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Questions and Answers about  Accreditation with CQL Canada

What should a provider look for in choosing an accrediting body?

The organization must consider what is important to them.  CQL Canada has a person-directed approach.  We believe what sets us apart from other accrediting bodies is that CQL Canada looks at the quality of services from the perspective of the person receiving supports and services.

CQL Canada views the accreditation process as a partnership in that accreditation with CQL Canada is not an event but a collaboration and ongoing relationship.  We recommend using CQL Canada’s self-assessment tools contained within the Quality Measures, to see if CQL Canada would be a good fit for your agency

How do the Personal Outcome Measures^® fit into the process?

The Personal Outcome Measures^® remain at the core and center of our work.  We affirm their importance and value as a learning, planning and evaluation tool.  Listening to and learning from the person is at the center of organizational life.  Since the Personal Outcome Measures^® were first introduced by The Council on Quality and Leadership (CQL) in 1993, the reliability and validity of the measures continues to be tested.  Our data base of more than 6500 Outcomes interviews with people supported guides our work and the work of hundreds of organizations.  Our focus on the person is as strong as ever and this core value is found throughout each section of the Quality Measures 2005^®.

What are the major steps in the accreditation process?

Application - you make the commitment to engage in the process by submitting your application to CQL Canada 6 - 12 months prior to the anticipated date of the review.

Validation of Shared Values and Basic Assurances^® - you complete self-assessments in these two areas and work with the CQL Canada team in validating the results.  Validation takes place at your organization and includes focus groups and other meetings, gatherings and visits with people.  CQL Canada team members spend time at locations where people are supported, provide a summary of findings, and plan with you for next steps and future visits.

Personal Outcome Measures^® Data Collection and Validation - you gather and summarize data based on interviews and conversations with people and share that with the CQL Canada team (you also have the option of requesting that CQL Canada gather this information).  Validation methods for Personal Outcomes data might take different forms at different organizations and takes place on-site at your organization.

Responsive Services^® and Community Life^® Validation - within twelve months of the validation of the Shared Values and Basic Assurances^® you complete self-assessments in these two areas and provide other supporting information. The CQL Canada team visits on-site and the organization provides the results of a community assessment, organizes focus groups and other meetings, and arranges for CQL Canada surveyor to observe at least one person-directed planning meeting.

Accreditation Partnership Agreement - the organization and the CQL Canada team together develop a partnership agreement for ongoing collaboration.  Included in this agreement are the actions the organization will take to continue the quality journey. It also outlines CQL Canada's responsibilities and contributions that support the organization’s ongoing quality improvement efforts.

What is the usual time frame for completing all these steps?

For most organizations, especially those who have worked with CQL Canada for awhile, the process will take place over a 6 to 12 month period.  For organizations who are newer to our approach or who need to address some findings, the process can extend over a longer time frame.

What happens at the end of the process?

The “end” is actually a new beginning. Accreditation with CQL Canada results in a four-year accreditation award, with annual agreements for collaboration. Collaboration links the organization and CQL Canada in a partnership.  Together, CQL Canada and the organization measure, analyze and plan. This process is co-evaluative and builds your organizational expertise to learn about and respond to people.

How is the CQL Canada Accreditation decision made?

The team gathers supporting evidence to determine whether the Basic Assurances^® for health, safety and human security for people are in place.  Additionally, the team must determine if the organization is fiscally and legally sound. The team evaluates how values are aligned with organizational practices.  The team validates Personal Outcome Measures^® interview data and determines if the focus of personal outcomes and community are integrated.  The team assesses the organization’s processes and management practices and evaluates the organization’s response to quality of Community Life^® issues.

What kinds of organizations can be accredited by CQL Canada?

