California DHPPD Form for Direct Care Service Hours
This form is essential for documenting direct care service hours in skilled nursing facilities in California. It ensures compliance with regulations set by the California Department of Public Health. Accurate completion aids in the assessment of care quality and resource allocation.
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How do I fill this out?
To fill out this form, start by entering the patient date in MM/DD/YY format. Next, input the total number of licensed skilled nursing beds and the facility’s CDPH license number. Ensure that all care hours are accurately recorded and verified by the Director of Nursing.
How to fill out the California DHPPD Form for Direct Care Service Hours?
1
Enter the date of the patient day in MM/DD/YY format.
2
Input the total number of licensed skilled nursing beds.
3
Record the CDPH license number for the facility.
4
Document the scheduled total direct care service hours.
5
Sign the form to verify the information is complete and true.
Who needs the California DHPPD Form for Direct Care Service Hours?
1
Nursing supervisors need this form to document patient care accurately.
2
Compliance officers in healthcare facilities require this for regulatory adherence.
3
Healthcare administrators use it for resource management and planning.
4
Quality assurance teams need the data for auditing and improvement.
5
Direct care staff must record their worked hours to ensure proper staffing.
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What are the instructions for submitting this form?
Submit the completed DHPPD form via email to cdph-nursing-reports@cdph.ca.gov. Alternatively, you may fax the form to (555) 123-4567. For physical submissions, mail to California Department of Public Health, 1616 Capitol Ave, Sacramento, CA 95814. Ensure submissions are made within the required timeframe for compliance.
What are the important dates for this form in 2024 and 2025?
The important dates for this form include quarterly assessments as per state regulations. Ensure that all entries are completed by the end of each quarter, specifically by March 31, June 30, September 30, and December 31 of each year. This helps in keeping track of compliance and care quality metrics effectively.
What is the purpose of this form?
The purpose of the California DHPPD form is to accurately capture the direct care service hours provided to patients in skilled nursing facilities. This documentation supports regulatory compliance with the California Department of Public Health’s standards. It is essential for auditing, quality control, and ensuring that adequate care resources are allocated based on patient needs.
Tell me about this form and its components and fields line-by-line.
- 1. Patient Date: Enter the date in MM/DD/YY format.
- 2. Total Licensed Skilled Nursing Beds: Input the total number of licensed beds available.
- 3. Patient Date Start Time: Provide the start time for the patient day in HH:MM AM/PM format.
- 4. CDPH License #: Enter the facility’s California Department of Public Health license number.
- 5. Facility Name: Document the official name of the healthcare facility.
- 6. Estimated Direct Care Service Hours: Record the total hours of direct care services expected.
- 7. Daily Census Changes: Document any changes in patient census for accurate tracking.
- 8. Actual Direct Care Service Hours: Record the actual hours of direct care services provided.
- 9. CNA Direct Care Service Hours: Input the total number of direct care hours provided by CNAs.
- 10. Signature: Director of Nursing or designee must sign to verify information.
What happens if I fail to submit this form?
Failing to submit this form can result in non-compliance with state regulations and possible penalties. It may lead to inadequate documentation of patient care, impacting quality assessments.
- Regulatory Penalties: Non-compliance can lead to fines or sanctions against the facility.
- Quality of Care Issues: Inaccurate records may hinder the assessment of care provided.
- Resource Misallocation: Lack of proper documentation can affect staffing and resource management.
How do I know when to use this form?
- 1. Daily Record Keeping: To maintain accurate records of care service hours for each patient.
- 2. Regulatory Compliance: To ensure adherence to state guidelines and regulations.
- 3. Quality Assessment: To evaluate the quality of care provided based on documented hours.
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