Calendar Evaluation & FPA Form Packet

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Calendar Evaluation & FPA Form Packet
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Calendar Evaluation and Facility Population Assessment PDF Form Packet

Downloadable PDF Documents (.zip File)

Specifically, the new guidelines advise surveyors "to determine if the facility has provided an ongoing program of activities designed to accommodate the individual resident's interests and help enhance her/his physical, mental, and psychosocial well-being, according to her/his comprehensive resident assessment."

Activity Directors Network has put together this packet to help the AD/TR keep better records of the types of activities being conducted and whether or not these activities are specifically tailored to meet the needs of each resident, while creating a better quality of life for everyone in the facility.

Includes:

  • Calendar Evaluation Instructions
  • Calendar Evaluation Form
  • FPA Instructions
  • FPA Resident Levels Instructions
  • FPA Resident Levels Form
  • FPA Self Calculating Form
  • FPA Activity Analysis Form

Calendar Evaluation Instructions

Includes a calendar evaluation key along with examples of how to implement this key into monthly activity calendars. Also explains how to fill out the calendar evaluation form included in this packet.

Calendar Evaluation Form

Refer to the Calendar Evaluation Instructions on how to fill out this form correctly. You may print this document out and fill it out by hand when necessary or you may fill it out in Adobe by clicking on the fields you wish to fill in and save it to your computer.

FPA Instructions

Contains a brief explanation of the policy, purpose, and procedure for maintaining an accurate Facility Population Assessment (FPA).

FPA Resident Levels Instructions

A breakdown of the 3 levels used for calculating the FPA. This will help determine whether a resident belongs in Level I, II, or III and exactly what should be expected from the residents in each level.

FPA Resident Levels Form

To be filled in with the resident's name under the level they would function best. You may print this document out and fill it out by hand when necessary or you may fill it out in Adobe by clicking on the fields you wish to fill in and save it to your computer.

FPA Self Calculating Form

A self calculating form to help the AD/TR figure out how many activities should be conducted per month in each level. Fill in the total number of residents in each level, the number of residents unable/unwilling to participate in each level, and the total number of groups conducted at your facility and the form will calculate everything else for you.

FPA Activity Analysis Form

In case there is ever an absence and someone needs to fill in as the activity leader for the day, this form will explain everything the substitute will need to know about the activity and its participants. This form also helps identify any potential problems or dissatisfaction with any activities being conducted.

**Upon purchase of this PDF form packet, an e-mail will be sent to the e-mail address used for your ADN Store Account. The e-mail will contain a link to download the .zip file containing the PDF documents.

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