LIC 625: Appraisal/Needs and Services Plan

The licensee and a physician, social worker or other appropriate consultant develop the plan ^[3]. "Except as provided in Section 87638(g)(3)," when an initial appraisal or a reappraisal finds a resident service need that the home's general program does not meet, § 87457(c)(2) says advice "shall then be obtained from a physician, social worker, or other appropriate consultant" on whether the home can meet it. If it can, "the licensee and the consultant shall develop a plan of action" ^[3]. Section 87638(g)(3) covers the appraisal or reappraisal that the licensee sends with a resident's request to review a health condition relocation order ^[11]. The resident or the responsible person takes part in developing the appraisal ^[3].

The form has three signature lines, each with a date ^[1]:

• the licensee(s)
• the resident's authorized representative, facility social worker, physician or other appropriate consultant
• the resident or authorized representative, who agrees to release the assessment to the licensee "with the condition that it will be held confidential"

Above the licensee's signature, the form has a statement made "under penalty of perjury that the above information is true and correct to the best of my knowledge," and says an electronic signature is the legal equivalent of a handwritten one ^[1].

The top of the form asks for the resident's name, birth date, age and sex, the facility name, address and license number, who referred the resident, and a box for "Admission" or "Update" ^[1].

The plan follows an appraisal. Before admission the home completes a suitability determination that includes an appraisal of the person's service needs ^[3]. The plan comes up when "an initial appraisal or any reappraisal" finds an unmet need ^[3]. Neither § 87457(c)(2) nor the form gives a number of days for the plan ^[3][1].

Each plan sets its own time frames. The rule asks for "Objectives, within a time frame," and the form has a "Time frame" column for each need ^[3][1].

Updates. The form has an "Update" box ^[1]. The appraisal "shall be updated in writing as frequently as necessary or once every 12 months, whichever occurs first," and that reappraisal can find a new unmet need, which is the trigger for a plan ^[4][3].

CDSS lists the appraisal and "Appraisal Need and Services Plan, when applicable (LIC 625)" under "Residents Records." CDSS says these records "must be kept in the facility complete and current, and readily available for review" ^[2]. That list is dated 4/05.

Section 87506(a) requires a record for each resident, in the facility or at a central administrative location readily available to licensing staff. Item (b)(17)(A) puts "documents and information required by" § 87457 in that record ^[5]. Section 87505 requires the findings of the appraisal and any reappraisal to be documented in writing ^[7].

How long to keep it. Section 87506(e): "Original records or photographic reproductions shall be retained for a minimum of three (3) years following termination of service to the resident" ^[5]. Section 87506 does not name LIC 625 ^[5].

Resident records are confidential, and the licensee is responsible for storing them and safeguarding what they contain ^[5].

• The four parts of a plan of action. Section 87457(c)(2) says it "shall include" objectives within a time frame, plans for meeting the objectives, the individuals or agencies responsible for each part, and a method of evaluating progress ^[3].
• The form's columns. The form has columns for needs, objective/plan, time frame, person(s) responsible for implementation and method of evaluating progress ^[1].
• The need areas. The form groups needs as socialization, emotional, mental, physical/health and functioning skills ^[1].
• Background. The form opens with a box for the resident's medical history, conditions, functional limitations and capabilities, and likes and dislikes ^[1].
• The licensee's statements. The licensee signs a statement that the person "is compatible with the facility program" and "does not need skilled nursing care" to the licensee's best knowledge ^[1].