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ged_cut"]}
["令和６年度～令和８年度　運 営 状 況 点 検 書"]
["【看護小規模多機能型居宅介護】"]
[]
[" 点検日",null,null,null,null,null,null,null,null,null,"点検者（職・氏名）※原則として管理者が行ってください。　"]
[" 令和　　年 　月　  日"]
[]
["　"]
["法人",null,"名　　称"]
[null,null,"代表者職・氏名"]
[]
[" 事業所",null,"介護保険",null,null,null,null,14]
[null,null,"事業所番号"]
[null,null," フリガナ"]
[]
[null,null,"名　　　 称"]
[]
[]
[null,null,"所　在　地",null,null,null,null,"〒"]
[]
[]
[null,null,"連　絡　先",null,null,null,null,"電話番号",null,null,null,null,null,null,null,null,null,null,null,"ＦＡＸ番号"]
[]
[null,null,"開設年月日",null,null,null,null,"平成・令和",null,null,null,null,"年",null,null,"月",null,null,"日"]
[]
[null,null,"定　　　　員",null,null,null,null,"登録定員",null,null,null,null,null,null,"人","通いの定員",null,null,null,null,null,null,"人","宿泊の定員",null,null,null,null,null,null,"人"]
[]
[]
["短期利用居宅介護　実施の有無",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"有　・　無"]
[]
["※「勤務形態一覧表」等を添付してください。"]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"○",null,null,"×",null,null,"―"]
[]
[]
[]
[]
[]
["（１）　代表者"]
[null,"問1","　保健師若しくは看護師である。（問1に該当しない場合、問2,3に回答）"]
[]
[null,"問2","　（問1に該当しない場合に回答）\n　特別養護老人ホーム、老人デイサービスセンター、介護老人保健施設、  介護医療院、小規模多機能型居宅介護事業所、認知症対応型共同生活介護事業所、複合型サービス事業所等の従業者、訪問介護員等として認知症である者の介護に従事した経験あるいは保健医療サービス若しくは福祉サービスの経営に携わった経験がある｡",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第65条"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"老計発第0331004号2(3)②③"]
[null,"問3","　（問1に該当しない場合に回答）\n　「認知症対応型サービス事業開設者研修」を修了している。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"老計発第0331006号3"]
[]
[]
["（２）　管理者"]
[null,"問1","　常勤専従職員を配置している。\n\n※指定看護小規模多機能型居宅介護事業所の管理上支障がない場合は、当該看護小規模多機能型居宅介護事業所の他の職務、当該看護小規模多機能型居宅介護事業所に併設する認知症対応型共同生活介護事業所、地域密着型特定施設、地域密着型介護老人福祉施設、介護療養型医療施設(療養病床を有する診療所に限る)、介護医療院の職務若しくは同一敷地内にある他の事業所、施設等の職務の兼務が可能。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第64条第1項"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"老計発第0331004号2(2)①"]
[null,"問2","　保健師若しくは看護師である。（問2に該当しない場合、問3,4に回答）"]
[]
[null,"問3","　（問2に該当しない場合に回答）\n　特別養護老人ホーム、老人デイサービスセンター、介護老人保健施設、介護医療院、小規模多機能型居宅介護事業所、認知症対応型共同生活介護事業所、複合型サービス事業所等の従業者又は訪問介護員等として、３年以上、認知症である者の介護に従事した経験がある",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第64条第2項"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"老計発第0331004号2(2)②"]
[null,"問4","　（問2に該当しない場合に回答）\n　「認知症介護実践者研修」もしくは「基礎課程」及び「認知症対応型サービス事業管理者研修」を修了している。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"老計発第0331006号2"]
[]
[]
["（３）　介護支援専門員"]
[null,"問1","　専従職員を配置している。\n\n※利用者の処遇に支障がない場合は、当該看護小規模多機能型居宅介護事業所の他の職務又は当該看護小規模多機能型居宅介護事業所に併設する認知症対応型共同生活介護事業所、指定地域密着型特定施設、指定地域密着型介護老人福祉施設、指定介護療養型医療施設(療養病床を有する診療所に限る)、介護医療院の職務を兼務可能。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第63条第10項"]
[]
[null,"問2","　「小規模多機能型サービス等計画作成担当者研修」を修了している。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"老計発第0331006号1"]
[]
[null,"問3","　介護支援専門員は、看護小規模多機能型居宅介護計画の作成に当たっては、看護師等と密接な連携を図りながら行っている。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"老計発第0331006号1"]
[]
[]
["（４）　従業者"]
[null,"問1","　介護従業者のうち１人以上は、常勤の保健師又は看護師を配置している。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第63条第3項"]
[]
[null,"問2","　従業者のうち常勤換算方法で２．５以上は、保健師、看護師又は准看護師（以下、「看護職員」とする）を配置している。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第63条第4項"]
[]
[null,"問3","　通いサービス及び訪問サービス提供のうちそれぞれ１人以上は、看護職員である。"]
[]
[null,"問4","　常勤換算方法で、訪問サービスの提供に当たる介護従業者を２以上配置している。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第63条第4項"]
[]
[null,"問5","　常勤職員が勤務すべき勤務時間を記入してください。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"１日　　　時間　　　　分"]
[]
[null,"問6","　前年度の通いサービスの利用者数の平均値（新規事業所の場合は推定数）によって、以下の計算を行ってください。"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"通い","＋","訪問",null,"(ａ)"]
[null,null,"○１～３名 　　→ 問5で答えた時間数",null,null,null,null,null,null,null,null,null,"（",null,"）時間×",null,null,1,"＋",2,"＝",{"$f":"SUM(N80*(R80+T80))","v":0},"時間"]
[null,null,"○４～６名 　　→ 問5で答えた時間数",null,null,null,null,null,null,null,null,null,"（",null,"）時間×",null,null,2,"＋",2,"＝",{"$f":"SUM(N81*(R81+T81))","v":0},"時間"]
[null,null,"○７～９名 　　→ 問5で答えた時間数",null,null,null,null,null,null,null,null,null,"（",null,"）時間×",null,null,3,"＋",2,"＝",{"$f":"SUM(N82*(R82+T82))","v":0},"時間"]
[null,null,"○１０～１２名 → 問5で答えた時間数",null,null,null,null,null,null,null,null,null,"（",null,"）時間×",null,null,4,"＋",2,"＝",{"$f":"SUM(N83*(R83+T83))","v":0},"時間"]
[null,null,"○１３～１５名 → 問5で答えた時間数",null,null,null,null,null,null,null,null,null,"（",null,"）時間×",null,null,5,"＋",2,"＝",{"$f":"SUM(N84*(R84+T84))","v":0},"時間"]
[]
[null,"問7","　従業者の勤務の体制及び勤務形態一覧表(様式１)の日勤時間の合計が、問6で算出した時間(ａ)を下回った日はない。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第63条第1項"]
[]
[]
["（５）　夜勤体制"]
