Md. Code Regs. 10.07.14.26 - Service Plan
A. The assisted
living manager, or designee, shall ensure that all services are provided in a
manner that respects and enhances the dignity, privacy, and independence of
each resident. A service plan for each resident shall be developed in a manner
that enhances the principles of dignity, privacy, resident choice, resident
capabilities, individuality, and independence without compromising the health
or reasonable safety of other residents.
B. Assessment of Condition.
(1) The resident's service plan shall be
based on assessments of the resident's health, function, and psychosocial
status using the Resident Assessment Tool.
(2) A full assessment of the resident shall
be completed:
(a) Within 48 hours but not
later than required by nursing practice and the patient's condition after:
(i) A significant change of condition;
and
(ii) Each nonroutine
hospitalization; and
(b)
At least annually.
(3)
When the delegating nurse determines in the nurse's clinical judgment that the
resident does not require a full assessment within 48 hours, the delegating
nurse shall:
(a) Document the determination
and the reasons for the determination in the resident's record; and
(b) Ensure that a full assessment of the
resident is conducted within 7 calendar days.
(4) A review of the assessment shall be
conducted every 6 months for residents who do not have a change in condition.
Further evaluation by a health care practitioner is required and changes shall
be made to the resident's service plan, if there is a score change in any of
the following areas:
(a) Cognitive and
behavioral status;
(b) Ability to
self-administer medications; and
(c) Behaviors and communication.
(5) If the resident's previous
assessment did not indicate the need for awake overnight staff, each full
assessment or review of the full assessment shall include documentation as to
whether awake overnight staff is required due to a change in the resident's
condition.
C. The
assisted living manager, or designee, shall ensure that:
(1) A written service plan or other
documentation sufficiently recorded in the resident's record is developed by
staff, which at a minimum addresses:
(a) The
services to be provided to the resident, which are based on the assessment of
the resident;
(b) When and how
often the services are to be provided; and
(c) How and by whom the services are to be
provided;
(2) The
service plan is developed within 30 days of admission to the assisted living
program; and
(3) The service plan
is reviewed by staff at least every 6 months, and updated, if needed, unless a
resident's condition or preferences significantly change, in which case the
assisted living manager or designee shall review and update the service plan
sooner to respond to these changes.
Notes
Regulations .26 adopted effective December 29, 2008 (35:26 Md. R. 2249)
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