Specific results for criterion where corrective actions are required Where a standard is rated partially attained (PA) or unattained (UA) specific corrective actions are recorded under the relevant criteria for the standard. The following table contains the criterion where corrective actions have been recorded. Criterion can be linked to the relevant standard by looking at the code. For example, a Criterion 1.1.1.1: Service providers demonstrate knowledge and understanding of consumer rights and obligations, and incorporate them as part of their everyday practice relates to Standard 1.1.1: Consumer Rights During Service Delivery in Outcome 1.1: Consumer Rights. If there is a message data to display” instead of a table, then no corrective actions were required as a result of this audit. “no Criterion with desired Attainment Evidence Audit Finding Corrective action outcome Rating required and timeframe for completion (days) Criterion 1.3.3.3 PA Low The registered nurse completes an initial (i) One InterRAI assessment Ensure that InterRAI assessment within twenty-four hours of was not completed within assessments are Each stage of service admission and documents the initial care plan. twenty-one days of admission. completed within provision (assessment, Four of the four ARCC resident files reviewed The sample was increased and contractual planning, provision, identified that InterRAI assessments had been a further four new admissions in timeframes. evaluation, review, and exit) completed outside the required timeframes. the last 6 months did not have is provided within time Delays had been identified by the service prior an interRAI completed within 21 frames that safely meet the to audit and a new schedule had been days. 90 days needs of the consumer. implemented, and evidence of progress made (ii) Four InterRAI towards addressing the problem. were completed outside the six-monthly timeframe.
Specific results for criterion where corrective actions are required Where a standard is rated partially attained (PA) or unattained (UA) specific corrective actions are recorded under the relevant criteria for the standard. The following table contains the criterion where corrective actions have been recorded. Criterion can be linked to the relevant standard by looking at the code. For example, a Criterion 1.1.1.1: Service providers demonstrate knowledge and understanding of consumer rights and obligations, and incorporate them as part of their everyday practice relates to Standard 1.1.1: Consumer Rights During Service Delivery in Outcome 1.1: Consumer Rights. If there is a message “no data to display” instead of a table, then no corrective actions were required as a result of this audit. Criterion with desired outcome Attainment Rating Evidence Audit Finding Corrective action required and timeframe for completion (days) Criterion 1.3.3.3 Each stage of service provision (assessment, planning, provision, evaluation, review, and exit) is provided within time frames that safely meet the needs of the consumer. PA Low The registered nurse completes an initial assessment within twenty-four hours of admission and documents the initial care plan. Four of the four ARCC resident files reviewed identified that InterRAI assessments had been completed outside the required timeframes. Delays had been identified by the service prior to audit and a new schedule had been implemented, and evidence of progress made towards addressing the problem. (i) One InterRAI assessment was not completed within twenty-one days of admission. The sample was increased and a further four new admissions in the last 6 months did not have an interRAI completed within 21 days. (ii) Four InterRAI were completed outside the six-monthly timeframe. Ensure that InterRAI assessments are completed within contractual timeframes. 90 days
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