GRAPH
angiebell1
MONTHLYRECORDREVIEW.xlsxNC- Waiver Audit Results
| Operation: | ||||||||||||||||||
| Review Date: | Average Score | Number of Records Reviewed | ||||||||||||||||
| Individual Initials: | ||||||||||||||||||
| Overall Score: | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | 0 |
| Results | % Successful | |||||||||||||||||
| Section 1: Admission | ||||||||||||||||||
| Abbreviation List is current (F5.30) | 0% | |||||||||||||||||
| Person Served Profile (F2.1) | 0% | |||||||||||||||||
| Person Served Photo (F2.2) | 0% | |||||||||||||||||
| Intake Screening (F2.33) | 0% | |||||||||||||||||
| Admission Assessment (F2.3) | 0% | |||||||||||||||||
| Original LOE - do not purge | 0% | |||||||||||||||||
| Original Provider Choice Statement (F10.6)-do not purge | 0% | |||||||||||||||||
| Orientation / Annual Checklist (F2.30) - signed by QP & LRP | 0% | |||||||||||||||||
| CANC Consumer Information Form (F2.44)- updated when change of location/service/funding | 0% | |||||||||||||||||
| Admissions Agreement (F4.28) | 0% | |||||||||||||||||
| Section 2: Authorizations | ||||||||||||||||||
| Service Authorization - current for all services | 0% | |||||||||||||||||
| Section 3: Consents- updated annually unless otherwise indicated | ||||||||||||||||||
| Consent for Services (F4.7) | 0% | |||||||||||||||||
| Consent for Emergency Medical Services (F4.4) | 0% | |||||||||||||||||
| Consent to Enter (F4.25) | 0% | |||||||||||||||||
| General Consent (F4.10) | 0% | |||||||||||||||||
| Freedom of Choice Medical (F4.25)-NA for Periodic | 0% | |||||||||||||||||
| Community Vendors Choice Selection Form (F4.33) | 0% | |||||||||||||||||
| Consent for Medications (F4.3) Present for ALL MEDICATION - NA for Periodic if no meds given by staff | 0% | |||||||||||||||||
| Rights Acknowledgement (F4.2) | 0% | |||||||||||||||||
| Service Charge (F4.13) | 0% | |||||||||||||||||
| ResCare Notice of Privacy Practices (F4.23) | 0% | |||||||||||||||||
| Consent to Manage Funds (F4.5) -NA for Periodic | 0% | |||||||||||||||||
| Individual Grievance Process Acknowledgement (F4.34) - do not purge | 0% | |||||||||||||||||
| Verification of Receipt of Rights Manual / Welcome to Your New Home / Welcome to CANC (do not purge) | 0% | |||||||||||||||||
| Consent for Volunteer (F4.8) - per event, as needed | 0% | |||||||||||||||||
| Consent for Photo (F4.9) - per event, as needed | 0% | |||||||||||||||||
| Section 4: Legal | ||||||||||||||||||
| Guardianship / Custody Paper - if applicable | 0% | |||||||||||||||||
| Court Documents/orders - if applicable | 0% | |||||||||||||||||
| Copy of Current Medicaid Card - if applicable | 0% | |||||||||||||||||
| Other Miscellaneous Legal Documents- if applicable | 0% | |||||||||||||||||
| Section 5: Life Skills Assessments | ||||||||||||||||||
| Individual Self Assessment (F2.13) | 0% | |||||||||||||||||
| Recreation / Leisure Assessment (F2.8) | 0% | |||||||||||||||||
| Community / Home Life Assessment (F2.12) | 0% | |||||||||||||||||
| Human Development Assessment (F2.11) -NA for Periodic | 0% | |||||||||||||||||
| Choking Assessment (F2.45) | 0% | |||||||||||||||||
| Pneumonia Assessment (ResCare Form) -NA for Periodic | 0% | |||||||||||||||||
| Self Administration of Medication Assessment (SAM) -NA for Periodic | 0% | |||||||||||||||||
| Unsupervised time Assessment (F2.48) -NA for Periodic | 0% | |||||||||||||||||
| Vocational / Educational Assessment - if applicable | 0% | |||||||||||||||||
| Section 6: Evaluation | ||||||||||||||||||
| Psychological Evaluation | 0% | |||||||||||||||||
| NC SNAP -if applicable | 0% | |||||||||||||||||
| RISK Assessment | 0% | |||||||||||||||||
| SIS | 0% | |||||||||||||||||
| Additional Evaluations - IEP, other agency, etc. | 0% | |||||||||||||||||
| Section 7: Releases | ||||||||||||||||||
| Release to Disclose Information (F4.11, 4.11A) | 0% | |||||||||||||||||
| Release of Information Tracking Form (F4.16) | 0% | |||||||||||||||||
| Section 8: Medical (all items NA for Periodic unless staff is responsible for assisting with medications. Items marked Periodic should be in place when staff are assisting with medications.) | ||||||||||||||||||
| HART- completed in prior 12 months or when i) a significant health related change is observed or ii) health concerns identified in the assessment are addressed in the service plan for that person | 0% | |||||||||||||||||
| Acute and chronic health concerns are followed up by the appropriate health specialist | 0% | |||||||||||||||||
| Appointments are conducted on time and return appointments are scheduled and attended. MD recommendations are followed/implemented. | 0% | |||||||||||||||||
| Review medical consults and verify that recommendations have been followed | 0% | |||||||||||||||||
| Routine Medical Services | ||||||||||||||||||
| Physician orders present -PERIODIC | 0% | |||||||||||||||||
| Routine Standing Orders are current | 0% | |||||||||||||||||
| MAR Present -PERIODIC | 0% | |||||||||||||||||
| MAR has signatures -PERIDOC | 0% | |||||||||||||||||
| PRN medications documented correctly | 0% | |||||||||||||||||
| MAR matches physician orders -PERIODIC | 0% | |||||||||||||||||
| Physical exam - completed within the last 12 months | 0% | |||||||||||||||||
| Testicular exam | 0% | |||||||||||||||||
| GYN / PAP | 0% | |||||||||||||||||
| Breast exam | 0% | |||||||||||||||||
| Mammogram | 0% | |||||||||||||||||
| Annual TB screening / chest X-Ray | 0% | |||||||||||||||||
| Other immunizations (flu, pneumonia, tetanus, etc.) | 0% | |||||||||||||||||
| Audiology - every 5 years | 0% | |||||||||||||||||
| Dental - every 6 months | 0% | |||||||||||||||||
| Vision - every 2 years | 0% | |||||||||||||||||
| PSA Test - men over 50 | 0% | |||||||||||||||||
| Labs - done per physician order | 0% | |||||||||||||||||
| Neurology | 0% | |||||||||||||||||
| Cardiology | 0% | |||||||||||||||||
| Orthopedics | 0% | |||||||||||||||||
| Other Medical Specialties | 0% | |||||||||||||||||
| PT | 0% | |||||||||||||||||
| OT | 0% | |||||||||||||||||
| Speech | 0% | |||||||||||||||||
| Seizure Management Plan - as applicable | 0% | |||||||||||||||||
| Seizures are documented - as applicable | 0% | |||||||||||||||||
| Diet orders are present and match what is known by staff | 0% | |||||||||||||||||
| Psychiatric med management - every 90 days | 0% | |||||||||||||||||
| AIMS completed - every 6 months if receiving psych meds | 0% | |||||||||||||||||
| Section 9: Individual Support Plan | ||||||||||||||||||
| ISP/PCP is current and includes diagnosis, strengths, preferences, and problems/needs | 0% | |||||||||||||||||
| ISP/PCP is current and contains recommendations based on assessments | 0% | |||||||||||||||||
| Strategies / plans are in place to assist with development of casual social connections | 0% | |||||||||||||||||
| Signed by person served, family/LRP, and QP | 0% | |||||||||||||||||
| Crisis plan is present | 0% | |||||||||||||||||
| Cost summary is present -Innovation Waiver only | 0% | |||||||||||||||||
| Current Behavior Support Plan -if applicable | 0% | |||||||||||||||||
| BSP Consent - if applicable | 0% | |||||||||||||||||
| Section 10: Service Notes | ||||||||||||||||||
| Short range goals/methodology match LTGs for current ISP | 0% | |||||||||||||||||
| Short range goals/methodology signed by LRP | 0% | |||||||||||||||||
| Goals on grid match those in the Short Term Goals Action Plan | 0% | |||||||||||||||||
| Grids have name, record #, and Medicaid # on each page | 0% | |||||||||||||||||
| All goals are documented or reason not run is on reverse | 0% | |||||||||||||||||
| Date is complete mm/dd/yyyy | 0% | |||||||||||||||||
| Initials present for each day | 0% | |||||||||||||||||
| Staff signature is present on the back of each page, and includes job title | 0% | |||||||||||||||||
| Trained per frequency in plan/authorization | 0% | |||||||||||||||||
| QP Quarterly Reviews are current (based on ISP date) and reflect status of goals / service | 0% | |||||||||||||||||
| QP Quarterly Reviews are signed and dated by QP - must include written signature and date | 0% | |||||||||||||||||
| For Cardinal Members: Preference Assessment is completed quarterly | 0% | |||||||||||||||||
| Documentation present to show coordination of services by QP- QP anecdotal notes or emails | 0% | |||||||||||||||||
| Section 11: Correspondence | ||||||||||||||||||
| Verification of Family/Guardian as Direct Support Employee -as applicable | 0% | |||||||||||||||||
| Monthly Budget/Money Disbursement or NDC Statement -NA for Periodic | 0% | |||||||||||||||||
| Asset List (F2.4) Residential Services Only | 0% | |||||||||||||||||
| Yes | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
| No | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
| N/A | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
| total scored | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
| percentage achieved | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | |
Community Living - North Carolina ICF/ IDD Services Record Review Results Summary
NC- ICF Audit Results
| Operation: | ||||||||||||||||||
| Review Date: | Average Score | Number of Records Reviewed | ||||||||||||||||
| Individual Initials: | ||||||||||||||||||
| Overall Score: | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | 0 |
| Results | % Successful | |||||||||||||||||
| Section 1: Record System | ||||||||||||||||||
| Abbreviation List is current (F5.30) | 0% | |||||||||||||||||
| Section 2: Identifying Information | ||||||||||||||||||
| Consumer Profile (F2.1) | 0% | |||||||||||||||||
| Consumer Photo (F2.2) | 0% | |||||||||||||||||
| Copy of Social Security Card | 0% | |||||||||||||||||
| Copy of North Carolina ID | 0% | |||||||||||||||||
| Birth Certificate | 0% | |||||||||||||||||
| Section 3: Personal Schedule | ||||||||||||||||||
| Daily Personal Schedule (F2.6) | 0% | |||||||||||||||||
| Section 4: Transition | ||||||||||||||||||
| Intake Screening (F2.33) | 0% | |||||||||||||||||
| Transition Checklist (F2.5) - as applicable | 0% | |||||||||||||||||
| Admission Assessment (F2.3) | 0% | |||||||||||||||||
| Orientation / Annual Checklist (F2.30) - signed by QP & LRP | 0% | |||||||||||||||||
| Provider Choice Statement (F10.6) | 0% | |||||||||||||||||
| Plan for first 30 Days living in the Home | 0% | |||||||||||||||||
| Discharge Summary (F2.22) - as applicable | 0% | |||||||||||||||||
| If Deceased, Report of Death of a Consumer (F6.6) - as applicable | 0% | |||||||||||||||||
| Burial Instructions (F4.14) | 0% | |||||||||||||||||
| Section 5: Individual Support Plan | ||||||||||||||||||
| ISP/PCP is current and includes diagnosis, strengths, preferences, and problems/needs | 0% | |||||||||||||||||
| ISP/PCP is current and contains recommendations based on assessments | 0% | |||||||||||||||||
| Strategies / plans are in place to assist with development of casual social connections | 0% | |||||||||||||||||
| Individual Served attended ISP - signature or mark on attendance sheet | 0% | |||||||||||||||||
| ISP signed by Guardian/LRP | 0% | |||||||||||||||||
| Priority needs are identified and match WTPs | 0% | |||||||||||||||||
| Person served funds to carry match info in CHL | 0% | |||||||||||||||||
| Section 5.3: Program Goals | ||||||||||||||||||
| Goals are single outcome | 0% | |||||||||||||||||
| Goals are measurable | 0% | |||||||||||||||||
| Trained per frequency | 0% | |||||||||||||||||
| Goals revised as needed | 0% | |||||||||||||||||
| Met goals are replaced with new goals in a timely manner | 0% | |||||||||||||||||
| Section 5.4: Addendum | ||||||||||||||||||
| IDT/special Team Meeting have signatures | 0% | |||||||||||||||||
| Quarterly Summary or Monthly Core Team Meetings are present | 0% | |||||||||||||||||
| Section 5.5: Monthly Review | ||||||||||||||||||
| Monthly QP Review (F2.34) are current and reflect status of goals/service | 0% | |||||||||||||||||
| QP Monthly Reviews are signed and dated by QP - must include written signature and date | 0% | |||||||||||||||||
| Section 6.2: Communication | ||||||||||||||||||
| Speech Therapy Assessment - as applicable | 0% | |||||||||||||||||
| Quarterly Speech Therapy Notes - as applicable | 0% | |||||||||||||||||
| Notation that service is not needed - as applicable | 0% | |||||||||||||||||
| Section 6.3: Employment/Educational Assessment | ||||||||||||||||||
| Employment/Educational/Vocational Assessment (F2.10) - as applicable | 0% | |||||||||||||||||
| Quarterly Vocational Updates - as applicable | 0% | |||||||||||||||||
| Educational/Vocational Summary (F2.14)- school age children as applicable | 0% | |||||||||||||||||
| Individual education Plan (IEP) - school age children | 0% | |||||||||||||||||
| Section 6.4: Life Skills | ||||||||||||||||||
| Community Home Life Assessment (F2.12) | 0% | |||||||||||||||||
| Human Development Assessment (F2.11) | 0% | |||||||||||||||||
| Individual Self-Assessment (F2.13) | 0% | |||||||||||||||||
| Section 6.5: Nutrition | ||||||||||||||||||
| Nutrition Assessment (F5.19) | 0% | |||||||||||||||||
| Quarterly Nutrition Notes | 0% | |||||||||||||||||
| Diet History | 0% | |||||||||||||||||
| Section 6.6: Occupational Therapy | ||||||||||||||||||
| Occupational Therapy Assessment - as applicable | 0% | |||||||||||||||||
| Quarterly Occupational Therapy Notes - as applicable | 0% | |||||||||||||||||
| Notation that service is not needed - as applicable | 0% | |||||||||||||||||
| Section 6.7: Physical Therapy | ||||||||||||||||||
| Physical Therapy Assessment - as applicable | 0% | |||||||||||||||||
| Quarterly Physical Therapy Notes - as applicable | 0% | |||||||||||||||||
| Notation that service is not needed - as applicable | 0% | |||||||||||||||||
| Section 6.8: Psychology | ||||||||||||||||||
| Behavior Support Plan | 0% | |||||||||||||||||
| BSP Consent | 0% | |||||||||||||||||
| Behavioral Monthly Note (F7.6) | 0% | |||||||||||||||||
| Functional Behavioral Assessment (F7.7) | 0% | |||||||||||||||||
| Psychological Evaluation | 0% | |||||||||||||||||
| Psychological Assessment - annual | 0% | |||||||||||||||||
| Section 6.9: Psychiatric | ||||||||||||||||||
| Psychiatric Assessment | 0% | |||||||||||||||||
| Psychiatric Consult Report | 0% | |||||||||||||||||
| AIMS (F5.5) - every 6 months | 0% | |||||||||||||||||
| Section 6.10: Recreation | ||||||||||||||||||
| Recreation / Leisure Assessment (F2.8) | 0% | |||||||||||||||||
| Section 6.11: Social | ||||||||||||||||||
| Visitation/Communication Record (F2.27) - completed forms | 0% | |||||||||||||||||
| Community Participation/Home Activity Form (F2.23) - completed forms | 0% | |||||||||||||||||
| Section 7: Medical | ||||||||||||||||||
| Medical Consultation Report (F5.29) - separated and tabbed by medical specialty | 0% | |||||||||||||||||
| Acute and chronic health concerns are followed up by the appropriate health specialist | 0% | |||||||||||||||||
| Appointments are conducted on time and return appointments are scheduled and attended | 0% | |||||||||||||||||
| MD recommendations are followed/implemented - Review medical consults and verify that recommendations have been followed | 0% | |||||||||||||||||
| Section 7.2: Audiology | ||||||||||||||||||
| Audiological Examination - every 5 years | 0% | |||||||||||||||||
| Audiological Screening (F5.52) - completed by nurse on years when audiology exam not done | 0% | |||||||||||||||||
| Section 7.3: Dental | ||||||||||||||||||
| Dental Examination (F5.2) - every 6 months | 0% | |||||||||||||||||
| Section 7.4: Physical | ||||||||||||||||||
| Annual Physical Examination (F5.1) | 0% | |||||||||||||||||
| GYN / PAP | 0% | |||||||||||||||||
| Testicular exam | 0% | |||||||||||||||||
| Physician Orders are current | 0% | |||||||||||||||||
| Routine Standing Orders are current | 0% | |||||||||||||||||
| MAR are present (paper MAR as needed) | 0% | |||||||||||||||||
| Paper MAR has signatures | 0% | |||||||||||||||||
| MAR has PRN medications documented correctly | 0% | |||||||||||||||||
| MAR matches physician orders | 0% | |||||||||||||||||
| Section 7.6: Visual Screening | ||||||||||||||||||
| Vision Examination (F5.4)- every 2 years | 0% | |||||||||||||||||
| Vision Screening (F5.53) - completed by nurse on year when vision exam not done | 0% | |||||||||||||||||
| Section 7.7: Laboratory Screening | ||||||||||||||||||
| PSA Test - men over 50 | 0% | |||||||||||||||||
| Labs | 0% | |||||||||||||||||
| Section 7.8: Health | ||||||||||||||||||
| Annual TB screening / chest X-Ray | 0% | |||||||||||||||||
| Other immunizations (flu, pneumonia, tetanus, etc.) | 0% | |||||||||||||||||
| Immunization/Communicable Disease Record (F5.28) | 0% | |||||||||||||||||
| Intake/Output record (F5.33) - as applicable | 0% | |||||||||||||||||
| Medication History Record (F.10) | 0% | |||||||||||||||||
| Pharmacy Assessment | 0% | |||||||||||||||||
| Pharmacy Review (F5.9) | 0% | |||||||||||||||||
| Seizure Observation Record (F5.16) - as applicable | 0% | |||||||||||||||||
| Seizure Precautionary Statement (F5.14)- as applicable | 0% | |||||||||||||||||
| Monthly Seizure Summary Report (F5.15) - as applicable | 0% | |||||||||||||||||
| Section 8.1: Health Services Summary | ||||||||||||||||||
| Health Services Summary (F5.24) | 0% | |||||||||||||||||
| Annual Nursing Assessment (F5.48) | 0% | |||||||||||||||||
| Nursing Intake/Assessment | 0% | |||||||||||||||||
| Health Care Plan (F5.22) as applicable | 0% | |||||||||||||||||
| Section 8.2: Nursing Monthly Summary | ||||||||||||||||||
| Nursing Monthly Summary (F5.23) | 0% | |||||||||||||||||
| Section 8.3: Physical Observation/Nursing Notes | ||||||||||||||||||
| Nurse's Notes (F5.36) | 0% | |||||||||||||||||
| Section 8.4: Medication/Treatment Administration | ||||||||||||||||||
| Monthly MAR/TAR | 0% | |||||||||||||||||
| Section 9: Consents | ||||||||||||||||||
| Consent for Services (F4.7) | 0% | |||||||||||||||||
| Consent for Emergency Medical Services (F4.4) | 0% | |||||||||||||||||
| Consent to Enter (F4.25) | 0% | |||||||||||||||||
| General Consent (F4.10) | 0% | |||||||||||||||||
| Freedom of Choice Medical (F4.25) | 0% | |||||||||||||||||
| Consent for Medications (F4.3) Present for ALL MEDICATION | 0% | |||||||||||||||||
| Consent to Manage Funds (F4.5) | 0% | |||||||||||||||||
| Consent for Volunteer Activities (F4.8) event specific | 0% | |||||||||||||||||
| Consent for Photo Release (F4.9) event specific | 0% | |||||||||||||||||
| Rights Acknowledgement (F4.2) | 0% | |||||||||||||||||
| Service Charge (F4.13) | 0% | |||||||||||||||||
| ResCare Notice of Privacy Practices (F4.23) | 0% | |||||||||||||||||
| Release to Disclose Information (F4.11, 4.11A) | 0% | |||||||||||||||||
| Admissions Agreement (F4.28) | 0% | |||||||||||||||||
| Verification of Receipt of Rights Manual / Welcome to Your New Home / Welcome to CANC | 0% | |||||||||||||||||
| Tracking of Release to Disclose Information (F4.16) Kept in record and separate file | 0% | |||||||||||||||||
| Individual Grievance Process Acknowledgement (F4.34) | 0% | |||||||||||||||||
| Section 10: Financial/Budget Plan | ||||||||||||||||||
| Asset List (F2.4) | 0% | |||||||||||||||||
| SSI/SSA Correspondence | 0% | |||||||||||||||||
| Section 11: Legal | ||||||||||||||||||
| Guardianship Documents | 0% | |||||||||||||||||
| Section 13: Correspondence | ||||||||||||||||||
| Correspondence to/from Guardian/Family | 0% | |||||||||||||||||
| Client Funds Statements/Cover Letter | 0% | |||||||||||||||||
| Yes | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
| No | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
| N/A | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
| total scored | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
| percentage achieved | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | ERROR:#DIV/0! | |
Community Living - North Carolina ICF/ IDD Review &12Record Review Results Summary
Monthly Planner
| Monthly Operational Record Audit Planning Tool | ||||||||||||||||||||
| In order to assist in organizing your operations Record Audits for the year: 1.) Insert the Names of your individuals (delete examples!) 2.) Indicate the month that the review will be conducted. Be sure to choose records from across caseloads/ homes. 3.) mark the date review was completed (This information should be maintained by the person that coordinates the reviews and not shared with team members within the operation. Announce the scheduled reviews each month) | ||||||||||||||||||||
| x | Home | Line of Business | January | February | March | April | May | June | July | August | September | October | November | December | Completed date | |||||
| Example: S. Smith | Maplewood | ICF/IDD | X | |||||||||||||||||
| C. Flowers | Basswood | Waiver/ HCS | X | |||||||||||||||||
| L. Wall | Treeline | Foster | X | LOB | ||||||||||||||||
| R. Cramer | Idaho Street | Waiver/ HCS | X | ICF/IDD | ||||||||||||||||
| Waiver/ HCS | ||||||||||||||||||||
| Host | ||||||||||||||||||||
| Foster | ||||||||||||||||||||
| Periodic | ||||||||||||||||||||
| other | ||||||||||||||||||||
Summary
| Record Review Summary for Month of: | |||
| Operation: | 0 | ||
| Line of Business | Average Score | Number of Reviews Completed | |
| Waiver Results | ERROR:#DIV/0! | 0 | |
| ICF Results | ERROR:#DIV/0! | 0 | |
| Totals | ERROR:#DIV/0! | 0 |
