{"product_id":"1-1-in-room-activity-plan-and-visit-log-fillable-pdf-for-activity-directors-color-and-b-w-1","title":"1:1 In-Room Activity Plan and Visit Log, Fillable PDF for Activity Directors, Color and B\u0026W","description":"\u003cp\u003eA fillable 8-page 1:1 In-Room Activity Plan and Visit Log for activity directors, life enrichment coordinators and activity therapists in nursing homes, memory care, assisted living and skilled nursing. Use it for residents who are bed-bound, in isolation, living with advanced dementia, or who will not join groups.\u003c\/p\u003e\u003cp\u003eCMS State Operations Manual Appendix PP, F679 guidance describes in-room and one-to-one approaches, for example for a resident who isolates in a room or bed. The approach lists in this plan are taken from that guidance, and the comfort and activity ideas from the National Institute on Aging and the Alzheimer's Association, each marked with a source tag on the page. It helps you decide what to offer, schedule the visits, record how the resident responded, and review the plan every month. It is a planning tool and not an official CMS form. It does not guarantee survey compliance. Always follow your facility policy and your state rules.\u003c\/p\u003e\u003cp\u003eIt works alongside our Activity Assessment Form. Use the assessment for the full picture, and this plan to go deeper on 1:1 and in-room visits. It is not a facility-wide tracker: one plan and log for one resident.\u003c\/p\u003e\u003cp\u003eWHAT IS INSIDE (8 pages, US Letter and A4)\u003cbr\u003ePage 1: Resident snapshot and why 1:1 (reasons for in-room visits, precautions and safety, best time of day, longest comfortable visit, resident and family wishes)\u003cbr\u003ePage 2: Interests and what comforts (F679 topics to learn, senses and comfort, comfortable setting, signs of enjoyment)\u003cbr\u003ePage 3: In-room and one-to-one approaches named in CMS F679 guidance, plus a blank visit flow for your own notes\u003cbr\u003ePage 4: Activity ideas checklist in five groups with source tags, plus materials and safety\u003cbr\u003ePage 5: Weekly 1:1 schedule with visits per week, length, staff and a backup idea if the resident declines\u003cbr\u003ePage 6: Visit log with 24 rows: date, activity, minutes, how the resident seemed, how it went, notes and initials\u003cbr\u003ePage 7: Monthly review and goal progress (continue, revise or stop), what worked, changes for next month\u003cbr\u003ePage 8: Handoff card for staff, family notes and update log, and sign-off with a credentials line\u003c\/p\u003e\u003cp\u003eCOLOR AND BLACK-AND-WHITE\u003cbr\u003e- Color version for screen use and color printing\u003cbr\u003e- Black-and-white ink-saver version with light grey bars and no dark fills, made for copiers and low-ink printing\u003cbr\u003e- Both versions have the same 8 pages and the same fillable fields\u003c\/p\u003e\u003cp\u003eFILLABLE AND PRINTABLE\u003cbr\u003e- Over 480 fillable fields: text boxes, check boxes and drop-down lists\u003cbr\u003e- Type on a computer or tablet in a PDF reader, or print and write by hand\u003cbr\u003e- Save a blank copy and make one file per resident. Copy page 6 and page 7 when you need more rows or months\u003c\/p\u003e\u003cp\u003eGOOD TO KNOW\u003cbr\u003e- Digital download: one zip file with four PDFs (US Letter and A4, each in color and black-and-white) and a Read Me First page. Unzip before you open the PDFs\u003cbr\u003e- No physical item is shipped\u003cbr\u003e- Fillable fields work best in Adobe Acrobat Reader or a similar PDF app. Check that your app saves typed entries before you use it for real records\u003cbr\u003e- Do not enter resident information into a file you store on an unsecured device. Follow your facility's privacy rules\u003cbr\u003e- Not medical or legal advice, and not a guarantee of survey compliance\u003cbr\u003e- Designed by BeingBrightStudio\u003c\/p\u003e","brand":"BeingBrightStudio","offers":[{"title":"Default Title","offer_id":67985429954835,"sku":null,"price":4.99,"currency_code":"USD","in_stock":true}],"thumbnail_url":"\/\/cdn.shopify.com\/s\/files\/1\/0978\/8732\/2387\/files\/e8HQ8odTKb.jpg?v=1794294795","url":"https:\/\/www.activitydirectorspayactivitydirectors.com\/products\/1-1-in-room-activity-plan-and-visit-log-fillable-pdf-for-activity-directors-color-and-b-w-1","provider":"Activity Directors Pay Activity Directors","version":"1.0","type":"link"}