Table 2: ACFI evidence summary ACFI evidence summary This must be attached to the evidence provided for each resident’s reconsideration to assist in organising the evidence you are providing for each reconsideration Note: the ACCR or NSAF must be included in the ACFI appraisal pack. ACFI Checklist complete? Evidence provided Comments (provide details of attachments title, section and/or page numbers) Mental and Behavioural Diagnosis Disorder/diagnosis Source material ACCR/NSAF GP comprehensive medical assessment Other practitioner assessment / notes Provide the title of additional documents that were seen at review Provide the title of documents that were NOT seen at review Medical Diagnosis Disorder/diagnosis Source material ACCR/NSAF GP comprehensive medical assessment Other practitioner assessment / notes Documentation seen at review Provide the title of additional documents that were seen at review New documentation Provide the title of documents that were NOT seen at review 1: Nutrition Nutrition Checklist Contemporaneous Assessment (e.g. Registered Nurse, Allied Health) Readiness to eat Eating Documentation seen at review Provide the title of documents that were seen at review New documentation Provide the title of documents that were NOT seen at review 2: Mobility Mobility Checklist Contemporaneous Assessment (e.g. Registered Nurse, Allied Health) Transfers Locomotion Documentation seen at review Provide the title of additional documents that were seen at review New documentation Provide the title of documents that were NOT seen at review 3: Hygiene Personal hygiene Checklist Contemporaneous Assessment (e.g. Registered Nurse, Allied Health) Dressing and undressing Washing and drying Grooming Documentation seen at review Provide the title of additional documents that were seen at review New documentation Provide the title of documents that were NOT seen at review 4: Toileting Toileting Checklist Contemporaneous Assessment (e.g. Registered Nurse, Allied Health) Use of toilet Toilet completion
Documentation seen at review Provide the title of additional documents that were seen at review New documentation Provide the title of documents that were NOT seen at review 5: Continence Continence Assessment Summary Continence Checklist Continence Record Evidence of incontinence prior to scheduled toileting Urinary continence Faecal continence Documentation seen at review Provide the title of additional documents that were seen at review New documentation Provide the title of documents that were NOT seen at review 6: Cognition Cognitive Skills Assessment Summary Cognitive Checklist PAS – CIS (if appropriate) Clinical report Documentation seen at review Provide the title of additional documents that were seen at review New documentation Provide the title of documents that were NOT seen at review 7: Wandering Assessment summary Behaviour Checklist Behaviour record Documentation seen at review Provide the title of additional documents that were seen at review New documentation Provide the title of documents that were NOT seen at review 8: Verbal Assessment summary Behaviour Checklist Behaviour record Documentation seen at review Provide the title of additional documents that were seen at review New documentation Provide the title of documents that were NOT seen at review