing support and involvement of the contracting VA facility. B. Transition Criteria: Contract housing is intended to provide short-term case management services as a "step up" or "step down" emergent transitional housing program. Veterans either are admitted directly off the street or they are discharge from or pending inpatient or residential care. Many may require discharge to longer term transitional housing placement or to long term permanent housing (HUD-VA Supported Housing). Veterans will work with the contracting agency staff and contract liaison to determine the next steps for the veteran. C. Discharge Criteria: Discharges from contract housing facilities are determined by individual needs. 1. Veterans who have achieved their goals to transition to the highest level of independent living. 2. Program rule violations or for showing no motivation to work toward treatment goals are reviewed between the contract case managers and the Contract Liaison prior to discharge from the program unless the Veteran is danger to self or others. 3. The contractor's case manager will contact the VA Contract Liaison within 24 hours notice of the client not returning to property. In the event that the client does not return in the evening, the Contract Liaison will be notified the following morning. 4. In addition, the Contractor shall provide treatment and discharge planning reflecting a team assessment of health, social and vocational needs and the involvement of the veteran, the VA staff and appropriate community resources in resolving problems and setting goals. D. Therapeutic and Rehabilitative Services: Referrals and information for Therapeutic and Rehabilitative Services will be provided to veterans in the plan developed by the contractor's case manager, with input from the Veteran and the VA Contract Liaison. The contractor must be able to provide linkages that include the following: 1. Structured group activities as appropriate - examples include group therapy, social skills training, Alcoholics Anonymous, Narcotics Anonymous, vocational counseling and physical activities as appropriate. 2. Collaboration with the VA program staff, which will provide supportive psychosocial services. 3. Individual professional counseling, including counseling on self care skills, adaptive coping skills and, as appropriate, vocational rehabilitation counseling, in collaboration with VA program and community resources. 4. Assistance to develop life skills for responsible living patterns, to maintain an acceptable level of personal hygiene and grooming, and to achieve a more adaptive level of psychosocial functioning, upgraded social skills, and improved personal relationships, maintaining personal financial responsibilities. 5. Support for an alcohol/drug abuse-free lifestyle provided in an environment conducive to social interaction and the fullest development of the resident's rehabilitative potential. 6. Assistance to gain and to apply knowledge of the illness/recovery process in an environment supportive of recovery models. 7. A program that promotes community interaction. E. On-site Basic Services 1. Clean, sanitary, and home-like housing to all veterans. 2. Handicap and wheelchair accessible per City, State, and Federal guidelines. 3. A supervised alcohol and drug-free environment for an individual's desire for sobriety and an alcohol and drug-free lifestyle. 4. Staffing on a 24-hour, 7 days per week basis (Please refer to D. Therapeutic and Rehabilitative Requirements, (I.) Personnel in this document for further staffing information). 5. The contractor shall provide locked storage boxes for resident(s) medications. 6. Food/Meals shall be provided by the contractor 7 days a week throughout this contract; unless a participant receives financial compensation and is able to purchase his/her own food. The Contracting Agency staff in collaboration with the VA Liaison will determine if the participant will be able to purchase his/her own food. 7. Sanitary procedures shall be established and maintained for washing dishes, cleaning equipment and work areas, and for proper waste disposal. 8. Residents shall be housed with no more than two per room. The contractor shall provide beds with mattresses for the resident's use; plus one nightstand/table in each room. Space shall be provided for resident to hang clothes either in fixed or portable closet areas in each room. 9. Linens/bedding to be provided by contractor. 10. The contractor shall furnish, on site, adequate laundry facilities (including detergents) available for veterans to do their own laundry, at no cost to the veteran. 11. The contractor shall comply with the principles listed in 38 CFR 17.707(b) to provide housing and supportive services in a manner that is free from religious discrimination. 12. If urine toxicology screening or other procedures are required, the agency staff will provide or coordinate with an outside agency under the following standard certifications to include Centers for Medicare and Medicaid Services (CMS), Clinical Laboratory Improvement Amendments (CLIA) for clinical diagnostics, Drug and Alcohol Testing Industry Association (DATIA) for specimen collections, and Arizona Department of Public Safety for blood alcohol testing. F. Records and Reports: The contractor shall maintain an individual clinical record on each veteran outplaced under this contract. The contractor must comply with the requirements of the "Confidentiality of Certain Medical Records" (38 USC 4132), and the "Confidentiality of Alcohol and Drug Abuse Patients' Records" (42 CFR, Part 11) when appropriate, and shall be part of the contract. All case records will be maintained with such security and confidentiality as required, and will be made available on a need to know basis to appropriate VA staff members involved with the treatment program of the veterans concerned. The contractor is subject to annual security inspections by the VA Security department. In addition to reasons for referral, the clinical record maintained by the contract facilities will include: 1. All essential identifying data relevant to the resident and his/her family, including a socio cultural vocational assessment. 2. Data relating to the resident's admission to include the targeted goals for constructive changes which are to be attained during the residential rehabilitation episode, and the anticipated length of stay, if known. 3. Copies of any medical prescriptions issued by physicians, including orders, if any, for medications to be taken. 4. Reports of periodic re evaluation by program staff, to include any measures of movement toward rehabilitation goals, with particular focus on the attainment of self help skills. 5. Final summaries on each resident who leaves the program, to include a description of beneficial changes realized during the residential period, reasons for leaving, the resident's future plans, and follow-up locator information. 6. Upon discharge or death of the patient, the medical records for all VA beneficiaries will be retained by the residential treatment center for a period of at least three years following termination of care. 7. The C&A requirements do not apply, and that a Security Accreditation Package is not required. D. ADDITIONAL CONTRACT REQUIREMENTS A. Additional Guidelines: 1. Temporary absences from the program may require that the veteran be discharged. How long the veteran is absent and whether or not the absence is locally approved determines whether or not the veteran will be discharged. 2. The guidelines outlined will determine if a veteran should be discharged: a. If a veteran leaves the program in excess of 24 hours without consultation with the VA Contract Liaison. Absence of the patient from the Contract Facility in excess of 24 hours will not be reimbursable except with the prior approval of the VA Medical Center Director, or his/her designee. b. If a veteran leaves the program he must consult with the VA Contract Liaison and the absence must be in line with treatment goals. If the veteran leaves after 14 days, the veteran will be discharged. [Note: the contract agency can only bill for the first 72 hours. As a result, the provider has the option of discharging the veteran after the first 72 hours but must discharge the veteran after the 14th day.] c. When and if the veteran returns, depends on whether it is separate episode of treatment and the veteran must gain entrance into the contract program through the HCHV walk-in clinic. d. If the veteran has an approved absence and returns to residential treatment in less than 14 days, there is no need to complete discharge paperwork or to readmit the veteran. However, the Contract provider can only bill for 3 of those absent days (first 72 hours). 3. Fire, Safety: The Contract Facility warrants that all applicable fire laws (City, State, Federal) are being complied with and there are no recommendations of fire officials which have not been resolved. Fire drills will be conducted monthly with an evening Fire Drill every quarter with documentation of each, along with documentation of new patient fire and safety orientation. Contracted staff will have fire and safety training every two months with documentation. 4. Programming conflict: In the event of programming conflict, VA program requirements will take precedence. B. Quality Improvement will: 1. Conduct utilization review audits from the Northeast Program Evaluation Center (NEPEC) data collection. 2. Verify quality of patient care for veterans, 3. Ensure confidentiality of patient record information, and 4. Determine the completeness and accuracy of financial records. The comprehensive NEPEC program monitoring and evaluation study mandated by law will draw part of its data from the housing settings. 5. The contract facility shall notify the authorizing PVAHCS on call Emergency Department (ED) Social Worker immediately when a medical emergency requiring hospitalization occurs. The veteran will be admitted to an appropriate VA facility. When such admission is not feasible because of the nature of the emergency hospitalization in a non-Federal hospital may be accomplished provided VA authorization is obtained in advance. If hospitalization of a non-emergency nature is required that admission to the VA hospital will be accomplished promptly. 