[null,"問1","(宿泊サービスの利用者がいる場合)\n　夜間及び深夜の時間帯に勤務する介護従業者を１名以上、宿直者を１名以上配置している。また、看護職員である必要はないが、電話等による連絡体制は確保していること。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第63条第1項"]
[]
[null,"問2","(宿泊サービスの利用者がいない場合)\n　夜間及び深夜の時間帯に勤務する介護従業者を１名以上、宿直者を１名以上配置しているか、訪問サービスを提供するために必要な連絡体制を整備している。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第63条第5項"]
[]
[]
[]
["（１）　構造"]
[null,"問1","　耐火建築物あるいは準耐火建築物である。　また、建築基準法及び消防法の基準に適合している。"]
[]
[]
["（２）　設備"]
[null,"問1","　居間、食堂、台所、宿泊室、浴室、便所、洗面設備、消火設備その他の非常災害に際して必要な設備を基準どおり設置している。"]
[]
[]
["（３）　居間・食堂"]
[null,"問1","　利用者及び従業者が一同に会するのに充分な広さを有している。"]
[]
[null,null,null,"　通いサービスの利用定員が１６人以上の場合、利用者１人当たり３㎡以上となっている。"]
[]
["（４）　宿泊室"]
[null,"問1","　１の宿泊室の定員は１人である。\n\n※ただし、利用者の処遇上必要と認められる場合は、２人とすることができる。"]
[]
[null,"問2","　１の宿泊室の床面積は７.４３㎡以上である。"]
[]
[null,"問3","（個室以外の宿泊室を設けている場合）"]
[null,null,null,"①","　プライバシーが確保されたしつらえになっている。"]
[null,null,null,null,"　※パーティションや家具での仕切りは可。カーテンは不可。"]
[null,null,null,"②","　個室以外の宿泊室は、全宿泊室の半数以下となっている。"]
[null,null,null,null,"　※例えば、全宿泊室数が5室の場合、個室以外の宿泊室は2室"]
[null,null,null,null,"　※平成27年3月31日以前に開所した事業所は除きます。"]
[null,null,null,"③","　野外の光が室内にも届くようになっている。"]
[null,null,null,"④","　空調設備等により室内の適温を確保している。"]
[null,null,null,"⑤","　パーティション、ベッド等は常時、直ちに設置できる場所に置いている。"]
[]
["（５）　消火設備その他の非常災害に際して必要な設備"]
[null,"問1","　消防法その他の法令等に規定された設備を有している。"]
[]
[null,"問2","　消防法その他の法令等に基づき、定期的に設備を点検している。"]
[]
[]
[]
[]
[]
[]
["（１）　内容及び手続の説明及び同意"]
[null,"問1","　サービスの提供の開始に際し、あらかじめ、利用申込者又はその家族に対し、運営規程の概要、従業者の勤務の体制その他の利用申込者のサービスの選択に資すると認められる重要事項を記した文書を交付して説明を行い、当該提供の開始について文書により利用申込者の同意を得ている。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第3条の7第1項"]
[]
[]
["（２）　提供拒否の禁止"]
[null,"問1","　正当な理由なくサービスの提供を拒んでいない。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第3条の8"]
[null,null,"　×の場合：提供拒否した理由（　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　）"]
[]
["（３）　サービス提供困難時の対応"]
[null,"問1","　利用申込者に対し自ら当該事業所におけるサービスを提供をすることが困難であると認めた場合は、当該利用申込者に係る居宅介護支援事業者への連絡、適当な他の事業所等の紹介その他の必要な措置を講じている。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第3条の9"]
[]
[]
["（４）　受給資格等の確認"]
[null,"問1","　指定看護小規模多機能型居宅介護の提供を求められた場合は、その者の提示する被保険者証によって、被保険者資格、要介護認定の有無及び要介護認定の有効期間を確かめている。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第3条の10第1項"]
[]
[null,"問2","　被保険者証に、法第７８条の３第２項に規定する認定審査会意見が記載されているときは、当該認定審査会意見に配慮して、指定看護小規模多機能型居宅介護を提供するように努めている。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第3条の10第2項"]
[]
[null,"問3","　サービスの提供を求められた場合は、その者の提示する負担割合証によって、利用者負担の割合が１割又は２割若しくは３割かを確認している。"]
[]
[]
["（５）　要介護認定の申請に係る援助"]
[null,"問1","　指定看護小規模多機能型居宅介護の提供の開始に際し、要介護認定を受けていない利用申込者については、要介護認定の申請が既に行われているかどうかを確認し、申請が行われていない場合は、当該利用申込者の意思を踏まえて速やかに当該申請が行われるよう必要な援助を行っている。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第3条の11第1項"]
[]
[null,"問2","　居宅介護支援が利用者に対して行われていない等の場合であって必要と認めるときは、要介護認定の更新の申請が、遅くとも当該利用者が受けている要介護認定の有効期間が終了する３０日前にはなされるよう、必要な援助を行っている。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第3条の11第2項"]
[]
[]
["（６）　心身の状況等の把握"]
[null,"問1","　指定看護小規模多機能型居宅介護の提供にあたっては、介護支援専門員が開催するサービス担当者会議等を通じて、利用者の心身の状況、その置かれている環境、他の保健医療サービス又は福祉サービスの利用状況等の把握に努めている。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第68条"]
[]
[]
["（７）　居宅サービス事業者等との連携"]
[null,"問1","　サービスの提供をするにあたって、居宅サービス事業者、地域包括支援センターその他保健医療サービス又は福祉サービスを提供する者と密接な連携に努めている。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第69条第1項"]
[]
[null,"問2","　サービスの提供をするにあたって、利用者の健康管理を適切に行うため、主治の医師との密接な連携に努めている。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第69条第2項"]
[]
[null,"問3","　サービスの提供の終了に際して、利用者又はその家族に対して適切な指導を行うとともに、当該利用者に係る居宅介護支援事業者に対する情報提供及び地域包括支援センター又は保健医療サービス若しくは福祉サービスを提供する者と密接な連携に努めている。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第69条第3項"]
[]
[]
["（８）　身分を証する書類の携行"]
[null,"問1","　指定看護小規模多機能型居宅介護従業者のうち、訪問サービスの提供に当たる者に身分を証する書類を携行させ、利用者や家族から求められたときは、その書類を提示させている。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第3条の18第1項"]
[]
[]
["（９）　サービス提供の記録"]
[null,"問1","　指定看護小規模多機能型居宅介護を提供した際には、サービスの提供日及び内容、保険給付の額その他必要事項を、利用者の居宅サービス計画の書面又はサービス利用票等に記載している。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第3条の18第1項"]
[]
[null,"問2","　指定看護小規模多機能型居宅介護を提供した際には、提供した具体的なサービスの内容等を記録するとともに、利用者からの申出があった場合には、文書の交付等によりその情報を利用者に提供している。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第3条の18第2項"]
[]
[]
["（10）　利用料等の受領"]
[null,"問1","　法定代理受領サービスに該当する指定看護小規模多機能型居宅介護を提供した際には、その利用者から利用料の一部として、当該指定看護小規模多機能型居宅介護に係る地域密着型介護サービス費用基準額から当該指定看護小規模多機能型居宅介護事業者に支払われる地域密着型介護サービス費の額を控除して得た額の支払を受けている。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第71条第1項"]
[]
[null,"問2","　法定代理受領サービスに該当しない指定看護小規模多機能型居宅介護を提供した際にその利用者から支払を受ける利用料の額と、指定看護小規模多機能型居宅介護に係る地域密着型介護サービス費用基準額との間に、不合理な差額が生じないようにしている。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第71条第2項"]
[]
[null,"問3","　問1・問2のほか、通常の事業の実施地域以外の地域に居住する利用者に対して行う送迎費用及び訪問サービスに要した交通費、食事の提供に要した費用、宿泊費、おむつ代、その他日常生活においても通常必要となるものに係る費用であって、その利用者に負担させることが適当なものを除き、利用者から費用の支払を受けていない。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第71条第3項"]
[]
[null,"問4","　サービスの提供に当たっては、あらかじめ、利用者又はその家族に対し、当該サービスの内容及び費用について説明を行い、利用者の同意を得ている。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第71条第5項"]
[]
[]
["（11）　自己評価及び外部評価"]
[null,"問1","　年に1回、自ら提供するサービスについて評価・点検（自己評価）を行うとともに、当該自己評価結果について、運営推進会議において、第三者の観点からサービスの評価（外部評価）を行っている。\n（実　施　日）令和　　年　　月　　日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第72条第2項\n平成18年老計発第1017001号"]
[]
[null,"問2","運営推進会議を活用した評価の結果の公表について",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"老計発第0331004号2(4)②"]
[null,null,null,"①","利用者及びその家族に対し、事業所自己評価及びサービス評価総括表を公表している。"]
[null,null,null,"②","事業所内の見やすい場所への掲示や自らのホームページへの掲載などにより開示している。"]
[null,null,null,"③","利用者及びその家族に運営推進会議を活用した評価の結果を交付している。"]
[]
["（12）　身体的拘束の廃止"]
[null,"問1","　サービス提供に当たっては、当該利用者又は他の利用者等の生命又は身体を保護するため緊急やむを得ない場合を除き、身体的拘束その他利用者の行動を制限しないようにしている。"]
[]
[null,"問2","　運営規程に「身体的拘束の廃止」及び「身体的拘束その他利用者の行動を制限する行為を行う際の手続き」について定めている。"]
[]
[null,"問3","　重要事項説明により「身体的拘束の廃止」及び「身体的拘束その他利用者の行動を制限する行為を行う際の手続き」について説明している。"]
[]
[null,"問4","身体的拘束等の適正化のための対策を検討する委員会（テレビ電話装置等を活用して行うことができるものとする。）を三月に一回以上開催「身体拘束廃止委員会」等の体制を整備している。"]
[]
[null,"問5","「身体的拘束廃止委員会」の結果について、介護職員その他の従業者に周知徹底を図っている。"]
[]
[null,"問6","　身体的拘束等の適正化のための指針を整備している。"]
[]
[null,"問7","　介護職員その他の従業者に対し、身体的拘束等の適正化のための研修を定期的に実施している。"]
[]
[null,"問8","　事業所内の研修等を通じて、「身体的拘束による弊害」「やむを得ない場合に身体的拘束その他利用者の行動を制限する行為を行う際の手続き」等を従業者に周知している。"]
[]
[null,"問9","　やむを得ず身体的拘束を行う場合に備えて、「身体的拘束廃止委員会」等で「切迫性」「非代替性」「一時性」の３つの要件を全て満たしているかを検討した際に、その結果を記録する様式を定めている。かつ、その様式は「切迫性」「非代替性」「一時性」の各要件の検討結果を分けて記載できる様式になっている。"]
[]
[null,"問10","　やむを得ず身体的拘束を行う場合に備えて、利用者や家族に対して「身体的拘束の内容」「目的」「理由」「拘束の時間」「時間帯」「期間」等を説明するための様式、身体拘束を行った場合に、その「態様」及び「時間」その際の「利用者の心身の状況」等を記録するための様式を定めている。"]
[]
[null,"問11","　やむを得ず身体的拘束を行う場合には、「切迫性」「非代替性」「一時性」のすべてを満たしているかについて「身体拘束廃止委員会」等で検討している。"]
[]
[null,"問12","　問10について「切迫性」「非代替性」「一時性」の検討結果を事業所で定めた様式を用いて、各要件の検討結果を第三者でも把握できるよう詳細に記録している。"]
[]
[null,"問13","　やむを得ず身体的拘束を行う場合には、利用者や家族に対し、事業所で定めた様式を用いて「身体的拘束の内容」「目的」「理由」「拘束の時間」「時間帯」「期間」等を詳細に説明し、理解を得ている。"]
[]
[null,"問14","　身体的拘束を行った場合には、常に観察し、事業所で定めた様式を用いて、その「態様」及び「時間」、その際の「利用者の心身の状況」等を第三者でも把握できるよう詳細に記録している。"]
[]
[null,"問15","　身体的拘束を行った場合には、「一時性」で決めた期間の終了前及び利用者の観察の状況に応じて、問11のとおり再検討を行っている。"]
[]
[null,"問16","　問15の再検討の結果、身体的拘束を継続することになった場合には、問13のとおり利用者や家族に対して、説明して理解を得ている。"]
[]
[null,"問17","　身体的拘束の必要がなくなった場合、すみやかに拘束を解除している。"]
[]
[null,"問18","　身体的拘束が必要とされた利用者について、拘束を廃止し、生活の質を向上させるためのアセスメントの実施、小規模多機能型居宅介護計画への位置づけ等が行われている。"]
[]
[]
["（13）　主治の医師との関係"]
[null,"問1","　常勤の保健師又は看護師は、主治の医師の指示に基づき適切な看護サービスが提供されるよう管理している。"]
[]
[null,"問2","　看護サービスの提供の開始に際し、主治の医師（利用申込者の選定により加療している医師）による指示を文書で受けている。また、主治医以外の複数の医師から指示書の交付を受けていない。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第77条第1項"]
[null,"問3","　主冶の医師に看護小規模多機能型居宅介護計画及び看護小規模多機能型居宅介護報告書を提出し、看護サービスの提供に当たって主冶の医師との密接な連携を図っている。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第77条第4.5項"]
[]
["（14）　居宅サービス計画の作成"]
[null,"問1","　管理者は、介護支援専門員に居宅サービス計画の作成に関する業務を担当させている。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第74条第1項"]
[]
[null,"問2","　利用者全員について居宅サービス計画を作成している。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第74条第1項"]
[]
[null,"問3","　計画担当介護支援専門員は、居宅サービス計画の作成に当たっては、利用者について、その有する能力や既に提供を受けている居宅サービス、介護者の状況等の評価を通じて利用者が抱える問題点を明らかにし、利用者が自立した日常生活を営むことができるように支援する上で解決すべき課題を把握している。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"平成11年省令第38号第13条第6項"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"平成11年老企第22号3(7)⑥"]
[null,"問4","　計画担当介護支援専門員は、解決すべき課題の把握（アセスメント）にあたっては、利用者及びその家族に面接して行っている。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"平成11年省令第38号第13条第7項"]
[]
[null,"問5","　居宅サービス計画の作成にあたり、利用者の抱える解決すべき課題に対応するための最も適切なサービスの組合せについて検討している。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"平成11年省令第38号第13条第8項"]
[]
[null,"問6","　居宅サービス計画には以下の項目を記載している。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"平成11年省令第38号第13条第8項"]
[]
[null,null,null,null,"ⅰ　利用者及びその家族の生活に対する意向"]
[null,null,null,null,"ⅱ　総合的な援助の方針"]
[null,null,null,null,"ⅲ　生活全般の解決すべき課題"]
[null,null,null,null,"ⅳ　提供されるサービスの目標及びその期間"]
[null,null,null,null,"ⅴ　サービスの種類、内容・種別及び利用料"]
[null,null,null,null,"ⅵ　サービスを提供する上での留意事項等"]
[null,"問7","　居宅サービス計画原案に位置付けた指定居宅サービス等の担当者からなるサービス担当者会議の開催により、利用者の状況に関する情報を共有するとともに専門的な見地からの意見を求めている。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"平成11年省令第38号第13条第9項"]
[]
[null,"問8","　居宅サービス計画は全表（１～３表及び６，７表）作成している。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"平成11年老企第22号3(7)⑩"]
[]
[null,"問9","　居宅サービス計画の原案の内容について利用者又はその家族に対して説明し、文書により利用者の同意を得ている。また、居宅サービス計画を利用者及び担当者に交付している。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"平成11年省令第38号第13条第10・11項"]
[]
[null,"問10","　介護支援専門員は、居宅サービス計画に位置付けた指定居宅サービス事業者等に対して、個別サービス計画の提出を求めている。"]
[]
[null,"問11","　指定居宅サービス事業者等から利用者に係る情報の提供を受けたときその他必要と認めるときは、利用者の服薬状況、口腔機能その他の利用者の心身又は生活の状況に係る情報のうち必要と認めるものを、利用者の同意を得て主治の医師又は薬剤師に提供している。"]
[]
[null,"問12","　モニタリングに当たっては、利用者及びその家族、指定居宅サービス事業者等との連絡を以下の方法にて継続的に行っている。\n　イ　少なくとも一月に一回、利用者の居宅を訪問し、利用者に面接すること。\n　ロ　少なくとも一月に一回、モニタリングの結果を記録すること",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"平成11年省令第38号第13条第13項"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"平成11年老企第22号3(7)⑬"]
[null,"問13","　要介護認定を受けている利用者が要介護更新認定を受けた場合又は要介護状態区分の変更の認定を受けた場合には、サービス担当者会議の開催により、居宅サービス計画の変更の必要性について、担当者に対し、専門的な見地からの意見を求めている。ただし、やむを得ない理由がある場合には、担当者に対する照会等により意見を求めている。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"平成11年省令第38号第13条第15項"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"平成11年老企第22号3(7)⑮"]
[null,"問14","　居宅サービス計画を変更した場合、全表（１～３表及び６，７表）について作成し直している。\n\n※サービス内容への具体的な影響がほとんど認められないような軽微な変更（例えば時間帯の変更など）の場合については、全て作成し直すのではなく、当該変更記録の箇所の冒頭に変更時点を明記しつつ同一用紙に継続して記載することができます。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"平成11年老企第22号3(7)⑮"]
[]
[null,"問15","　利用者がその居宅において日常生活を営むことが困難となったと認める場合又は利用者が介護保険施設への入院又は入所を希望する場合には、介護保険施設への紹介その他の便宜の提供を行っている。\n\n※該当者がいない場合については、当該内容を承知していたら○",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"平成11年省令第38号第13条第16項"]
[]
[null,"問16","　介護支援専門員は、利用者が訪問看護、通所リハビリテーション等の医療サービスの利用を希望している場合その他必要な場合には、利用者の同意を得て主治の医師又は歯科医師(以下「主治の医師等」という。)の意見を求めている。\n\n※該当者がいない場合については、当該内容を承知していたら○"]
[]
[null,"問17","　問17の場合において、居宅サービス計画を作成した際には、当該居宅サービス計画を主治の医師等に交付している。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"平成11年省令第38号第13条第18項"]
[]
[null,"問18","　主治の医師等の指示や医学的観点からの留意事項が示されているときは、次の点を確認している。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"平成11年省令第38号第13条第19項"]
[]
[null,null,null,null,"ⅰ　確認をした日時"]
[null,null,null,null,"ⅱ　確認をした相手（担当者） ※医師本人でなくて可"]
[null,null,null,null,"ⅲ　指示を出している主治の医師名及び医療機関名"]
[null,null,null,null,"ⅳ　指示の出ている期間"]
[null,null,null,null,"ⅴ　指示の内容"]
[null,null,"※医師又は歯科医師の指示の確認方法は必ずしも医師本人からの直接の聞き取りや医師の出す指示書である必要はありませんが、上記の確認事項について、利用者の受診時の同行など（医師の指示内容を当該医療機関職員に聞いておいてもらい、それを伝えてもらうことでも可）により確認してください。"]
[null,"問19","　居宅サービス計画に福祉用具貸与を位置付ける場合に、その利用の妥当性を検討し、当該計画に福祉用具貸与が必要な理由を記載するとともに、必要に応じて随時サービス担当者会議を開催し、継続して福祉用具貸与を受ける必要性について検証をした上で、継続して福祉用具貸与を受ける必要がある場合にはその理由を居宅サービス計画に記載している。\n\n※該当者がいない場合については、当該内容を承知していたら○",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"平成11年省令第38号第13条第21項"]
[]
[null,"問20","　軽度者に対象外種目の福祉用具貸与を位置付ける場合は、認定調査の調査票の必要な部分の写しを入手している。また、その写しを指定福祉用具貸与事業者へ送付している。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"平成11年老企第22号3(7)⑳"]
[]
[null,"問21","　軽度者の福祉用具貸与については、\n　①　医師の医学的な所見に基づき判断され、\n　②　サービス担当者会議等を通じた適切なマネジメントにより\n　③　福祉用具貸与が特に必要であることを市に書面等確実な方法で確認している。\n\n※医師の医学的な所見については、主治医意見書による確認のほか、医師の診断書又は担当の介護支援専門員が聴取した居宅サービス計画に記載する医師の所見により確認する方法で差し支えありません。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"平成11年老企第22号3(7)⑳"]
[]
[null,"問22","　居宅サービス計画に特定福祉用具販売を位置付ける場合、その利用の妥当性を検討し、当該計画に特定福祉用具販売が必要な理由を記載している。\n\n※該当者がいない場合については、当該内容を承知していたら○",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"平成11年省令第38号第13条第22項"]
[]
[null,"問23","　特定福祉用具販売を位置付ける場合は、サービス担当者会議を開催して、専門的意見の聴取をしている。\n\n※該当者がいない場合については、当該内容を承知していたら○",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"平成11年老企第22号3(7)⑳"]
[]
[]
["（15）　看護小規模多機能型居宅介護計画及び報告書の作成"]
[null,"問1","　管理者は、介護支援専門員に看護小規模多機能型居宅介護計画の作成に関する業務を担当させている。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第78条第2項"]
[null,"問2","　介護支援専門員は、看護師等と密接な連携を図りつつ、看護小規模多機能型居宅介護計画の作成に当たっている。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第78条第3項"]
[null,"問3","　看護小規模多機能型居宅介護計画の作成に当たっては、地域における活動への参加の機会の提供等により、利用者の多様な活動の確保に努めるようにしている。"]
[]
[null,"問4","　介護支援専門員は、利用者の心身の状況、希望及びその置かれている環境を踏まえて、介護従業者と協議の上、援助の目標、当該目標を達成するための具体的なサービスの内容等を記載した看護小規模多機能型居宅介護計画を作成している。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第79条第1項"]
[null,"問5","　看護小規模多機能型居宅介護計画の作成に当たっては、利用者又はその家族に対しその内容等について説明し、文書により利用者の同意を得ている。また、看護小規模多機能型居宅介護計画を利用者に交付している。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第79条第2項"]
[null,"問6","　介護支援専門員は、計画作成後においても看護小規模多機能型居宅介護計画の実施状況及び利用者の様態の変化等の把握を行い、必要に応じて看護小規模多機能型居宅介護計画の変更をしている。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第79条第3項"]
[null,"問7","　短期利用居宅介護費を算定した場合、看護小規模多機能型居宅介護計画を作成している。"]
[null,"問8","　短期利用費を算定した利用者の担当介護支援専門員から、当該利用者の看護小規模多機能型居宅介護計画の提出の求めがあった際は、当該看護小規模多機能型居宅介護計画を提供することに協力するよう努めている。"]
[null,"問9","　看護師等が、訪問日、提供した看護内容、サービス提供結果等を記載した看護小規模多機能型居宅介護報告書を作成している。\n\n※当該指定看護小規模多機能型居宅介護事業者が病院又は診療所である場合にあっては、主治の医師の文書による指示及び看護小規模多機能型居宅介護報告書の提出は、診療記録の記載をもって代えることができます。"]
