Or. Admin. Code § 333-536-0065 - Service Plan
(1) For clients
receiving any service(s) described in OAR 333-536-0045, the service(s) provided
shall be in accordance with a written service plan developed in collaboration
with a client or the client's representative based on the client's or the
client's representative's request and an agency evaluation of the client. The
service plan must be consistent with the agency's capabilities.
(2) The agency administrator, administrator's
designee or administrator's delegate shall conduct and document an initial
evaluation of the client including but not limited to the client's physical,
mental and emotional needs. The evaluation must be dated, and signed by the
individual who conducted the evaluation, and maintained in the client's agency
record.
(3) The agency
administrator, administrator's designee, or administrator's delegate, in
collaboration with the client or the client's representative, shall complete a
written service plan within seven days after the initiation of services. The
service plan:
(a) May be developed and
maintained in electronic form;
(b)
Shall include a list of individuals participating in the development of the
plan; and
(c) Shall be signed and
dated when it is complete and acceptable to all individuals participating in
the development of the plan.
(4) The completed service plan shall be
client-directed or client representative-directed and include at least the
following:
(a) A comprehensive list of client
information including but not limited to:
(A)
Client's name, address, and telephone number;
(B) The client's medical
condition(s);
(C) The types of
services being received, including but not limited to:
(i) Medication services - include the tasks
to be performed and who will perform the tasks; and
(ii) Nursing services - include current
identification of the delegated specific nursing procedures to be provided and
specify the caregivers to whom the nursing procedure(s) have been
delegated.
(D) The name
of the client's primary care provider;
(E) Any special instructions or notations
pertinent to providing services including, but not limited to,
allergies;
(b) The
schedule for the provision of services specifying a range of hours for services
per month;
(c) The services to be
provided, specifying the tasks to be conducted; and
(d) Pertinent information about the client's
needs in relation to the services to be provided to ensure the provision of
safe and appropriate care.
(5) The administrator, the administrator
designee or administrator's delegate must review the client's service plan with
each caregiver before the initial delivery of client care.
(a) Each caregiver providing in-home care
services to the client must confirm that the service plan was reviewed prior to
providing client care.
(b) The date
of the review(s), the signature or a unique electronic identifier such as an
individual's log-in and password into a computer program or an electronic stamp
of the agency administrator, administrator's designee, or administrator's
delegate and each caregiver must be documented in the client's
record.
(c) A list of assigned
caregivers must be documented in the client's record.
(6) A client or a client's representative may
request changes in the service plan. All changes must be reviewed and approved
by the agency and must be communicated to the caregiver(s) and documented in
the client's record.
(7) An agency
shall maintain the original service plan and all updated service plans in each
client's agency record. Complete and legible copies of the service plan(s)
shall be given to the client or client's representative upon request.
Notes
Statutory/Other Authority: ORS 443.340
Statutes/Other Implemented: ORS 443.340
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