Samaritan Institute Accreditation Documentation

A.  General

  1. Proposed Site-Visit Schedule
  2. Board President and Executive Director Self-Studies
  3. Historical Sketch of the Center to Date
  4. A HIPPA/Red Flag Business Associate Agreement filled out in the accreditation visitors name to be signed by visitor and returned to the Center

B.  Organization

  1. Copy of original incorporation papers (EIN filing) with any subsequent revisions (See Corp Documents)
  2. Copy of initial and permanent IRS letters affirming 501c3 exemption status
  3. Written definition of Center's primary service area and/or constituency
  4. Organizational chart with narrative discussions showing leadership structure and responsibility
  5. Copy of Center's by-laws with date of latest revision

C.  Board of Directors

  1. List of Board members with name, address, phone numbers, board office and/or committee, congregational affiliation, occupation, geographical or professional area they represent, and terms of service
  2. Copies of Board minutes and reports for past twelve months
  3. Written description of the Center's new board member orientation process
  4. Copy of Center's current strategic plan
  5. Written description of the Center's practices in the area of board development, financial management, fund-raising, marketing, establishing compensation, community collaborations, and program evaluation.
  6. Summary of the Center's client satisfaction and/or outcome data for the past full year.

 D.  Personnel

  1. Copy of Center's personnel policies and job descriptions (See Corporate Documents/Center Policies)
  2. Up-to-date listing of the Center's staff members and consultants showing their names, job titles, professional affiliations, licensures or certifications, and full or part-time work status
  3. Statement and documentation of the Center's standards for employment, supervision, and evaluation of all persons, including trainees, who are providing services not requiring a state credential
  4. Signed statement from executive director and board president confirming that all persons providing services for the Center are to their knowledge in good standing professionally and practicing within the boundaries and ethical standards of their credentialing and training
  5. Written agreement(s) with physician(s) and/or healthcare organization(s), and documentation of provider and/or organizational professional good standing (Corporate Documents/Healthcare Provider Agreements)
  6. List of staff members by name with date of most recent annual review, name of supervisor or consultant, and frequency of supervision/consultant contact (Annual Review Roster)

E.  Services

  1. A descriptive listing of the Center's current counseling and non-counseling services and programs
  2. A copy of the Center's clinical policies and procedures and Case Management Procedures
  3. Copies of the Forms used in the Center's clinical practice
  4. A brief description of the pattern of staff gatherings (clinical, administrative, non-counseling services case consultation, other) and a listing of the dates and attendees for these staff meetings during the year.
  5. A copy of the endorsement page(s) for the Center's professional liability coverage
  6. For Center programs other than professional clinical practice include the quality assurance policies and practices for administration, risk management, record keeping, and service evaluation.(Petition)
  7. A copy of the Center's integrated services policy and procedures

F.  Finances

  1. Copy of current budget with date adopted by board and year-to-date financial reports
  2. Copy of most recent audit or financial review
  3. Copy of plan(s) for Center financial development
  4. Copy of Center fee policy and, if applicable, scale for financial assistance

G.  Facilities

  1. List of current service locations noting cost, hours of use, and hours counseling provided in the past twelve months
  2. Copies of current facility agreements, signed and dated (See Corporate Documents )

H.  Administration

  1. Copy of office administrative procedures and Policies and Practices
  2. Copies of current materials for marketing and fund raising including brochures, newsletters, program announcements, bulletin inserts, solicitation letters, etc.

I.  Program Accountability

  1. Copies of most recent annual report
  2. Description of Center quality and performance improvement QI-PI plan and results
  3. CCC job description, advisory team or committee minutes, program plan (if applicable) - not applicable
  4. List of current official Center relations, e.g. with employee assistance programs, state agencies, seminaries for training, businesses for contracted service, third party payers for approved payment, endorsing congregations or judicatories, provider panels on which staff members are included, etc. (Corporate Documents - Covenant Agreements)
  5. Copy of most recent report from any other accrediting or certifying body, e.g. AAPC, Council on Accreditation, state mental health board, etc.  - not applicable