[null,"問10","　常勤の保健師又は看護師は、看護小規模多機能型居宅介護計画に沿った看護サービスの実施状況を把握し、看護小規模多機能型居宅介護計画及び看護小規模多機能型居宅介護報告書に関し、助言、指導等必要な管理を行っている。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第80条"]
[null,"問11","　指定看護小規模多機能型居宅介護事業者は、主治医との連携を図り、適切な看護サービスを提供するため、看護小規模多機能型居宅介護計画及び看護小規模多機能型居宅介護報告書を定期的に主治医に提出している。"]
[]
["（16）　介護等"]
[null,"問1","　利用者の負担により、利用者の居宅又は当該サービスの拠点における看護小規模多機能型介護従業者以外の者による介護を受けさせていない。"]
[]
[null,"問2","　利用者の食事その他の家事等は、可能な限り利用者と介護従業者が共同で行うよう努めている。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第53条第1項"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第53条第2項"]
["（17）　社会生活上の便宜の提供等"]
[null,"問1","　利用者の外出の機会の確保等利用者の意向を踏まえた社会生活の継続のための支援に努めている。"]
[]
[null,"問2","　利用者が日常生活を営むのに必要な行政機関等に対する手続について、その者又はその家族において行うことが困難である場合は、その者の同意を得て代行している。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第81条"]
[]
[null,"問3","　常に利用者の家族との連携を図るとともに、利用者とその家族との交流等の機会を確保するよう努めている。"]
[]
[]
["（18）　緊急時等の対応"]
[null,"問1","　利用者に病状の急変等が生じた場合等は、速やかに主治の医師又は協力医療機関への連絡を行う等の必要な措置を講じている。"]
[]
[null,"問2","　看護職員がサービスの提供を行っているときに、利用者に病状の急変等が生じた場合等にあっては、必要に応じて臨時応急の手当てを行っている。"]
[]
[]
["（19）　管理者の責務"]
[null,"問1","　事業所の従業者の管理、サービスの利用の申込みに係る調整、業務の実施状況の把握その他の管理を一元的に行っている。"]
[]
[null,"問2","　従業者に運営基準等の法令を遵守させるために必要な指揮命令を行っている。"]
[]
[]
["（20）　運営規程"]
[null,"問１","　次に掲げる事業の運営についての重要事項に関する規程を定めている。"]
[]
[null,null,"①","事業の目的、運営の方針、事業所名称、事業所所在地"]
[null,null,"②","従業者の職種、員数及び職務の内容"]
[null,null,"③","営業日及び営業時間"]
[null,null,"④","指定看護小規模多機能型居宅介護の登録定員並びに通いサービス及び宿泊サービスの利用定員"]
[null,null,"⑤","指定看護小規模多機能型居宅介護の内容及び利用料その他の費用の額（別紙料金表含む）"]
[null,null,"⑥","通常の事業の実施地域"]
[null,null,"⑦","サービス利用に当たっての留意事項"]
[null,null,"⑧","緊急やむを得ない場合に身体的拘束等を行う際の手続"]
[null,null,"⑨","緊急時等における対応方法"]
[null,null,"⑩","非常災害対策"]
[null,null,"⑪","虐待の防止に関する措置"]
[null,null,"⑫","個人情報の管理の方法"]
[null,null,"⑬","苦情への対応方法"]
[null,null,"⑭","事故発生の防止策および事故発生時の対応方法"]
[null,null,"⑮ 　その他運営に関する重要事項"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"老計発第0331004号2(5)④"]
["（21）　勤務体制の確保等"]
[null,"問1","　従業者の勤務体制表(ローテーション表)を作成している。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第82条の2第1項"]
[null,"問2","　全職員について、タイムカード等により勤務実績が分かるようにしている。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"老計発第0331004号第3の三の3(15)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第82条の2第2項"]
[null,"問3","　従業者の資質の向上のために、研修の機会を確保している。"]
[]
[null,"問4","　介護に直接携わる職員のうち、医療・福祉関係の資格を有さない者に、認知症介護基礎研修を受講させるために必要な措置を講じている。"]
[]
[null,"問5","　適切な指定看護小規模多機能型居宅介護の提供を確保する観点から、職場において行われる性的な言動又は優越的な関係を背景とした言動であって業務上必要かつ相当な範囲を超えたものにより従業者の就業環境が害されることを防止するための方針の明確化等の必要な措置を講じている。"]
[]
[]
["（22）　定員の遵守",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第83条第1項"]
[null,"問1","　利用者の様態や希望等により特に必要と認められる場合（※）や災害その他のやむを得ない事情等がある場合を除き、登録定員並びに通いサービス及び宿泊サービスの利用定員を超えてサービス提供を行っていない。"]
[null,null,"※特に必要と認められる場合とは…",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第83条第2項"]
[null,null,"①登録者の介護者が急病のため、急遽、事業所において通いサービスを提供したことにより、当該登録者が利用した時間帯における利用者数が定員を超える場合。"]
[null,null,"②事業所において看取りを希望する登録者に対し、宿泊室においてサービスを提供したことにより通いサービスの提供時間帯における利用者数が定員を超える場合。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第83条第3項"]
[null,null,"③登録者全員を集めて催しを兼ねたサービスを提供するため、通いサービスの利用者数が定員を超える場合。"]
[null,null,"④上記に準ずる状況により特に必要と認められる場合。"]
[null,"問2","（通いサービス利用）\n　通いサービスの利用者が登録定員に比べて著しく少ない状態が続いていない。\n\n※「著しく少ない状態｣とは、登録定員のおおむね３分の1以下であること。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第58条第1項"]
[]
[]
["（23）　業務継続計画の策定"]
[null,"問1","　感染症や非常災害の発生時において、利用者に対する指定看護小規模多機能型居宅介護の提供を継続的に実施するための、及び非常時の体制で早期の業務再開を図るための計画（以下「業務継続計画」という。）を策定し、当該業務継続計画に従い必要な措置を講じなけれならない。"]
[]
[null,"問2","　従業者に対し、業務継続計画について周知するとともに、必要な研修及び訓練を定期的に実施している。"]
[]
[null,"問3","　定期的に業務継続計画の見直しを行い、必要に応じて業務改善計画の変更を行っている。"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第58条第2項"]
["（24）　非常災害対策"]
[null,"問1","　非常災害に関する具体的計画（消防計画及び風水害、地震等の災害に対処するための計画）を立て、非常災害時の関係機関への通報及び連携体制を整備し、それらを定期的に従業者に周知するとともに、定期的に避難、救出その他の必要な訓練を定期的に行っている。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第58条第2項"]
[]
[null,"問2","　運営推進会議を活用し、地域住民との密接な連携体制を確保するなど、訓練時や火災等の際に消火･避難等に協力を得られる体制作りに努めている。"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第3条の32"]
["（25）　衛生管理等",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"老計発第0331004号第3の一の4(21)③"]
[null,"問1","　利用者の使用する施設、食器その他の設備又は飲用に供する水について、衛生的な管理に努め、又は衛生上必要な措置を講じている。"]
[]
[null,"問2","　看護小規模多機能型居宅介護事業所における感染症の予防及びまん延の防止のための対策を検討する委員会（テレビ電話装置等を活用して行うことができる。）をおおむね6月に１回以上開催するとともに、その結果について、従業者に周知徹底を図ること。"]
[]
[null,"問3","　看護小規模多機能型居宅介護事業所における感染症の予防及びまん延の防止のための指針を整備している。"]
[]
[null,"問4","　看護小規模多機能型居宅介護事業所において､従業者に対し、感染症の予防及びまん延の防止のための研修及び訓練を定期的に実施している。"]
[]
[null,"問5"," 　「循環式浴槽のレジオネラ症防止対策マニュアル」の管理概要に従い、適切に循環式浴槽を管理している。\n\n※循環式浴槽を設置している施設のみ回答。"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第37条第1項"]
["（26）　協力医療機関等"]
[null,"問1","　協力医療機関を定めている。"]
