ARE WE PREPARED FOR STATE INSPECTION?
This is an important question facility Administrators, Directors of Nursing and ASC owners alike should be asking themselves. Whether you are a Licensed facility, or a Registered Surgical Practice making the transition to Licensure, compliance with N.J.A.C. 8:43A is imperative.
Preparedness is the key to avoiding potential citations as a result of deficiencies identified by an NJDOH survey team. Our firm is well versed with the Standards for Licensure. Using our proven methods, we can assist in all areas of preparation ahead of a survey inspection. Our team will also offer support with maintaining compliance in anticipation of future unscheduled survey inspections.
The following is a non-inclusive list of the areas of concentration that our group can assist your staff in preparing for an inspection:
- Policies and Procedures
- Employee files / Health files / Physician Health files
- In-service records
- Staff education / Orientation / Competencies
- Credentialing program
- Bylaws / Staff, Corporate and Credentialing meeting minutes
- Appointment of privileges
- Required contracts
- Review sterile processing, storage and handling of instrumentation
- Review manufacturer’s instructions for use
- Quality Improvement and Performance Improvement plans
- Environment of Care