6. In the event a beneficiary receiving care under this contract dies, the contract facility shall promptly notify either the COTR or on call ED Social Worker (after hours) and immediately assemble, inventory, and safeguard the patient's personal effects. The funds, deposits, and effects left by veteran upon the premises of the contract facility shall be delivered by the facility to the person or persons entitled thereto under the laws currently governing the contract facility for making disposition of funds and effects left by veterans, unless the beneficiary died without leaving a will, heirs, or next of kin capable of inheriting. When disposition has been made the itemized inventory, with a notation as to the disposition of the funds and effects, shall be immediately forwarded to the PVAHCS office. Should a deceased veteran leave no will, heirs, or next of kin, their personal property and funds wherever located vests in and becomes the property of the United States in trust. In these cases the contract facility shall forward an inventory of any such property and funds in its possession to the appropriate VA office and shall hold them (except articles of clothing necessary for proper burial) under safeguard until instructions are received from the PVAHCS official concerning disposition. 7. The PVAHCS will process payments for services rendered in accordance with such authorization upon receipt of billings submitted by the housing center at the completion of each month's services. The PVAHCS will pay per diem for the day of a patient's admission to the Contract Program or the day of the veteran's discharge, but not both. If a beneficiary is admitted to and discharged from the housing center on the same calendar day, payment will be authorized for one day. Invoices shall be submitted to the address shown. 8. Continuity of Care: In the event that the agency is no longer able to provide housing/ services to residents the VA will coordinate with community agencies and PVAHCS HCHV Homeless Program Resources in an attempt to provide housing for veterans who would be displaced from the existing program. C. Governing Law: This contract shall be governed, construed and enforced in accordance with applicable Federal, State and Local Law. D. Order of Precedence: The terms, conditions, and attachments referenced herein, including any formal written modifications thereto, constitute the complete agreement between the parties and take precedence over any other language, oral or written. E. Personnel: Sufficient staff must be provided in numbers and positions qualified to carry out the policies, responsibilities, and services of the program: 1. The Case Manager and Case Aid ratio should not exceed fifteen. 2. There must be, at a minimum, a full-time administrative staff member or staff designee, on duty on the premises who is available for emergencies 24 hours per day, 7-days per week. 3. The Contract Facility provides services to veterans to include providing a safe, secure, confidential and structured environment that address the needs of the veteran. 4. VA inspection teams will evaluate the ability of the Contract Facility to consistently assure the presence of staff capable of providing the services required under the terms of the contract. 5. The records of contractor personnel shall be subject to review by the VA Chief of Staff or his/her designated Contract Liaison and HCHV Coordinator. 6. The Contractor must identify each person functioning as "Key Personnel" under this contract, and provide to the VA a description of the services to be provided by such person, together with a resume summarizing that person's relevant skills and experience. 7. The Contractor shall assign to this contract personnel that by education and training (and, when required, certification or licensure) are qualified to provide the Basic Services and Supplemental Services required by this SOW. 8. During the first thirty (90) calendar days of contract performance, the Contractor shall make NO substitutions of key personnel unless the substitution is necessitated by illness, death, or termination of employment. Within 14 days after substitutions necessitated by situations described above, the Contractor shall provide resumes for the substitute key personnel. For substitutions proposed by the Contractor after the initial 30 calendar day period, the Contractor shall provide resumes for the substitute personnel, together with any other additional information requested by the Contracting Officer, at least 15 days before the substitution is to occur. The Contracting Officer shall notify the Contractor within fifteen (15) calendar days after receipt of all required information if the VA refuses to accept the substitute key personnel. The VA reserves the right to refuse or revoke acceptance of key personnel if personal or professional conduct, or lack of required skills or experience, jeopardizes patient care or interferes with the regular and ordinary operation of the facility. 9. Temporary substitutions of key personnel shall be permitted in accordance with the Contractor's contingency plan. The Contractor's contingency plan to be utilized if personnel leave Contractor's employment or are unable to continue performance in accordance with the terms and conditions of the resulting contract must be submitted as part of the Contractor's offer. 