Ill. Admin. Code tit. 89, § 146.245 - Assessment and Service Plan and Quarterly Evaluation
a) Interview: The SLP provider shall conduct
a standardized interview geared toward the resident's service needs at or
before the time of occupancy but not before the DON, or successor tool, and
other required PAS assessments are completed and determinations provided to the
SLP provider.
b) Initial
Assessment: The SLP provider shall complete an initial assessment and service
plan within 24 hours after admission that identifies needs and potential
immediate problems. Each assessment shall be completed by, or co-signed by, a
licensed practical nurse or a registered professional nurse.
c) Comprehensive Resident Assessment: The SLP
provider shall complete a Comprehensive Resident Assessment Instrument (RAI)
within 14 days after admission, annually and upon a significant change in the
resident's mental or physical status. Each RAI shall be completed by, or
co-signed by, a registered professional nurse.
d) Service Plan: Within seven days after
completion of the RAI, a written service plan shall be developed by, or
co-signed by, a registered professional nurse, with input from the resident and
his or her designated representative. This includes coordination and inclusion
of services being delivered to a resident by an outside entity. The service
plan shall include a description of expected outcomes, approaches, frequency
and duration of services provided and whether the services will be provided by
licensed or unlicensed staff. The service plan must be individualized to
address the health and behavior needs of each resident. The service plan shall
document any services recommended by the SLP provider that are refused by the
resident. The service plan shall be reviewed and updated in conjunction with
the quarterly evaluation or as dictated by changes in resident needs or
preferences.
e) Quarterly
Evaluation: A quarterly evaluation of the health and behavior status of each
resident using a Department designated form shall be completed by, or co-signed
by, a registered professional nurse.
f) Service Plan for Identified Sex Offenders:
Within seven days after completion of the RAI, a written service plan shall be
developed by, or co-signed by, a registered professional nurse that addresses
the following:
1) the amount of supervision
required by the individual to ensure the safety of all residents, staff and
visitors; and
2) determination of
approaches developed in the service plan are appropriate and effective in
dealing with any behaviors specific to the identified offender.
g) Progress Notes: Progress notes
shall be completed at least monthly to document decline or improvement in
resident status. A progress note does not have to be completed if there is no
change in resident status. Any SLP staff may write progress notes.
h) The SLP manager or licensed nursing staff
shall alert the resident, his or her physician and his or her designated
representative when a change in a resident's mental or physical status is
observed by staff. Except in life-threatening situations, the reporting shall
be within 24 hours after the observation. Serious or life-threatening
situations should be reported to the physician and the resident's designated
representative immediately. The SLP staff shall be responsible for reporting
only those changes that should be apparent to observers familiar with the
conditions of older persons or persons with disabilities.
Notes
Amended at 33 Ill. Reg. 11803, effective August 1, 2009
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