The range of the services and supports offered by CQL Canada accredited organizations include:

·         Service coordination

·         Family and individual support

·         Behavioral health care

·         Employment and other work related day supports

·         Residential services of all types

·         Leisure Respite Services and supports for people with all types of disability

·         Services and supports for families, children and youth

·         Services for seniors

·         Networks of support, as well as individual providers

·         And most other human services

What is the turnaround time from receipt of application to first visit?

Plan at least six months ahead.  In other words, apply six months in advance of when you would like to receive your first visit.

When site visits are conducted, what is reviewed?

CQL Canada conducts its initial site visit as part of the review of Basic Assurances^®, Shared Values and Personal Outcome Measures^®.  Follow up visits aid in assessing Responsive Services^® and Community Life^®.  These site visits contribute to information gathering in a number of Indicators/Factors.

How does the initial review differ from the follow-up visits?

The initial review looks at the roles and responsibilities within the organization, and how the provider interacts with the consumers in meeting needs.  The first visit includes assessment of the Basic Assurances^®, Shared Values and Personal Outcome Measures^®.   Subsequent visits look at Responsive Services^® and Community Life^® with a community assessment.  The next visit (one-year follow-up) looks at the interactions the organization has within the broader community.  It includes a review of Basic Assurances^®, Responsive Services^® and Community Life^®.   An additional visit in the second or third year reviews the Integrated Quality Management Plan.

How much does CQL Canada look at health issues?

CQL Canada uses the Personal Outcome Measures^® to determine if persons receiving supports and services are in the best possible health and live, work and recreate in safe environments with individualized supports.  CQL Canada employs other information gathering strategies including focus groups with people receiving services and supports, direct support professionals, and targeted interviews that include individuals with chronic health issues.  They look at the organization’s quality management system around health and safety.  They look at the health systems to assure, for example, that medications are managed appropriately and administered safely.  They discuss medical and other emergency procedures.  It would vary from organization to organization.  The Basic Assurances^® are focused on the health, safety and human security for all people.

What if an organization wants to only have Basic Assurances ^® reviewed?

It is possible that an organization may want to request a review using the Basic Assurance^®.  By reviewing only Basic Assurances^®, an organization could earn a Basic Assurances^® Certification for a period of two years.  A Basic Assurances^® Certificate is not an accreditation award.

What if an agency has offices in multiple cities and for whatever reason, one office does not meet CQL Canada criteria for accreditation.   Is a portion of the agency accredited?

CQL Canada accredits the entire organization; not sites or programs. They will visit a representative sample of sites and when they finish, the entire agency is either accredited or not.

Focus groups are one method of information gathering that CQL Canada uses.  Who selects participants for the focus group?

For the initial review, CQL Canada asks the organization to arrange at least four focus groups - one for people receiving supports and services, one for direct support professionals, one for family members, and one for community members.  There may be additional focus groups needed for other reasons.  For example, if the organization provides what we refer to as episodic services, we might ask the organization to set up a focus group of those service users.  The organization makes all arrangements for the focus groups including participant selection.

For subsequent reviews, there are other focus groups. CQL Canada will use other information gathering strategies to include a sample of people whom we interview using the Personal Outcome Measures^® and people for targeted interviews around specific assurances.  CQL Canada always selects the sample.  CQL Canada asks the organization to identify people for targeted interviews who meet specific criteria.  Some of the people for targeted interviews are identified by the organization (i.e. the person who made the most recent complaint) and some are selected by CQL Canada from a list provided by the organization on the accreditation application (i.e. person who has agreed to a restrictive intervention). CQL Canada respects that some people choose to be excluded from the sample or the information gathering process.

How does CQL Canada determine the participation of community groups in the community meetings?

The provider identifies and invites community groups with which it interacts.  Examples of community groups that have participated in this process are the mayor’s office, churches, employers, other community service providers such as Meals on Wheels, and a variety of others.

CQL Canada has a process for training interviewers.  Can organizations or providers send representatives to become a certified trainer/interviewer?