10. All Contractor staff providing services to Veterans under this contract must have an appropriate background security check before receiving an initial referral of Veterans under the contract. The Contractor shall ensure all appropriate security documentation is submitted through the local law enforcement agency and that security and/or background documentation is provided within the contract personnel records subject to be reviewed by the VA Chief of Staff or his/her designated Contract Liaison and HCHV Coordinator. F. Referrals: The VA is responsible for determining eligibility of Veterans prior to referral to the Contractor for treatment. A written referral (hard copy, fax or e-mail are acceptable) signed by an HCHV outreach worker, liaison or case manager, shall be provided to the Contractor for each Veteran referred for services under the contract. 1. A list of authorized VA ordering officials for the contract shall be provided to the Contractor upon award of the contract. Ordering officials may be added or deleted from the list during the term of the contract at the discretion of VA Contracting Officer. The Contractor shall be provided an updated list of authorized VA ordering officials whenever such changes are made. 2. It is understood that the Length of stay will not exceed 90 days without prior written approval of the VA Contract Liaison. 3. The length of stay for a Veteran may be up to 90 days, depending upon the needs of the Veteran as mutually determined by the Veteran, the Contractor's staff, and VA Contract Liaison or designee. An extension of the referral period up to a total of 5 months may be authorized by the VA Contract Liaison or designee, provided that there is clinical need and that funding is available. Treatment periods in excess of 6 months for individual Veterans must be authorized by the Medical Center Director or designee. G. Absences and Cancellation 1. The contractor shall notify the VA of unauthorized absences to the VA Contract Liaison or designee. Should a Veteran absent himself/herself from the Contractor's facility in an unauthorized manner, payment for services for that Veteran shall be continued for a maximum period of two days, provided there is an active outreach attempt on the part of the Contractor's staff to return the Veteran to the facility and there is a reasonable belief that the Veteran will return. Management of program dropout will be an element of quality assurance review of this program. Absences of the Veteran from the facility in excess of two days will not be reimbursable unless authorized in advance by the VA Contract Liaison and/or HCHV Coordinator. 2. VA reserves the right to remove any or all Veterans from the facility at any time, without additional cost, when it is determined to be in the best interest of the VA or the Veteran. 3. The contractor shall notify the authorizing VA facility immediately when a medical emergency occurs that requires hospitalization of a referred Veteran. It is agreed that the Veteran will be admitted to the appropriate VA facility. When such admission is not feasible because of the nature of the emergency, it is agreed that hospitalization in a non-federal hospital may be accomplished provided that VA authorization is obtained. If hospitalization of a non-emergency nature is required it is agreed that admission to the appropriate VA facility will be accomplished promptly. H. Contractor Staff Conduct/Complaints Handling The contractor shall notify the authorizing VA Contract Liaison, designee and/or HCHV Coordinator immediately of any incidents involving veterans residing in the residential program. The contractor shall notify the HCHV Contract Liaison by telephone during the hours of 7:30am and 4:00pm. For all incidents that occur after normal business hours, the contractor should notify the Administrator on Duty (AOD). The contractor shall provide the HCHV Contract Liaison and the COTR with a copy of the incident report within 24 hours. The contractor shall maintain a copy of the incident report in the Veteran's case record. 1. Contractor personnel shall be expected to treat referred Veterans with dignity and respect and abide by standards of conduct mirroring those prescribed by current federal personnel regulations. The Contractor shall comply with the VA Patient's Bill of Rights as set forth in 38 CFR 17.34a (copy available upon request). 2. The VA reserves the right to exclude Contractor staff members from providing services to Veterans under this contract based on breaches of conduct, including conduct that jeopardizes patient care or interferes with the regular and ordinary operation of the facility. Breaches of conduct include intoxication or debilitation resulting from drug use, theft, patient abuse, dereliction or negligence in performing directed tasks, or other conduct resulting in formal complaints by Veterans or other staff members to designated Government representatives. The Contractor and Contracting Officer's Technical Representative shall deal with issues raised concerning contractor personnel conduct. The Contracting Officer shall be the final arbiter on questions of acceptability and in validating complaints. 