While most Accreditation Managers focus all their attention of their accreditation files they are failing to address the other half, their facility’s compliance with the accreditation standards. This is a common mistake but it can have devastating consequences. While most policies can be amended pretty quickly to comply with a standard this is not so with brick and mortal facilities. Some changes to a building infrastructure is easy while other require capital expenditures, planning, and approvals, all of which can take a lot of time. The New Jersey Public Safety Accreditation Coalition (PAC) has developed two comprehensive copyrighted and proprietary programs to assist agencies in successfully negotiating this area of accreditation. These programs are the Facility Assessment and the Facility Inspection.
The Facility Assessment is performed by a trained and experienced Facility Assessment Compliance Officer. He/she will perform a complete assessment of an agency’s facility or facilities to see how they comply with applicable accreditation standards. A representative of the agency’s primary functions will be on hand for the assessment so the compliance officer may interview them if needed. When the assessment is completed the compliance officer will complete a report that is turned over to the agency’s Chief Executive Officer. Post assessment the PAC will continue to work with the agency to come into compliance with any areas that are of issue and will also help liaison with local, county, state, and federal agencies to facilitate an expiated compliance schedule. The PAC has high level liaison connections with many different accrediting, regulatory, and compliance organizations that can be used to help facilitate a plan and help improve communication.
The Facility Inspection is also performed by a trained and experienced Facility Assessment Compliance Officer but the purpose of the Facility Inspection is to review an agency’s facility right before their official assessment to make sure their current operations and facility usage complies with all the applicable accreditation standards. The Facility Inspection is typically performed within 2 weeks of the official on-site visit but needs to be schedule at least a month in advance to guarantee the availability of the compliance officer. The agency’s Accreditation Manager and at least one member of the Command Staff will accompany the compliance officer on the inspection tour. The agency will be left with a checklist they can use to replicate the inspection each day of the official on-site assessment before the assessors arrive for the day. This practically guarantees a smooth on-site process.
Some of the areas the compliance officer will assess / inspect are as follows: