{"ref":"CA-HSP-IDG-02","title":"Plan of Care, 15-Day Review and Caregiver Education","category":"Hospice care","summary":"Sets out how the individualized plan of care is written from the comprehensive assessment, the nineteen items California requires it to contain, who approves and signs it (the attending physician or, only if there is none or the attending is unavailable, the Medical Director or Designee), how changes are approved in writing before they are made, the review at least every 15 days, and how caregivers are taught and their teaching recorded.","inShort":["Give care only as the current plan of care says.","Do not change the plan until the physician has approved the change in writing.","The plan is reviewed at least every 15 days.","Teach caregivers their tasks in their own language and write down what you taught.","Give written instructions on controlled substances and their safe disposal, and get a signature showing the family received and understood them."],"primaryCitation":"22 CCR §74868(c)","citations":["22 CCR §74868(b), (c), (f), (g)","22 CCR §74872","22 CCR §74892(f), (r)","Cal. Health & Safety Code §1746(l)"],"federalCitations":["42 CFR §418.56(b)-(d)","42 CFR §418.200","42 CFR §418.104(a)(1)"],"surveyorAsks":["Show me this patient's current plan of care. Who approved and signed it?","Show me the last change to the plan. Where is the physician's written approval, and was it given before the change was made?"],"forms":[{"ref":"CA-HSP-IDG-02-A","title":"Caregiver Education and Responsibilities Record"}],"headings":["Terms of Reference","1. Purpose","2. Scope","3. Definitions","4. Policy Statement (22 CCR §74868(c))","5. The Initial Plan of Care","6. Content of the Plan of Care","7. Approval and Signature","8. Modifications","9. The 15-Day Review","10. Caregiver Education","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-hospice","state":"California","service":"Hospice","guides":[{"path":"/guides/hospice-policies/","h1":"What policies are required for hospice?"},{"path":"/guides/hospice-conditions-of-participation/","h1":"Hospice Conditions of Participation: which policies each one needs"}],"agency":{"name":"Sample Agency","legalName":"Sample Agency, LLC","logo":null}}