Yes. CQL Canada offers certification as an interviewer or as a trainer.  A certified interviewer completes training in the Personal Outcomes Assessment Workshop and successfully completes inter-rater-reliability.  A certified trainer participates in the Personal Outcomes Assessment Workshop taught by an experienced CQL Canada staff, observes a CQL Canada staff conducting a workshop, successfully completes inter-rater reliability and conducts a workshop under the supervision of a CQL Canada staff person.  There is a fee for this training.  CQL Canada Certification

An organization may be allowed to do some of the individual interviews themselves.   How comfortable is CQL Canada allowing that?

The Quality Measures 2005^® process was designed to be collaborative.  Organizations are encouraged to share in the CQL Canada Accreditation process.  Depending on the organization’s experience with the Personal Outcome Measures^®, the organization is expected to be involved in the collection of the Personal Outcome Measures^® data. Organizations, who have certified interviewers and/or trainers, collect most of the data with validation by CQL Canada Review Team Members.  In organizations, where experience is limited, CQL Canada collects most of the data.  The CQL Canada Review Team Members work with the organization to determine the most effective way to gather information which promotes organizational learning and assures the data are reliable.  Some examples include CQL Canada staff observing the organization’s staff conduct interviews, joint decision-making, or review of the organization’s methods for reliability.

Community assessment is a component of the review.  How does CQL Canada examine the community assessment?

The assigned surveyor will examine the process the organization used for the community assessment as well as the outcome of the assessment.  The surveyor will validate the community assessment.

How do you determine the review team size?

The size of the review team is based on several factors.  Each survey is tailored according to the number of individuals supported, the geographical area served, the variety of services provided by the agency and the number of people in the sample.

Does CQL Canada accredit organizations that provide only case management and no other services?

Yes, although the review may look slightly different from the typical organization review as the case management provider may be seen as a network.  CQL Canada may use focus groups and individual consumer/family interviews and not site visits.

Does CQL Canada accredit small agencies?

Yes, CQL Canada does accredit small agencies. 

What if several small agencies want to form an affiliation to share the cost of accreditation and one of the agencies does not meet criteria for accreditation?

CQL Canada will view those affiliated providers as a network.  During the survey, they will visit homes or sites of each participating agency.  At the end of the visit the network is either accredited or it is not.  Creating an artificial network for the purpose of accreditation is usually not advisable as systems and practice testing will apply to the network as a whole.

How often do you make changes in the accreditation criteria?

In the past, it was every three years, but the standards have remained constant for the past ten years.  We introduced the Quality Measures 2005^® in 2005 and have made improvements in our process during the last year.  The Quality Measures 2005^® has continued to be grounded in the Personal Outcome Measures^® with an increased emphasis on gathering information to demonstrate systems and practices in measuring Shared Values, Basic Assurances^®, Responsive Services^® and Community Life^®.   Because an agency will have an accreditation visit every four years with two follow–up visits within the accreditation cycle, an agency will be notified of changes and/or modifications.

How do you ensure staff alignment with values?

CQL Canada employs different techniques to ensure alignment with values as part of the Quality Measures 2005^® review.  First, the organization completes a self-assessment and CQL Canada validates the organization’s self-assessment by talking with people in the organization and community, looking at the organization’s systems and practices in services, fundraising, and all the work that you do.  We use the probes to guide us in determining the presence of the Indicators and Factors in Shared Values.

Does CQL Canada have levels of accreditation (such as a one-year, conditional, etc.)?

With the Quality Measures 2005^®, an organization is either accredited for a four-year period or not at all.  However, if an organization is unsuccessful in demonstrating 100% of the Basic Assurances^®, and has at least 34 of the Basic Assurances^® indicators present, the organization is given up to twelve months to develop and implement a plan to address any systems and practices that were not present.  An additional follow up visit may be necessary for a CQL Canada surveyor to validate the presence of any Basic Assurances^® indicators which were not present in the initial visit.