[]
[null,"問2","　協力歯科医療機関を定めている。\n\n※あらかじめ定めておくよう努めてください。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第3条の33第1項"]
[]
[null,"問3","　サービス提供体制の確保、夜間における緊急時の対応等のため、介護老人福祉施設、介護老人保健施設、介護医療院、病院等との連携及び支援の体制を整えている。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第3条の33第2項"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"老計発第0331004号第3の一の4(21)②"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第34条第3項"]
["（27）　掲示"]
[null,"問1","　事業所の見やすい場所に、運営規程の概要、従業者の勤務の体制、その他のサービスの選択に資すると認められる重要事項を掲示している。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第37条第2項"]
[]
[null,"問2","　重要事項を事業所のウェブサイトに掲載している。\n　※ウェブサイトとは、法人のホームページ等又は介護サービス情報公表システムのことをいう。\n　※令和７年度より義務付け"]
[]
[]
["（28）　秘密保持"]
[null,"問1","　従業者は正当な理由がなく、その業務上知り得た利用者又はその家族の秘密を漏らしていない。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第85条第1項"]
[]
[null,"問2","　従業者であった者が、正当な理由がなく、その業務上知り得た利用者又はその家族の秘密を漏らすことがないよう、必要な措置を講じている。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第85条第1項"]
[]
[null,"問3","　サービス担当者会議等において、利用者及び利用者の家族の個人情報を用いる場合は同意をあらかじめ文書により得ている。"]
[]
[]
["（29）　居宅介護支援事業者に対する利益供与の禁止"]
[null,"問1","　指定居宅介護支援事業者又はその従業者に対し、利用者に特定の事業者によるサービスを利用させることの対償として、金品その他の財産上の利益を供与していない。"]
[]
[]
["（30）　苦情処理"]
[null,"問1","　苦情を受け付けるための窓口を設置する等の必要な措置を講じている。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第85条第2項"]
[]
[null,"問2","　苦情を受け付けた場合には、当該苦情の内容等を記録している。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第85条第3項"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第85条第4項"]
["（31）　地域との連携"]
[null,"問1","　利用者、利用者の家族、市職員又は事業所が所在する地域を管轄する地域包括支援センター職員、地域住民の代表者等で構成される協議会（運営推進会議）を設置している。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第85条第5項"]
[]
[null,"問2","　概ね２か月に１回以上、協議会（運営推進会議）に対し活動状況を報告し、その評価を受けるとともに、必要な要望、助言等を聴く機会を設けている。"]
[null,null,"※前年度4月～3月の間の開催回数（　　　　回)"]
[null,"問3","　複数の事業所の運営推進会議を合同で開催したことがある。（該当する場合のみ、問4･5・6に回答。ただし、併設している他の地域密着型サービスと合同で行う場合は該当なしとする。)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第3条の38第1項"]
[]
[null,"問4","　（問3に該当する場合）次の条件を満たしている。\n　ア　利用者及び利用者家族については匿名とするなど、個人情報・プライバシーを保護すること。\n　イ　同一の日常生活圏内に所在する事業所であること。ただし、事業所間のネットワーク形成の促進が図られる範囲で、地域の実情に合わせて、市区域の単位等内に所在する事業所であっても差し支えない。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第3条の38第2項"]
[]
[null,"問5","　（問3に該当する場合）\n　合同開催の回数は、問2の開催回数の半数を超えていない。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第3条の38第3項"]
[]
[null,"問6","　（問3に該当する場合）\n　外部評価を行う運営推進会議は単独開催で行っている。"]
[]
[null,"問7","　地域住民又はボランティア団体等との連携や協力を行うなど、地域交流を図っている。"]
[]
[null,"問8","　利用者からの苦情に関して、市等が派遣する者が相談及び援助を行う事業その他の事業に協力するよう努めている。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第3条の38第3項"]
[]
[null,"問9","　事業所の所在する建物と同一の建物に居住する利用者に対してサービスを提供する場合には、当該建物に居住する利用者以外の者に対してもサービスを提供するよう努めている。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第3条の38第3項"]
[]
[]
["（32）　事故発生時の対応"]
[null,"問1","　サービスの提供により事故が発生した場合は、速やかに市、利用者の家族等に連絡を行うとともに、必要な措置を講じている。"]
[]
[null,"問2","　サービスの提供により事故が発生した場合は、事故の状況及び事故に際して採った処置について記録している。"]
[]
[null,"問3","　サービスの提供により賠償すべき事故が発生した場合は、損害賠償を速やかに行っている。"]
[]
[]
["（33）　虐待の防止"]
[null,"問1","　事業所における虐待の防止のための対策を検討する委員会（テレビ電話装置等を活用して行うことができる。）を定期的に開催するとともに、その結果について、従業者に周知徹底を図ること。"]
[]
[null,"問2","　事業所における虐待の防止のための指針を整備している。"]
[]
[null,"問3","　従業者に対し、虐待の防止のための研修を定期的に実施している。"]
[]
[null,"問4","　虐待の防止に関する措置を適切に実施するため担当者を置いている。"]
[]
[]
["(34)　安全・質の確保・負担軽減委員会設置"]
[null,"問1","　事業所における業務の効率化、介護サービスの質の向上その他の生産性の向上に資する取組の促進を図るため、事業所における利用者の安全並びに介護サービスの質の確保及び職員の負担軽減に資する方策を検討するための委員会を定期的に開催に開催している。\n※テレビ電話装置等を活用して行うことができるものとする。"]
[]
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["（35）　記録の整備"]
[null,"問1","　従業者、設備、備品及び会計に関する諸記録を整備している。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第3条の38第3項"]
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[null,"問2","　管理者を含め、従業者全員の雇用契約等の写し、資格証の写しを保管している。"]
[]
[null,"問3","　利用者に対する指定小規模多機能型居宅介護の提供に関する次に掲げる記録を整備し、その完結の日から５年間保存している。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第3条の38第3項"]
[]
[null,null,null,"１　居宅サービス計画\n２　看護小規模多機能型居宅介護計画\n３　身体的拘束等の態様及び時間、その際の利用者の心身の状況並びに緊急やむを得ない理由の記録\n４　主治の医師による指示の文書\n５　看護小規模多機能型居宅介護報告書\n６　提供した具体的なサービスの内容等の記録\n７　市への通知に係る記録\n８　苦情の内容等の記録\n９　事故の状況及び事故に際して採った処置についての記録\n１０　運営推進会議の報告、評価、要望、助言等の記録",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"省令第34号第3条の38第3項"]
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["　●　加　算　等　　（算定している加算等について点検を行ってください）"]
[null,null,null,null,null,null,null,"※該当がない場合は、―と記入してください。"]
["（１）　基本報酬"]
[null,"問1","　看護小規模多機能型居宅介護事業所の所在する建物と同一の建物に居住する利用者及び同一の建物以外に居住する利用者を区別し、適切な基本報酬を算定している。"]
[null,"問2","　利用者が月途中から登録した場合又は月途中に登録を終了した場合には、登録していた期間に対応した単位数を算定している。\n\n※登録していた期間とは、登録日から当該月の末日まで又は当該月の初日から登録終了日まで。\n※登録日とは、利用契約を結んだ日ではなく、実際にサービスの利用を開始した日とする。\n※登録終了日とは、利用者と事業者との間の契約を終了した日とする。"]
[]
