Central Fabrication Accreditation Guide

      ABC prides itself on being the premier accrediting body in the orthotic, prosthetic and                pedorthic professions and feels that our survey process and team of surveyors are the              best. We believe the best central fabrication businesses will achieve this accreditation as a        demonstration of their dedication to best business practices and the provision of quality            items/devices.

Surveyors

ABC employs a team of trained and qualified surveyors who will conduct your survey. Their role is to review the information presented and clarify, observe and verify the data that supports your compliance with the applicable standards.

During your onsite survey, your surveyor will discuss with your facility representative any area where standards are not fully met and he or she will provide best practice suggestions to help your facility achieve optimum performance. ABC surveyors are trained to be minimally intrusive throughout the survey in order to reduce interruptions to your business operations.

All surveyors must disclose to ABC any potential conflict of interest with you or your facility before they are assigned to conduct your survey. You may also notify ABC of a potential conflict of interest with any of our surveyors by submitting a letter with your application or by emailing ABC staff. Any surveyor with a confirmed conflict will not conduct your survey.

Surveyors are unavailable once your onsite survey is completed. ABC will not provide the surveyor’s personal contact information, including address, phone number or email. If you wish to send correspondence to your surveyor, please mail:

 ABC                                                                                                                                                                                   Attn: Facility Accreditation                                                                                                                                                   330 John Carlyle St., Suite 210                                                                                                                                 Alexandria, VA 22314

Survey Types

Initial Survey

An initial onsite accreditation survey will be used to determine if you have met the accreditation standards. We recommend that you use the PreApplication Checklist provided in this publication to help ensure that you are prepared for the survey.

Resurvey

If your facility experiences significant changes, such as a location move or change of ownership, you will be required to undergo a resurvey. Resurveys will also be required if the surveyor is denied access to the facility. To begin the resurvey process, you must submit a new application along with the appropriate fees.

Verification Survey

If any deficiencies were found during your survey, you may be required to submit a Corrective Action Plan (CAP) outlining how you corrected these deficiencies. A verification survey is sometimes required to ensure that the corrections detailed in your CAP have been implemented. During this survey, the surveyor will confirm that any deficiencies from your initial survey have been rectified and that any items documented in your corrective action plan have been completed. ABC will inform you in writing if we require a verification survey. You will be responsible for any fees associated with a verification survey.

Quality Control Survey

On occasion, ABC will randomly conduct a quality control survey to determine consistency among ABC accredited locations and evaluate surveyor performance. We appreciate your cooperation if this occurs at your facility. In addition, we reserve the right to conduct a quality control survey to determine ongoing compliance with ABC standards. These surveys are random and unannounced and may be initiated in response to complaints. There is no charge to the facility for quality control surveys.

Survey Structure

When your surveyor arrives at your facility, he or she will identify that they are from ABC and will present you with their photo identification badge. Make sure the individual’s badge is valid and from ABC. If not, do not allow the individual into your facility and call ABC.

Initial Interview: You’ll have a brief interview with your surveyor.

You can expect the surveyor to:

• Discuss the purpose of the survey and go over the schedule
• Answer any questions you may have about the survey process
• Determine the general layout of the facility

The Survey: To verify that you have met the requirements of ABC’s Central Fabrication Standards, your surveyor will look at and focus on the following items and areas:

• Your business’s Policies and Procedures Manual
• Personnel files
• Accounting and bookkeeping records
• Contracts with vendors
• Fire and emergency evacuation plans
• Customer satisfaction surveys and survey analysis
• Information on fabrication turnaround times
• Employee interviews

By applying for accreditation, you authorize ABC and its surveyors access to all records (including personnel, financial management, risk management, operational review, quality assurance and quality improvement) necessary to determine your facility’s degree of compliance with the ABC standards. Your surveyor will also conduct staff interviews and may examine other areas as they relate to the standards. ABC and its surveyors comply with all HIPAA, privacy and confidentiality requirements.

Closing Interview: After your survey has been completed, your surveyor will brief you on their findings and make any suggestions for overall improvement. During the closing interview please keep in mind:

• You will have plenty of opportunity to clarify or submit any information that may not have been available during the survey.
• Your surveyor may have suggestions that could help you comply with the standards; this is your chance to talk to the surveyor one on one. Be sure to take notes.
• Your surveyor does not know whether you passed the survey and is not permitted to discuss your results.
• All significant recommendations and deficiencies will be discussed with you. A final survey report will be sent to you from ABC.

After the Survey

Results

Surveyors submit their initial reports to ABC. All results are validated and finalized by ABC Facility Accreditation staff. Finalized results will be mailed to you two to four weeks after your survey. Any questions regarding accreditation status should be directed to ABC.

Your survey report and decision letter will indicate if you are Compliant, Partially Compliant or Non-Compliant with each standard. Standards where you were found to be Partially Compliant or Non-Compliant will include comments to assist you in taking corrective action to meet the standard. If deficiencies are found, you may need to submit a Corrective Action Plan (CAP.) If your facility meets all of the accreditation criteria, ABC will award you accreditation.