Providing quality care in your home...
SAMPLE SERVICE PLAN
John Doe 1/1/11
1111 S. Broadway, Santa Maria, CA 123-4567
Mr. Doe was a housing inspector in Fresno
He was active in the Elks until his stroke two years ago
Approx age 82
Able to stand but unsteady when standing, can ambulate with
assistance
Very poor vision from macular degeneration
Decreased hearing
Becomes upset and frustrated easily from hemorrhoids pain
Significant near memory loss
Remain alert for requests to assist with transferring to commode
Prompt to void every 2 hours, to reduce incontinence
Encourage to ambulate for voiding. Assist with gait belt. Use
wheel chair if he declines to walk.
Office juice or water to reduce thirst.
Give instructions in slow steady voice. Give time to react. Repeat
phrases exactly.
If frustration or anger appear, stop, give distance, remain calm,
resume simple instructions.
Remain ready to assist for night time voiding and in case of
discomfort.
Report significant pain to wife in AM.
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We strive to meet each of these ten standards continually for each client. Your needs are systematically assessed to create an individualized service plan.
We assumed all was done correctly. After mother passed away, we received a letter from the California Franchise Tax Board.
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