assessment Governing Body Rep: Medical Director: Other: Date(s) of assessment or update Date(s) assessment reviewed with QAA/QAPI committee Part 1: Our Resident Profile Numbers Indicate the number of residents you are licensed to provide care for: (enter number of beds) _____. Consider if it would also be helpful to differentiate between long-stay and short-stay residents or other categorizations (e.g., unit floors or specialty areas or units, such as those that provide care and support for persons living with dementia or using ventilators). Indicate your average daily census: (enter a range) _____. Consider if it would also be helpful to differentiate between long-stay and short-stay residents or other categorizations (e.g., unit floors or specialty areas or units, such as those that provide care and support for persons living with dementia or using ventilators). 1.2.a. Consider if it would be helpful to describe the number of persons admitted and discharged, as these processes can impact staffing needs. Number (enter average or Number (enter average or range) of persons admitted range) of persons discharged Weekday Weekend Diseases/conditions, physical and cognitive disabilities Indicate if you may accept residents with, or your residents may develop, the following common diseases, conditions, physical and cognitive disabilities, or combinations of conditions that require complex medical care and management. For example, start with this list and modify as needed. The intent is not to list every possible diagnosis or condition. Rather, it is to document common diagnoses or conditions in order to identify the types of human and material resources necessary to meet the needs of resident’s living with these conditions or combinations of these conditions.
assessment Governing Body Rep: Medical Director: Other: Date(s) of assessment or update Date(s) assessment reviewed with QAA/QAPI committee Part 1: Our Resident Profile Numbers Indicate the number of residents you are licensed to provide care for: (enter number of beds) _____. Consider if it would also be helpful to differentiate between long-stay and short-stay residents or other categorizations (e.g., unit floors or specialty areas or units, such as those that provide care and support for persons living with dementia or using ventilators). Indicate your average daily census: (enter a range) _____. Consider if it would also be helpful to differentiate between long-stay and short-stay residents or other categorizations (e.g., unit floors or specialty areas or units, such as those that provide care and support for persons living with dementia or using ventilators). 1.2.a. Consider if it would be helpful to describe the number of persons admitted and discharged, as these processes can impact staffing needs. Number (enter average or range) of persons admitted Number (enter average or range) of persons discharged Weekday Weekend Diseases/conditions, physical and cognitive disabilities Indicate if you may accept residents with, or your residents may develop, the following common diseases, conditions, physical and cognitive disabilities, or combinations of conditions that require complex medical care and management. For example, start with this list and modify as needed. The intent is not to list every possible diagnosis or condition. Rather, it is to document common diagnoses or conditions in order to identify the types of human and material resources necessary to meet the needs of resident’s living with these conditions or combinations of these conditions.
Facility%20Assessment%20Tool.docx