[null,"問3","　通い、訪問、宿泊のサービスの提供回数について、登録者１人当たり平均回数が、週４回に満たない場合は、所定単位数の100分の70に相当する単位数を算定している。"]
[]
[null,"問4","　利用者が、短期入所生活介護、短期入所療養介護、特定施設入居者生活介護、認知症対応型共同生活介護、地域密着型特定施設入居者生活介護、地域密着型介護老人福祉施設入所者生活介護を受けている間は看護小規模多機能型居宅介護費を算定していない。"]
[]
[null,"問5","　短期利用居宅介護費を算定する場合"]
[null,null,null,"　登録者数が、看護小規模多機能型居宅介護事業所の登録定員未満である。"]
[null,null,null,"　利用者の状態や利用者の家族等の事情により、居宅介護支援事業所の介護支援専門員が緊急に利用することが必要と認めた場合及び看護小規模多機能型居宅介護事業所の介護支援専門員が登録者に対するサービスの提供に支障がないと認めた場合である。"]
[null,null,null,"　利用の開始に当たって、あらかじめ７日以内（利用者の日常生活上の世話を行う家族等の疾病等やむを得ない事情がある場合は１４日以内）の利用期間を定めている。"]
[null,null,null,"　人員基準を満たしている。"]
[null,null,null,"　問3のサービス提供が過小である場合の減算に該当していない。"]
[]
["（２）　初期加算"]
[null,"問1","　登録した日から起算して30日以内の期間について算定している。"]
[]
[null,"問2","　30日を超える病院又は診療所への入院後に、再び看護小規模多機能型居宅介護の利用を開始した場合に、算定している。"]
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["（３）　認知症加算(Ⅰ)(Ⅱ)（Ⅲ）（Ⅳ）"]
[null,"問1","　日常生活自立度のランクについては、医師の判定結果又は主治医意見書、あるいは医師の判定が無い場合は、認定調査票により確認している。"]
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[null,"問2","(Ⅰ)(Ⅱ)(Ⅲ)\n　日常生活に支障をきたすおそれのある症状又は行動が認められることから介護を必要とする認知症の者（日常生活自立度のランクⅢ、Ⅳ又はＭに該当する者）に対して指定小規模多機能型居宅介護を行った場合に算定している。"]
[]
[null,"問3","(Ⅰ)(Ⅱ)\n　認知症介護に係る専門的な研修を修了している者を、事業所における日常生活に支障を来すおそれのある症状又は行動が認められることから介護を必要とする認知症の者の数が２０人未満である場合にあっては１以上、対象者の数が２０人以上である場合にあっては１に対象者の数が１９を超えて１０又はその端数を増すごとに１を加えて得た数以上配置し、チームとして専門的な認知症ケアを実施している。"]
[]
[null,"問4","(Ⅰ)(Ⅱ)\n事業所の従業者に対する認知症ケアに関する留意事項の伝達又は技術的指導に係る会議を定期的に開催している。"]
[]
[null,"問5","(Ⅰ)\n認知症介護の指導に係る専門的な研修を修了している者を１名以上配置し、事業所全体の認知症ケアの指導等を実施している。"]
[]
[null,"問6","(Ⅰ)\n事業所における介護職員、看護職員ごとの認知症ケアに関する研修計画を作成し、当該計画に従い、研修（外部における研修を含む。）を実施又は実施を予定している。"]
[]
[null,"問7","(Ⅳ)\n　要介護２であって、周囲の者による日常生活に対する注意を必要とする認知症の者（日常生活自立度のランクⅡに該当する者）に対して指定看護小規模多機能型居宅介護を行った場合に算定している。"]
[]
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["（４）　認知症行動・心理症状緊急対応加算（短期利用居宅介護費）"]
[null,"問1","　医師が、利用者に認知症の行動・心理症状が認められるため、在宅での生活が困難であり、緊急に短期利用（短期利用居宅介護費）が必要であると判断した場合であって、介護支援専門員、受け入れ事業所の職員と連携し、利用者又は家族の同意の上、短期利用を行っている。"]
[]
[null,"問2","　医師が判断した当該日又はその次の日に利用を開始している。"]
[]
[null,"問3","　利用開始日から起算して７日を限度として算定している。"]
[]
[null,"問4","　次に掲げる者が、直接、短期利用（短期利用居宅介護費）を開始した場合には算定していない。\n　ａ　病院又は診療所に入院中の者\n　ｂ　介護保険施設又は地域密着型介護老人福祉施設に入院中又は利用中の者\n　ｃ　認知症対応型共同生活介護、地域密着型特定施設入居者生活介護、\n　　　特定施設入居者生活介護、短期入所生活介護、短期入所療養介護、\n　　　短期利用認知症対応型共同生活介護、短期利用特定施設入居者生活介護及び\n　　　地域密着型短期利用特定施設入居者生活介護を利用中の者"]
[]
[null,"問5","　判断を行った医師は診療録等に症状、判断の内容等を記録している。また、事業所も判断を行った医師名、日付及び利用開始に当たっての留意事項等を介護サービス計画書に記録している。"]
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["（５）　若年性認知症利用者受入加算"]
[null,"問1","　受け入れた若年性認知症利用者ごとに個別の担当者を定めている。"]
[]
[null,"問2","　認知症加算を算定していない。"]
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["（６）　栄養アセスメント加算"]
[null,"問1","　事業所の従業者として又は外部との連携により管理栄養士を1名以上配置している。"]
[]
[null,"問2","　利用者ごとに、管理栄養士、看護職員、介護職員、生活相談員その他の職種の者（以下「管理栄養士等」）が共同して栄養アセスメント（利用者ごとの低栄養状態のリスク及び解決すべき課題を把握すること。）を実施（３月に１回以上）し、当該利用者又はその家族等に対してその結果を説明し、相談等に必要に応じ対応している。"]
[]
[null,"問3","　栄養アセスメントは、利用者ごとに行われるケアマネジメントの一環として行われている。"]
[]
[null,"問4","　栄養アセスメントは、３月に１回以上、次の手順により行っている。\n　イ　利用者ごとの低栄養状態のリスクを、利用開始時に把握すること。\n　ロ　管理栄養士等が共同して、利用者ごとの摂食・嚥下機能及び食形態にも配慮しつつ、解決\n　　すべき栄養管理上の把握を行うこと。\n　ハ　イ及びロの結果を当該利用者又はその家族に対して説明し、必要に応じ解決すべき栄養管\n　　理上の課題に応じた栄養食時相談、情報提供等を行うこと。\n　ニ　低栄養状態にある利用者又はそのおそれのある利用者については、介護支援専門員と情報\n　　共有を行い、栄養改善加算に係る栄養改善サービスの提供を検討するように依頼すること。"]
[]
[null,"問5","　問４の手順にあわせて、利用者の体重について、１月毎に測定している。"]
[]
[null,"問6","　利用者ごとの栄養状態等の情報をＬＩＦＥを用いて厚生労働省に提出し、栄養管理の実施に当たって、当該情報その他栄養管理の適切かつ有効な実施のために必要な情報を活用している。"]
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[null,"問7","　利用者が栄養改善加算の算定に係る栄養改善サービスを受けている間及び当該栄養改善サービスが終了した日の属する月は、算定していない。"]
[]
[null,"問8","　定員超過利用・人員基準欠如に該当していない。"]
[]
[]
["（７）　栄養改善加算"]
[null,"問1","　事業所の従業者として又は外部との連携により管理栄養士を1名以上配置している。"]
[]
[null,"問2","　利用者の栄養状態を利用開始時に把握し、管理栄養士、看護職員、介護職員、生活相談員その他の職種の者（以下「管理栄養士等」）が共同して、利用者ごとの摂食・嚥下機能及び食形態にも配慮した栄養ケア計画を作成している。"]
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[null,"問3","　利用者ごとの栄養ケア計画に従い、必要に応じて当該利用者の居宅を訪問し、管理栄養士等が栄養改善サービスを行っているとともに、利用者の栄養状態を定期的に記録している。"]
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[null,"問4","　低栄養状態にある利用者又はそのおそれのある利用者に対して、栄養改善サービスを行っている。"]
[]
[null,"問5","　栄養改善サービスの提供は、利用者ごとに行われるケアマネジメントの一環として行われている。"]
[]
[null,"問6","　栄養改善サービスの提供は、次の手順により行っている。\n　イ　利用者ごとの低栄養状態のリスクを、利用開始時に把握すること。\n　ロ　利用開始時に、管理栄養士が中心となって、利用者ごとの摂食・嚥下機能及び食形態にも配\n　　慮しつつ、栄養状態に関する解決すべき課題の把握（栄養アセスメント）を行い、管理栄養士等\n　　が共同して、栄養食時相談に関する事項（食事に関する内容の説明等）、解決すべき栄養管理\n　　上の課題等に対し取り組むべき事項等を記載した栄養ケア計画を作成すること。作成した栄養\n　　ケア計画については、栄養改善サービスの対象となる利用者又はその家族に説明し、その同意\n　　を得ること。\n　ハ　栄養ケア計画に基づき、管理栄養士等が利用者ごとに栄養改善サービスを提供すること。\n　　その際、栄養ケア計画に実施上の問題点があれば直ちに当該計画を修正すること。\n　ニ　栄養改善サービスの提供に当たり、居宅における食事の状況を聞き取った結果、課題があ\n　　る場合は、当該課題を解決するため、利用者又はその家族の同意を得て、当該利用者の居宅\n　　を訪問し、居宅での食事状況・食事環境等の具体的な課題の把握や、主として食事の準備をす\n　　る者に対する栄養食時相談等の栄養改善サービスを提供すること。\n　ホ　利用者の栄養状態に応じて、定期的に、利用者の生活機能の状況を検討し、おおむね３月ご\n　　とに体重を測定する等により栄養状態の評価を行い、その結果を当該利用者を担当する介護支\n　　援専門員や主治の医師に対して情報提供すること。　"]
