{"ref":"CA-HH-ADM-02","title":"Initial Nursing Assessment, Start of Care, and Comprehensive Assessment","category":"Service delivery","summary":"Sets out how care starts: the Agency’s own start-of-care time frame; the registered nurse’s initial nursing assessment before any care (22 CCR §74707(a)(2)), including the initial assessment of the patient and the care environment for aide cases (§74709(a)(1)); consulting the practitioner when the initial plan does not meet the patient’s needs (§74697(c)); and, if the Agency is Medicare-certified, the initial assessment visit within 48 hours, the comprehensive assessment within 5 calendar days after the start of care with its required content, and its updates (42 CFR §484.55).","inShort":["A registered nurse sees the patient and the home before any care starts. An LVN or aide never does the first assessment.","For a therapy-only patient, the therapist may do the first assessment.","At the first visit, give the rights, advance directive, and consent forms before any treatment.","Check every medication the patient uses and record allergies where everyone can see them.","If the orders do not meet the patient’s needs, call the doctor for new orders.","Update the assessment when the patient’s condition changes or they come home from the hospital."],"primaryCitation":"22 CCR §74707(a)(2)","citations":["22 CCR §74707(a)(2)","22 CCR §74707(b)","22 CCR §74709(a)(1)","22 CCR §74697(c)","22 CCR §74743(a)","22 CCR §74711(b)(2)","22 CCR §74711(b)(7)","22 CCR §74735(a)(1)","22 CCR §74735(a)(4)"],"federalCitations":["42 CFR §484.55","42 CFR §484.55(a)","42 CFR §484.55(b)","42 CFR §484.55(c)","42 CFR §484.55(d)","42 CFR §484.60(a)(1)"],"surveyorAsks":["Who did the initial nursing assessment for this patient, and was it done before any care was given?","What is your start-of-care time frame, and did you meet it for this patient?"],"forms":[{"ref":"CA-HH-ADM-02-A","title":"Start of Care Checklist"}],"headings":["Terms of Reference","1. Purpose","2. Scope","3. Definitions","4. Policy Statement (22 CCR §74707(a)(2))","5. Scheduling the First Visit","6. Who Does the First Assessment","7. The First Visit","8. The Comprehensive Assessment","9. From Assessment to Plan of Treatment","10. Updating the Assessment","11. Responsibilities","12. Records and Compliance Monitoring","13. Staff Training","14. References","15. Related Policies and Forms","16. Approval","17. Revision History"],"version":"1.0","sample":false,"pack":"ca-hha","state":"California","service":"Home health","guides":[{"path":"/guides/home-health-agency-policies/","h1":"What policies and procedures are required for home health agencies?"},{"path":"/guides/home-health-conditions-of-participation/","h1":"Home health Conditions of Participation: which policies each one needs"}],"agency":{"name":"Sample Agency","legalName":"Sample Agency, LLC","logo":null}}