Section 47. Resident Care Planning

A. Developmental and content of care plans: Except In the case of a person admitted for short-term care, within two weeks following admission a written care plan shall be developed, based on the resident's history and assessments from all appropriate disciplines and the physician's evaluations and orders, which shall include: (1) Measurable goals with specific time limits for attainment. (2) The specific approaches for delivery needed care, and indication of which professional 8.370.16 NMAC 21 disciplines are responsible for delivering the care. B. Evaluations and updates: The care of each resident shall be reviewed by each of the services involved in the resident's care and the care plan evaluated and updated no less than quarterly or more often as needed. C. Implementation: The care plans shall be substantially followed.