Outpatient 587 Admin Interview

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Administrative Interview

  Date

• Program; Reviewer; administrator

  Yes

  No

  N/A

1.21 Incident Review Committee

• Regular meeting, distribution of findings and recommendations, monitoring of corrections or changes

  Yes

  No

  N/A

1.22 Incident Review Committee

• selection process, composition of committee, type of training required

  Yes

  No

  N/A

*1.23 Incident Reporting

• responsible person for reporting, ask for examples of reportable incidents in the past year, procedures for external reporting

  Yes

  No

  N/A

2.22 Recipient objection to treatment

• what procedures are followed, are recipients aware of their greivance rights, any problems with process in past

  Yes

  No

  N/A

2.31 and 2.32 Recipients Input

• process used to obtain recipient opinions regarding satisfaction, use of recipient information to improve the program

  Yes

  No

  N/A

4.12 Waiting Lists and admittance delays

• presence of active waiting list, length of waiting list, usual length of delay for admittance, causes of delay, actions take or needed to reduce entry delays

  Yes

  No

  N/A

*5.11 Staffing

• maintanence of staffing levels during the past year, handling of shortfalls, any revision to improved staffing plan

  Yes

  No

  N/A

2.12 and 2.13 Hiring and training practices

• assessemnt of staff qualifications with regard to ethnic and cultural needs, process followed for recruitment of ethnic and culturally competent staff, kinds of training experiences to foster staffs cultural and ethnic awareness.

  Yes

  No

  N/A

*5.21 Governing Body

• communication process between the governing body and program, attendees at board meeting from program staff, process to get program related issues to governing body, responsiveness of governing body.

  Yes

  No

  N/A

5.31 Fiscal Matters

• recent fiscal audit available, what did audit indicate specific to this program, management letter with audit, governing body's awareness of results, course of action taken for items notes as problematic.

  Yes

  No

  N/A

5.23 Prgrams with satellites

• communication process between the satellites and main site, meetings regulary scheduled including staff from the main and satellite locations, kinds of issues discussed.

  Yes

  No

  N/A