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AL Rule Review – 69.26 Service Plans

Service plan regulatory insufficiencies (RI) are usually the highest cited RI during assisted living surveys for various reasons. As we work through the rules, examples of RIs will be provided to help programs maintain compliance.

481-69.26(1) requires that each tenant must have a service plan developed that is based on the evaluations conducted in accordance with subrules 481-69.22 and shall be designed to meet the specific service needs of the individual tenant. The service plan shall subsequently be updated annually and whenever changes are needed.

Examples of non-compliance include but are not limited to:

  • Evaluations are not completed, which indicates that the service plan was not developed or updated based on evaluations. When you initially develop the service plan – which must be done prior to taking occupancy of the apartment or unit, the evaluations must be completed first. Then once you develop the service plan, based on the evaluations, you complete the occupancy agreement. Anytime that you significantly update the service plan, evaluations (including functional, health, and cognition) must be present. DIAL includes an algorithm at the end of 481-69 that helps identify when a change is significant enough to require a significant change evaluation and updating the service plan.
  • The service plan does not include all service needs. This can include a multitude of examples but think about everything that the program needs to be aware of to provide care and services to the tenant. Some examples could include – ADL supports, assistance with medication management, wound care, catheter, mobility supports, etc.
  • The service plan is not updated. This is likely the most common concern cited and again can include a multitude of examples. Here are some to consider: therapy services added or discontinued, hospice services, change in a program provided service, behaviors and interventions, new medications that may significantly impact the tenant such as insulin or anticoagulants.

While assisted living service plans are not intended to be as detailed as a nursing home care plan, there are times when it may seem like it is. Just remember the only time someone has been cited for having too much detail on the service plan is when it’s no longer applicable and wasn’t removed.