LHCSA Annual Program Review Template

LHCSA Annual Program Review Template
A complete annual program evaluation template for Licensed Home Care Services Agencies, aligned to the quality improvement requirements at 10 NYCRR 766.9. Section 1 walks the reviewer through seven program domains with Yes/No scoring, comments, and corrective action columns: Organization; Administration (Governing Body, CQI, Administrative Personnel, Personnel, Reports and Records, Fiscal); Admission and Discharge; Skilled Nursing; Therapy Services; Home Health Aide Services; and Medical Social Work. Statistical tables capture visit volume by discipline, referrals, admissions, discharges, and diagnosis breakdowns, followed by recommendations for corrective action, the four required conclusions (appropriate, adequate, effective, efficient), and a narrative summary with operational highlights, quality improvement summary, prior-period goal achievement, and goals for the next period. Signature lines for the CQI Coordinator and Governing Body representative close the document. A branded, editable Word template ready to customize with your agency name.