Health Care Assessments and Care Plans. 23. At six months from the effective date of this MOA, or shortly thereafter, the United States will assess the TSVHs to determine if the State is ensuring that adequate and appropriate health care services are offered to the residents of the TSVHs.
Health Care Assessments and Care Plans. Maple Lawn shall ensure that individuals receive accurate, complete, and timely assessment, consistent with generally accepted professional standards. More specifically, Maple Lawn shall: Conduct comprehensive health care assessments of all individuals, and repeat annually unless required more frequently by each individual’s condition. The assessments shall be sufficient to enable the physician to reach a reliable diagnosis, if applicable, for each individual. For each individual assessed as having a health care concern or concerns, a physician shall document a clinically justifiable health care diagnosis for each of the individual’s conditions. Develop and implement a system to ensure that referrals and testing procedures are completed and results are placed in the individual’s medical record within 30 days. Based on the comprehensive health care assessment, ensure that a physician develops for each individual an integrated health care plan to address any healthcare condition identified through the assessment process. Ensure that each individual’s health care plan is implemented properly, day-to-day, to meet each individual’s individualized health care needs. Ensure that assessments, diagnosis/determination, and care plans are developed by an appropriately comprised interdisciplinary team of qualified professionals who are guided by generally accepted professional standards. Each care plan shall describe the medical, nursing, and psychological needs of the individual and how such needs will be met. Identify individuals, on an on-going basis, who are at-risk or present at-risk conditions to ensure that individuals’ health statuses are monitored accurately, and that individuals who experience a significant change of status are evaluated and treated. Ensure when an individual experiences a significant change of status, a re-assessment shall be conducted. Ensure that there are trained staff, particularly RNs, LPNs, and CNAs, to provide routine, preventative, and restorative care, and to respond to individuals’ needs. Implement monthly quality assurance mechanisms to track and analyze patterns and trends to monitor the delivery of medical, nursing, and all other health care services to individuals. Each month a report shall be created that includes:
Health Care Assessments and Care Plans. Maple Lawn shall ensure that individuals receive accurate, complete, and timely assessment, consistent with generally accepted professional standards. More specifically, Maple Lawn shall:
