FLTCA Alignment: 6-Plan of care

Written plan of care for each resident with planned care, goals of care, care directions, covering all aspects of care, based on assessment of the resident. The licensee shall ensure that the plan of care covers all aspects of care including: medical, nursing, personal support, mental health, nutritional, dietary, recreational, social, palliative, restorative, religious, and spiritual care. The resident and/or substitute decision-maker shall be given the opportunity to participate fully in the development and implementation of the resident’s plan of care. The plan of care must be documented, and staff of the home must be made aware of its contents. The plan of care must be revisited and reviewed when the resident is reassessed at least every six months and any other time when a goal in the plan is met, is deemed ineffective, or the resident’s care needs change.