Resources - Assisted Living Partners


Assisted Living

  Cognitive Assessment Tool
  Online Self Reporting Tool
This information will help guide you on how to report required incidents to DIA.
  Tenant Document Audit Tool
This tool can be used to audit tenant charts to ensure you have required documentation on file.
  Guide for RNs
This tool will help guide you on how and when to complete a nurse review, evaluation, and service plan. Learn what "triggers" to watch for which may indicate a significant change in condition.
This program is great to help you keep track of GDS scores, nurse review due dates, and evaluation/service plan due dates!
  LPN Orientation
This tool is designed to document LPN orientation/delegation by the RN.
  Dementia Training Certificate
This certificate can be used to document dementia training provided to staff.
  Involuntary Transfer Letter
This is a sample involuntary transfer letter for assisted living programs.
  AL Monitoring Entrance Form
This monitoring entrance form is used by DIA to gather information from programs during an onsite visit.
  Quality Assurance Checklist
This tool can be used to assist when audting a tenant chart.
  Assisted Living Annual Systems Inspection Form
This tool is used to document mechanicals systems (heating, cooling, plumbing, electrical, etc.) are found to be in proper working order.
  Nurse Review Worksheet
This nurse review worksheet will help nurses to determine if the issue at hand is a significant change in condition AND if changes might be necessary to the tenant's service plan.
  Nurse Review Guide
Nurse Reviews is one of the most cited areas for Assisted Living Programs. As we assist programs throughout the state, we find nurses are confused about how to write a nurse review. A nurse review is a narrative that "tells the story" about what is going on. There is a definite theme to a nurse review. This Nurse Review Guide provides a script of what should be included in a nurse review. This process has proven to be very successful for programs to maintain regulatory compliance.
  Meal Census Form
This tool can be used to record meals for Medicaid Home Delivered Meals.
  Medication Pass Monitoring Tool
This tool can be used to document employee competency with completing a medication pass.
  Iowa - Assisted Living Audit Tool
This tool is similar to a checklist that DIA uses to verify compliance with Transportation, Smoking, Activities, and Food Service.
  Group Interview Form
This tool is used by DIA monitors to interview tenants and/or family members.
  Employee Review Checklist
This form is used by DIA to audit employee files for regulatory compliance.
  MAR Audit Tool
This tool can be used for MAR monitoring.


  Medicaid Fee Breakdown Tool
This document will meet the requirement of a Fee Breakdown for HCBS Waiver Providers.
  CDAC Planning Worksheet
This document is used in conjunction with the Medicaid Fee Breakdown tool. It helps to determine what services to put on the CDAC Agreement.
  Assisted Living Service
This tool can be used to document for Assisted Living Service. Also refer to Assisted Living Service weekly documentation form as another option for documentation.
  Assisted Living Service - Weekly Form
This tool can be used to document Assisted Living Service on a weekly basis.
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