From ACGME (apparently, an "unfavorable" decision for an institution also bars the institution from starting a new residency program):
Procedures for review of sponsoring institutions for compliance with the Institutional Requirements of the Essentials have been established, in addition to the process of review and accreditation of programs in graduate medical education.
The purpose of the review is to determine whether the sponsoring institution has established, documented, and implemented institutional policies as required by the Institutional Requirements of the Essentials for the governance of all residency programs under its sponsorship.
Institutions that sponsor two or more programs will undergo an institutional site visit and will have formal review by the Institutional Review Committee of the ACGME. Institutions that sponsor only one residency program will undergo an institutional review as part of their program site visit and will be reviewed by the appropriate RRC. Results of institutional review evaluation for institutions with two or more programs are reported as either favorable or unfavorable in a formal letter of report. The date of the next institutional review will be identified in this letter. Results of institutional review for institutions with a single residency are incorporated into the letter of notification concerning program accreditation.
An institution that has received an unfavorable evaluation can request another institutional review earlier than the specified review cycle. Two successive unfavorable reviews of an institution will lead to a warning and a third successive unfavorable review to the withdrawal of accreditation of all the residency programs sponsored by the institution. An appeals mechanism has been established for the latter contingency.