Care Planning. You must ensure that:
a. each Resident has a Care Plan that is based on assessments of the Resident carried out using interRAI, and that all staff follow the Care Plan;
b. at the time of admission an initial Care Plan is developed and documented based on information from the Resident's most recent interRAI home care assessment carried out in accordance with clause D16.1, and on any other information relevant to the initial Care Plan;
Care Planning. You must ensure that:
a. staff providing support and care follow the Care Plan for each Resident;
b. the following are included in each Resident’s Care Plan, and are based on the Resident's assessment under clause E4.2:
Care Planning. You must ensure that:
a. each Resident has a Care Plan that is based on assessments of the Resident carried out using interRAI, and that all staff follow the Care Plan;
b. at the time of admission an initial Care Plan is developed and documented based on information from the Resident's most recent interRAI assessment carried out in accordance with clause D16.1, and on any other information relevant to the initial Care Plan;
c. each Care Plan is developed, documented, and evaluated by a Registered Nurse, and informed by interRAI, within 21 days of the Resident’s admission to your Unit. The Registered Nurse is responsible for ensuring the Plan reflects the Resident's assessed physical, sensory, cognitive, psycho-social, spiritual, and cultural abilities, issues, and needs;
d. the Registered Nurse who develops the Resident’s Care Plan considers the experiences and choices of each Resident in accordance with clauses D3 and D4;
e. each Resident and, if applicable, his or her family/whānau or nominated representative, have the opportunity to have input into the Resident’s care planning process;
f. each Resident’s Care Plan:
i. describes the Resident’s current abilities, level of independence, identified needs and issues, taking into account as far as practicable the Resident’s personal preferences and individual habits, routines, and characteristics;
ii. includes prevention-based strategies for minimising episodes of challenging behaviours;
iii. describes how the behaviour of the Resident is best managed over a 24 hour period;
iv. describes the activities that meet that Resident’s needs in relation to individual diversional, motivational, and recreational therapy during the 24-hour period. These activities must, to the extent clinically appropriate, reflect the Resident’s former routines and activities that are still familiar to the Resident;
v. addresses personal care needs, health care needs, rehabilitation/habilitation needs, maintenance of function needs and care of the dying; and
vi. focuses on the Resident and states actual or potential problems and issues, sets goals for addressing these and details required interventions; and
g. short-term needs together with planned interventions are documented either by amending the Care Plan or as a separate short-term Care Plan attached to the Care Plan.
Care Planning. On-going amendments: The agency may make changes to the care plan as the need arises on the basis that the resident’s representative will receive the latest version every three months. Photographs: The home is permitted to hold photographs of the resident for identification purposes and care records.
Care Planning. You must ensure that:
a. staff providing support and care follow the Care Plan for each Resident;
b. the following are included in each Resident’s Care Plan, and are based on the Resident's assessment under clause E4.2:
i. a description of the Resident's current abilities, level of independence, identified needs/deficits, habits, routines, and behavioural characteristics;
ii. prevention-based strategies for minimising episodes of challenging behaviours;
iii. a description of how the behaviour of the Resident is best managed over a 24 hour period; and
iv. a description of the activities that meet the Resident's needs in relation to individual diversional, motivational, and recreational therapy during the 24 hour period. These activities must, to the extent clinically appropriate, reflect the Resident's former routines and activities that are still familiar to the Resident.
a. You must ensure that support and care is flexible and individualised, focusing on the promotion of quality of life, and must minimise the need for restrictive practices through the management of challenging behaviour.
b. You must provide each Resident with appropriate activities which ensure diversion at appropriate times during the day, in accordance with the needs identified in the Care Plan of each Resident, and ensure that staff implement these activities each day.
c. Your staff must build a supportive relationship with the Residents. The goals of the supportive relationship are to relieve anxiety and maintain a sense of trust, security and self-worth.
d. You must ensure that involvement of family/whānau and support is promoted at all times.
Care Planning. Contractor shall designate an administrative employee whose position description includes shared responsibility with the QMHP for scheduling, facilitating, coordinating, overseeing and documenting the weekly IDT meetings and quarterly Care Planning meetings pursuant to OAR Chapter 411, Division 086 rules. The IDT meetings must:
a. Include the following persons: Individual and/ or their legal representative, Administrator or designee, RN, Social Services Coordinator, Activities Coordinator, QMHP and LMP. ODHS Designee, Contract Administrator and health care providers shall be invited to participate in the IDT as needed.
b. Be scheduled at a time that is convenient for team members to attend. CMHP and facility care planning functions are expected to be integrated into these weekly IDT meetings.
c. Review changes in Individual-specific medical or behavioral status, critical incidents, modify Behavior Plans and discuss other clinical and Nursing Facility operational issues, including any necessary staffing changes required to promote resident safety and stability, on a weekly basis.
d. Review each Individual’s response to scheduled and PRN medications prescribed for management of psychiatric or behavioral symptoms with the LMP.
e. Document participation and attendance in the weekly IDT and quarterly Care Plan meetings. Virtual participation is acceptable but must be documented. Team members who are unable to attend the meeting must receive copies of the updated Care Plans.
f. Implement policies and procedures for communicating and documenting Behavior Plan and Care Plan changes to Contractor’s direct care staff in a timely manner. Review of the Care Plan by Contractor’s staff must be documented.
g. Define timeframes and protocols for assessments and comprehensive Care Plan and Behavior Plan development as specified in the Memorandum of Understanding between Contractor and CMHP.
h. Ensure the Care Plan, in addition to licensure requirements:
(1) Describes the reasons the Individual continues to require Services under this Contract;
(2) Describes the Individual’s progress towards meeting discharge goals, their potential to transition to a less intensive program and strategies to address barriers to these goals.
i. Designate a member to review the Care Plan with the Individual in a manner which encourages the Individual’s fullest participation possible in the planning process, assures the Individual’s preferences, goals and ability to self-direct are maximized an...
Care Planning. Hospice and Facility shall permit each other to attend care planning meetings involving any Resident under Hospice’s care. Each party may reasonably request that a care planning meeting be held with the other to the extent such party has identified specific concerns involving the care of a Resident under Hospice’s care.
Care Planning. 12The Provider shall be responsible for preparing and updating the Care Plans for all Service Users as appropriate in its provision of the Services.
Care Planning. The insurance covers care planning and booking of private medical care. Care planning and booking of care can only take place during office hours. Emergency medical care cannot be booked by Euro Accident’s Medical Call Center.
Care Planning. A resident has the right to be fully informed of the resident’s treatment and care and to participate in the planning of treatment and care and changes in treatment and care.