1. Transportation: The Contractor shall assist the Veterans with local transportation to scheduled meetings and appointments. The Contractor will be expected to help the Veteran access public transportation, including providing information and instructions necessary to enable Veterans to utilize public transportation. If VA staff determines that adequate public transportation is not available or appropriate for a Veteran, the Contractor shall arrange for alternative transport by car. I. Facility 1. It is the responsibility of the Contractor to properly maintain its facilities and the VA shall have no responsibility for paying or reimbursing the Contractor for such expenses. The contract facility must: a. have a current occupancy permit issued by the local and state governments in the jurisdiction where the facility is located, or a statement from the appropriate city or state office, stating there is not a need for an occupancy permit. b. be in compliance with existing standards of State safety codes and local, and/or State health and sanitation codes. c. where applicable, be licensed under State or local authority. d. where applicable, be accredited by the State. e. be equipped with operational air conditioning /heating systems f. be kept clean free of dirt, grime, mold, or other hazardous substances and damaged noticeably detract from the overall appearance. g. be equipped with first aid equipment and an evacuation plan in case of emergency. h. have windows and doors that can be opened and closed in accordance with manufacturer standards. 2. The contractor facility must meet fire safety requirements, as follows: 3. The building must meet the requirements of the applicable residential occupancy chapters of the current version of NFPA 101, National Fire Protection Association's Life Safety Code. Any equivalencies or variances must be approved by the appropriate Veterans Health Administration Veterans Integrated Service Network (VISN) Director. 4. All residents in the facility must be mentally and physically capable of leaving the building, unaided, in the event of an emergency 5. Fire exit drills must be held at least quarterly. Residents must be instructed in evacuation procedures when the primary and/or secondary exits are blocked. A written fire plan for evacuation in the event of fire shall be developed and reviewed annually. The plan shall outline the duties, responsibilities and actions to be taken by the staff and residents in the event of a fire emergency. This plan shall be implemented during fire exit drills. 6. A written policy regarding tobacco smoking in the facility shall be established and enforced. 7. Portable fire extinguishers shall be installed at the facility. Use NFPA 10, Portable Fire Extinguishers, as guidance in selection and location requirements of extinguishers. 8. Requirements for fire protection equipment and systems shall be in accordance with NFPA 101. All fire protection systems and equipment, such as the fire alarm system, smoke detectors, and portable extinguishers, shall be inspected, tested and maintained in accordance with the applicable NFPA fire codes and the results documented. 9. The annual inspection by a VA team required is required. The Inspection of Facility and Program shall include a fire and safety inspection conducted at the facility unless a review of past Department of Veterans Affairs inspections or inspections made by the local authorities indicates that a fire and safety inspection would not be necessary, in which case the fire and safety inspection may be waived by the VA. J. Inspection of Facility and Program 1. Pre-Award Survey/Subsequent Inspections: The Contract Facility is subject to inspection by a VA Inspection Team prior to contract award and not more than 45 days prior to the annual contract renewal date, to insure compliance with all contract requirements. The multi-disciplinary VA team will consist of the VA Medical Center Contracting Officer's Technical Representative (COTR), a social worker, dietitian, registered nurse, a representative of the VA Police, and a Facilities Management Safety Officer, and other subject matter experts as determined necessary by the medical center director or HCHV Coordinator shall conduct a survey of the Contractor's facilities to be used to provide Veterans food, shelter, and therapeutic services to assure the facility provides quality care in a safe environment. Inspections may also be carried out at such other times as deemed necessary by the Department of Veterans Affairs. 2. Surveys of the housing setting shall be made quarterly by the COTR or a designated representative. 3. Prior to making each inspection of a facility, the team will: a. Review the report of most recent inspection, if any, and discuss with team members any problems or irregularities which they may have encountered earlier in dealing with the facility. b. The safety officer will be prepared to inspect the setting for conformity to the current Life Safety Code (National Fire Protection Association (NFPA #101); c. Review terms of any existing contract housing agreements. d. The clinical members of the team will be prepared to focus on an assessment of the quality of care provided by the facility and the quality of life within the facilities, giving particular attention to the following critical indicators: 1. Review of the veteran's treatment plan so as to reflect a client-driven plan, notes reflecting follow-up meetings and notes that discuss progress of client's goals. 2. Patient records maintained and secured, and maintain reasons for referral, goals, data on resident's family, medical prescriptions and orders. 3. Making a spot check of veterans' records to ensure accuracy with respect to veterans' length of stay and services provided to the veterans. 