Code of Maryland Regulations
Title 10 - MARYLAND DEPARTMENT OF HEALTH
Part 3
Subtitle 12 - ADULT HEALTH
Chapter 10.12.04 - Day Care for the Elderly and Adults with a Medical Disability
Section 10.12.04.22 - Care Planning
Universal Citation: MD Code Reg 10.12.04.22
Current through Register Vol. 51, No. 19, September 20, 2024
A. Individualized Plan of Care.
(1) There shall
be an individualized plan of care completed for each participant within 30 days
following admission.
(2) The
participant shall participate in the development of the plan of care, along
with the multidisciplinary team, unless the center documents the reasons why
the participant is unable or unwilling to participate.
(3) The plan of care shall be consistent with
the comprehensive assessment and shall include a problem list.
(4) A registered nurse shall update the plan
of care within 7 calendar days of a participant's change in status, but not
less than semiannually.
(5) The
participant's plan of care shall be based on the comprehensive assessment that
is completed by registered nurse as described in Regulation .21 of this
chapter.
(6) The plan of care shall
include:
(a) Orders by a Health care
provider;
(b) All pertinent
diagnoses;
(c) Frequency and types
of services required;
(d) Treatment
goals for each type of service ordered;
(e) Rehabilitation, services, and
prognosis;
(f) Functional and
cognitive limitations;
(g) Level of
activity permitted;
(h)
Diet;
(i) Medication and treatment
or treatments;
(j) Measurable goals
for each problem or need that is identified;
(k) Goals that are realistic, practical, and
tailored to the desired outcome for the participant; and
(l) Approaches to accomplishing each
goal.
(7) The
multidisciplinary team shall document all components of the participant's care
plan in the participant's medical record;
(8) The center shall give family members, and
others designated by the individual with proper consent or responsible parties,
an opportunity to participate in the care plan meeting.
B. Attendance and Unscheduled Absences.
(1) Staff shall maintain daily records on
each participant's attended days of care.
(2) When a participant is absent on a
scheduled day, staff shall investigate on the day of the occurrence to learn
the reason for the absence and document the reason.
(3) The center shall have documentation that:
(a) Absences are reviewed on at least a
30-day basis; and
(b) Appropriate
action has been taken.
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