The short answer
ADL flow sheets (also called CNA documentation or "point of care" records) are where nursing assistants record the hands-on care they give each shift: bathing, dressing, eating and how much of each meal was eaten, toileting and incontinence care, transfers, walking and turning and repositioning. They are usually entered on a kiosk or tablet. They are often the best evidence of whether basic care was actually given.
What they record
- "ADLs" are activities of daily living: bathing, dressing, eating, toileting, transferring and moving in bed.
- For each, the aide documents how much help was needed (independent, supervision, one-person or two-person assist).
- Meal intake is usually recorded as a percentage of each meal eaten.
- Repositioning and incontinence checks may be recorded each time or once per shift, depending on the facility.
Why they matter
Pressure injuries, dehydration and weight loss usually develop when basic care is missed. Flow sheets show whether a resident at risk for bedsores was actually turned, whether a resident who needs feeding help was actually fed, and whether incontinence care was done. Compare them with the care plan: if the plan says "turn every two hours" and the flow sheet shows one entry per shift, that is a gap.
Warning signs in the records
- Blank shifts, especially nights and weekends
- Identical entries every shift, which can mean "copy-forward" charting
- Entries documented when the resident was in the hospital
- Meal intake consistently below 50 percent with no dietitian follow-up
Staffing assignment sheets show which aide was responsible for the resident on each shift. Those are generally not available through a records request, but can be obtained in litigation.
The rules behind this
- 42 C.F.R. § 483.24 (activities of daily living)
- 42 C.F.R. § 483.25(b)(1) (pressure ulcers)
Related questions
This guide provides general information, not medical or legal advice. Rules change; confirm current requirements with the facility, the New York State Department of Health or a professional. Attorney Advertising.