4. Documentation that basic services are provided to veterans on an ongoing basis. 5. General observation of veterans indicating they maintain an acceptable level of personal hygiene and grooming. 6. There is evidence of facility-community interaction. This may be demonstrated by the nature of scheduled activities or by involvement of other than facility staff with the residents. 7. Observation of staff behavior and interaction with residents to determine if they convey an attitude of genuine concern and caring. 8. The agency shall provide documentation that staff is available for emergencies 24/7. 9. Discharge plan reflects a team assessment of health , social and vocational needs and the involvement of the veteran, the VA staff and appropriate community resources in resolving problems and setting goals. 10. There is documented evidence of the facility's commitment to the implementation of the Patient's Bill of Rights. 11. Other items to be included in the inspection: a. Assessment of whether the facility meets applicable fire, safety and sanitation standards. b. Inspecting the types of meals and other nutrition provided to residents (approval will be gained by the Nutritionist on the inspection team). 12. If, during the course of inspection, an unresolved discrimination complaint arises or maintenance of segregated facilities has been observed, a report will be forwarded to the VA Medical Center Director. The report will contain pertinent facts and observations with a description of action taken to correct the situation. A copy of the report will be given to the Contracting Officer and Contract Facility. 13. A formal report of each inspection will be prepared and forwarded to the Medical Center Contracting Officer. In accordance with normal contract administrative practices, the following actions shall ensue: a. The Facility will be advised of the findings of the inspection team. b. In the event deficiencies have been noted, the Facility will be given a reasonable time to take corrective action and to notify the Contracting Officer that the corrections have been made. c. Any unsatisfactory conditions noted during a follow-up visit to a contract facility will be reported in writing to the Contracting Officer through the Medical Center Director. In already existing contracts, satisfactory corrections must be made within a negotiated time frame with the Contract Liaison and Healthcare for Homeless Clinical Director. When this is not done, the Contracting Officer will consult with the concerned officials so that suitable arrangements can be made to discharge or transfer patients and terminate the contract. d. The original copy of the inspection report and pertinent correspondence will be kept in the contract file. 14. The Contract Facility (contractor) shall make documented information available to VA, as deemed necessary, to conduct utilization review audits, to verify quality of care to veterans, to assure confidentiality of veterans record information, and to determine the completeness and accuracy of financial records. The comprehensive programs monitoring the evaluating study mandated by 38 U.S.C 1720(f) will draw part of its data from the contract facilities. 15. The contractor will be advised of the findings of the inspection team. If deficiencies are noted during any inspection, the contractor will be given a reasonable time to take corrective action and to notify the Contracting Officer that the corrections have been made. A contract will not be awarded until noted deficiencies have been eliminated. Failure by the Contractor to take corrective action within a reasonable time will be reported to the VA Contracting Officer. If corrections are not made to the satisfaction of the VA, the Contracting Officer will consult with the appropriate officials so that suitable arrangements can be made to discontinue plans to award a contract, or to discharge or transfer patients and to terminate the existing contract, as appropriate. 16. The government shall, at its discretion, choose at any time, announced or unannounced to have VA personnel inspect the contractor's facility. 17. All Department of Veterans Affairs reports of inspection of residential facilities furnishing treatment and rehabilitation services to eligible veterans shall, to the extent possible, be made available to all government agencies charged with the responsibility of licensing or otherwise regulating or inspecting such institutions. P. Contract Changes/ Technical Directions: 1. The Contracting Officer is the only person authorized to approve changes or modify any of the requirements of this contract. The Contractor shall communicate with the Contracting Officer on all matters pertaining to contract administration. Only the Contracting Officer is authorized to make commitments or issue changes that shall affect price, quantity or quality of performance of this contract. 2. IN THE EVENT THE CONTRACTOR AFFECTS ANY SUCH CHANGE AT THE DIRECTION OF ANY PERSON OTHER THAN THE CONTRACTING OFFICER WITHOUT AUTHORITY, NO ADJUSTMENT SHALL BE MADE IN THE CONTRACT PRICE TO COVER AN INCREASE IN COSTS INCURRED AS A RESULT THEREOF. 3. The COTR will be responsible for the overall technical administration of this contract as outlined in the COTR Delegation of Authority, including monitoring of the Contractor's performance.