What would cause an organization to lose their accreditation?

Organizations maintain accreditation by meeting the threshold for Personal Outcome Measures^® Outcomes and Supports, continued demonstration of ongoing learning, evaluation and growth supporting Shared Values, presence of 46 Basic Assurances^® Indicators in systems and practice.  After the first year, the organization is expected to continue to meet the first year criteria, plus addressing targeted areas in Responsive Services^® and Community Life^® and demonstrated commitment to integrate Community Life^® into operations and strategic thinking.

When CQL Canada completes a report from their reviews, who receives the report?

The report is provided to the organization to be accredited.

What are the qualifications of the surveyors?

All CQL Canada surveyors have experience in supporting people in agencies just like yours; a minimum of a bachelor’s degree/community college is required, and surveyors hold broad and varied clinical backgrounds such as nursing, social work, psychology, behavioral analyst and more.  The organization may have some choice of surveyors assigned.

Will CQL Canada provide sample policies?

CQL Canada does not have “ready made” policies but we are available for technical assistance.  CQL Canada can also connect applicants with accredited providers who have developed similar policies.

What would be the initial investment for an organization?

This is a somewhat difficult question as each provider is unique. There are many options available. The organization might review the Quality Measures 2005^® materials, contact other organizations that are accredited, arrange for a consultation, or they might complete the self-assessments that are included in the Quality Measures 2005^® manuals.  They might begin by learning about and using the Personal Outcome Measures^®.  Really, this is an individual decision and can be best decided in consultation with a CQL Canada consultant.  We will consider the culture of the organization, the mission, the stated values and to what extent services are person and family centered.

What is the time commitment from the agency for preparation and management of accreditation?  How many hours may be needed?

It is difficult to specify how much time is needed.  It depends upon the size and complexity of the organization and where you may be in already achieving the outcomes.  Some larger organizations devote one or more staff positions; some smaller agencies manage it within current staff responsibilities, however, successful accreditation with CQL Canada requires all organizational members to be part of the process.

If providers agree with the person-centered philosophy and criteria but do not believe the funds are available to support the philosophy, how do they meet the criteria?

CQL Canada believes that one of the responsibilities of successful organizations is to support people using available resources creatively and efficiently.  Sometimes, that means looking outside of traditional models and being responsive to people and communities.  Quality is not about spending more money but using the resources wisely.

How is cost determined?

Cost is based on the size of the agency, number of individuals supported, geographic area served, number of interviews to be conducted, number of CQL Canada reviewers needed, and the variety of different services offered.  It is tailored to the organization. For organizations supporting fewer than 20 people or greater than 600, cost is individually negotiated.

Is the entire cost to be paid at the time of application, or can it be spread out over the accreditation cycle?

Once a provider decides to be accredited by CQL Canada a non-refundable deposit is required.  Subsequent payments are invoiced for at the time of the first validation visit, at the second validation visit and at the third visit.  All providers are given a written quote with cost clearly laid out and payment requirement over the four years.

How soon before our review should we apply?

Applications should be submitted a minimum of seven months, and sometimes up to a year, prior to the anticipated date of CQL Canada's first on-site visit.  However, we encourage organizations to contact CQL Canada as soon as the decision is made so that we may support your efforts.

How do we begin the process?

The first step after you decide if CQL Canada is a good fit for your organization is to contact CQL Canada at 705.849.4282 or bill@cqlcanada.com.  Then you can apply for accreditation.  Once the application is received by CQL Canada, you will be contacted by a representative to begin planning.  You may also request a consultation visit prior to the initial survey.  A visit will be scheduled and tailored to your organization.

For more information about the accreditation process download CQL Accreditation: An Integrated Approach to Quality .  The purpose of this manual is to outline the  Accreditation process using the Quality Measures 2005^®.  This manual provides an overview of the accreditation process beginning with the Accreditation Application and continuing through the Accreditation Partnership Agreement.