Shared Living Home Review Tool Shared Living Home Visit Review Tool IV. Residential Record: Indicate areas that have been assessed during the home visit. Additionally, if the area warrants follow-up, mark the appropriate column. Identify the concern/need in the comment section to discuss and plan for response. Assessed Record Components Additional Guidelines (In addition to MaineCare requirements, the following Follow Up prompts may be used as points to consider while assessing for health, safety and good practice) is in and documents can be located. Record Maintenance Documentation reflects provider is following written protocols, MaineCare requirements and best practices. Current, approved PCP most recent plan is contained in the record. Indication that the Routine documentation guardian is participating in planning (at the minimum signed off on the of progress notes plan). The plan is individualized for the consumer. The plan identifies all services, unmet needs etc. are meaningful, document progress toward goals outlined in the PCP. reflecting services document level of services provided according to the PCP. needs are identified and addressed appropriately. Services/Supports documentation of current status, his/her goals, authorized services etc. Documentation reflects efforts to address that the needs consumer is involved in community life, is in contact with unpaid supports and participates in decision making etc. Behavior Plans supports that the Provider is in compliance with Behavior Plans. Comments: Note details of concerns or issues to review for follow-up. Include all steps taken for follow-up on page 7 of tool. reflects at least an annual physical exam within the last Current medical (physical, dental, vision) year, timely dental and other exams. Recommendations are clearly noted & addressed. Physician the consumer is under guardianship, the documentation clearly notes the recommendations guardian was contacted prior to the consumer’s appointment/treatment. Provider tracks documentation of consent. Prior consent reflects that Physician recommendations are being for treatment implemented and followed. Comments: Note details of concerns or issues to review for follow-up. Include all steps taken for follow-up on page 7 of tool. Medication are stored and tracked appropriately. MAR is used and up to tracking system date with current medication regime. Administration policies are in place. doctor’s to prescription on file. provider is following reportable event procedure for missed and/or Prior consent re:changes refused dosages. to medication regime the consumer is under guardianship, the documentation clearly notes that the guardian was contacted prior to the changes in medications. Provider tracks documentation of consent.
Shared Living Home Review Tool Shared Living Home Visit Review Tool IV. Residential Record: Indicate areas that have been assessed during the home visit. Additionally, if the area warrants follow-up, mark the appropriate column. Identify the concern/need in the comment section to discuss and plan for response. Record Components Assessed Additional Follow Up Guidelines (In addition to MaineCare requirements, the following prompts may be used as points to consider while assessing for health, safety and good practice) Record Maintenance is in and documents can be located. Documentation reflects provider is following written protocols, MaineCare requirements and best practices. most recent plan is contained in the record. Indication that the guardian is participating in planning (at the minimum signed off on the plan). The plan is individualized for the consumer. The plan identifies all services, unmet needs etc. document progress toward goals outlined in the PCP. document level of services provided according to the PCP. needs are identified and addressed appropriately. documentation of current status, his/her goals, authorized services etc. Documentation reflects efforts to address that the consumer is involved in community life, is in contact with unpaid supports and participates in decision making etc. supports that the Provider is in compliance with Behavior Plans. Current, approved PCP Routine documentation of progress notes are meaningful, reflecting services Services/Supports needs Behavior Plans Comments: Note details of concerns or issues to review for follow-up. Include all steps taken for follow-up on page 7 of tool. Current medical (physical, dental, vision) reflects at least an annual physical exam within the last year, timely dental and other exams. Recommendations are clearly noted & addressed. the consumer is under guardianship, the documentation clearly notes the guardian was contacted prior to the consumer’s appointment/treatment. Provider tracks documentation of consent. reflects that Physician recommendations are being implemented and followed. Physician recommendations Prior consent for treatment Comments: Note details of concerns or issues to review for follow-up. Include all steps taken for follow-up on page 7 of tool. Medication tracking system are stored and tracked appropriately. MAR is used and up to date with current medication regime. Administration policies are in place. doctor’s to prescription on file. provider is following reportable event procedure for missed and/or refused dosages. the consumer is under guardianship, the documentation clearly notes that the guardian was contacted prior to the changes in medications. Provider tracks documentation of consent. Prior consent re:changes to medication regime
Shared-Living-Manual.docx