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[null,"問7","　利用者ごとの栄養ケア計画の進捗状況を定期的に評価している。"]
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[null,"問8","　対象の利用者は、次のイからホのいずれかに該当する者であって、栄養改善サービスの提供が必要と認められるものとしている。\n　イ　ＢＭＩが18.5未満である者\n　ロ　１～６月間で３％以上の体重の減少が認められる者又は「地域支援事業の実施について」（平\n　　成18 年６月９日老発第0609001 号厚生労働省老健局長通知）　に規定する基本チェックリスト\n　　のNo.11 の項目が「１」に該当する者\n　ハ　血清アルブミン値が3.5g/dl 以下である者\n　ニ　食事摂取量が不良（75％以下）である者\n　ホ　その他低栄養状態にある又はそのおそれがあると認められる者"]
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[null,"問9","　栄養改善サービスの提供に当たり、居宅における食事の状況を聞き取った結果、課題がある場合は、当該課題を解決するため、利用者又はその家族の同意を得て、当該利用者の居宅を訪問し、居宅での食事状況・食事環境等の具体的な課題の把握や、主として食事の準備をする者に対する栄養食事相談等の栄養改善サービスを提供している。"]
[]
[null,"問10","　おおむね３月ごとの評価の結果、問８のイからホのいずれかに該当する者であって、継続的に管理栄養士等がサービス提供を行うことにより、栄養改善の効果が期待できると認められるものについては、継続的に栄養改善サービスを提供している。"]
[]
[null,"問11","　定員超過利用・人員基準欠如に該当していない。"]
[]
[]
["（８）　口腔・栄養スクリーニング加算（Ⅰ）（Ⅱ）"]
[null,"問1","（Ⅰ）\n　利用開始時及び利用中６月ごとに利用者の口腔の健康状態について確認を行い、当該利用者の口腔の健康状態に関する情報（当該利用者の口腔の健康状態が低下しているおそれのある場合にあっては、その改善に必要な情報を含む。）を当該利用者を担当する介護支援専門員に提供している。"]
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[null,"問2","（Ⅰ）\n　利用開始時及び利用中６月ごとに利用者の栄養状態について確認を行い、当該利用者の栄養状態に関する情報（当該利用者が低栄養状態の場合にあっては、低栄養状態の改善に必要な情報を含む。）を当該利用者を担当する介護支援専門員に提供している。"]
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[null,"問3","（Ⅰ）\n　定員超過利用・人員基準欠如に該当していない。"]
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[null,"問4","（Ⅰ）\n　算定日が属する月が、次のいずれにも該当していない。"]
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[null,null,"ア","　栄養アセスメント加算を算定している又は当該利用者が栄養改善加算の算定に係る栄養改善サービスを受けている間である若しくは当該栄養改善サービスが終了した日の属する月であること。"]
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[null,null,"イ","　当該利用者が口腔機能向上加算の算定に係る口腔機能向上サービスを受けている間である又は当該口腔機能向上サービスが終了した日の属する月であること。"]
[]
[null,"問5","（Ⅱ）\n　次のいずれかに適合している。\n　"]
[null,null,"ア","次のいずれにも適合している。"]
[null,null,null,"ａ","　問1及び問3に適合すること。"]
[null,null,null,"ｂ","　算定日が属する月が、栄養アセスメント加算を算定している又は当該利用者が栄養改善加算の算定に係る栄養改善サービスを受けている間である若しくは当該栄養改善サービスが終了した日の属する月であること。"]
[]
[null,null,null,"ｃ","　算定日が属する月が、当該利用者が口腔機能向上加算の算定に係る口腔機能向上サービスを受けている間及び当該口腔機能向上サービスが終了した日の属する月ではないこと。"]
[]
[null,null,"イ","次のいずれにも適合している。"]
[null,null,null,"ａ","　問2及び問３に適合すること。"]
[null,null,null,"ｂ","　算定日が属する月が、栄養アセスメント加算を算定していない、かつ、当該利用者が栄養改善加算の算定に係る栄養改善サービスを受けている間又は当該栄養改善サービスが終了した日の属する月ではないこと。"]
[]
[null,null,null,"ｃ","　算定日が属する月が、当該利用者が口腔機能向上加算に係る口腔機能向上サービスを受けている間及び当該口腔機能向上サービスが終了した日の属する月であること。"]
[]
[null,"問6","（Ⅰ）（Ⅱ）\n 　口腔の健康状態のスクリーニング（以下「口腔スクリーニング」）及び栄養状態のスクリーニング（以下「栄養スクリーニング」）は、利用者ごとに行われるケアマネジメントの一環として行われている。"]
[]
[null,"問7","（Ⅰ）（Ⅱ）\n　当該利用者について、当該事業所以外ですでに本加算を算定している場合は、算定していない。"]
[]
[null,"問8","（Ⅰ）（Ⅱ）\n　口腔スクリーニング及び栄養スクリーニングを行うに当たっては、利用者について、それぞれ次に掲げる確認を行い、確認した情報を計画作成担当者に提供している。\n　イ　口腔スクリーニング\n　　　ａ　硬いものを避け、柔らかいものを中心に食べる者\n　　　ｂ　入れ歯を使っている者\n　　　ｃ　むせやすい者\n　ロ　栄養スクリーニング\n　　　ａ　ＢＭＩが18.5 未満である者\n　　　ｂ　 １～６月間で３％以上の体重の減少が認められる者又は「地域支援事業の実施について」\n　　　　（平成18 年６月９日老発第0609001 号厚生労働省老健局長通知）に規定する基本チェックリ\n　　　　ストのNo.11の項目が「１」に該当する者\n　　　ｃ　 血清アルブミン値が3.5g/dl 以下である者\n　　　ｄ　 食事摂取量が不良（75％以下）である者"]
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[null,"問9","（Ⅰ）（Ⅱ）\n　口腔・栄養スクリーニング加算の算定を行う事業所については、サービス担当者会議で決定すること\nとし、原則として、当該事業所が当該加算に基づく口腔スクリーニング又は栄養スクリーニングを継続的に実施している。"]
[]
["(９)　口腔機能向上加算"]
[null,"問1","（Ⅰ）（Ⅱ）\n　言語聴覚士、歯科衛生士又は看護職員を1名以上配置している。"]
[]
[null,"問2","（Ⅰ）（Ⅱ）\n　利用者の口腔機能を利用開始時に把握し、言語聴覚士、歯科衛生士、看護職員、介護職員、生活相談員その他の職種の者が共同して、利用者ごとの口腔機能改善管理指導計画を作成している。"]
[]
[null,"問3","（Ⅰ）（Ⅱ）\n　利用者ごとの口腔機能改善管理指導計画に従い、言語聴覚士、歯科衛生士又は看護職員が当該利用者の口腔機能の向上を目的として、個別的に実施される口腔清掃の指導若しくは実施又は摂食・嚥下機能に関する訓練の指導若しくは実施であって、利用者の心身の状態の維持又は向上に資すると認められるもの（以下「口腔機能向上サービス」という。）を行っているとともに、利用者の口腔機能を定期的に記録している。"]
[]
[null,"問4","（Ⅰ）（Ⅱ）\n　口腔機能が低下している利用者又はそのおそれのある利用者に対して、口腔機能向上サービスを行っている。"]
[]
[null,"問5","（Ⅰ）（Ⅱ）\n 　口腔機能向上サービスの提供は、利用者ごとに行われるケアマネジメントの一環として行われている。"]
[]
[null,"問6","（Ⅰ）（Ⅱ）　\n　口腔機能向上サービスの提供は、次の手順により行っている。\n　イ　利用者ごとの口腔機能を、利用開始時に把握すること。\n　ロ　利用開始時に、言語聴覚士、歯科衛生士又は看護職員が中心となって、利用者ごとの口腔\n　　衛生、摂食・嚥下機能に関する解決すべき課題の把握を行い、言語聴覚士等が共同して取り組\n　　むべき事項等を記載した口腔機能改善管理指導計画を作成すること。作成した口腔機能改善\n　　管理指導計画については、口腔機能向上サービスの対象となる利用者又はその家族に説明し、\n　　その同意を得ること。\n　ハ　口腔機能改善管理指導計画に基づき、言語聴覚士、歯科衛生士又は看護職員等が利用者\n　　ごとに口腔機能向上サービスを提供すること。その際、口腔機能改善管理指導計画に実施上\n　　の問題点があれば直ちに当該計画を修正すること。\n　ニ　利用者の口腔機能の状態に応じて、定期的に、利用者の生活機能の状況を検討し、おおむね\n　　３月ごとに口腔機能の状態の評価を行い、その結果について、当該利用者を担当する介護支\n　　援専門員や主治の医師、主治の歯科医師に対して情報提供すること。　"]
[]
[null,"問7","（Ⅰ）（Ⅱ）\n　おおむね３月ごとの評価の結果、次のイ又はロのいずれかに該当する者であって、継続的に言語聴覚士、歯科衛生士又は看護職員等がサービス提供を行うことにより、口腔機能の向上又は維持の効果が期待できると認められるものについては、継続的に口腔機能向上サービスを提供している。\n　イ　口腔清潔・唾液分泌・咀嚼・嚥下・食事摂取等の口腔機能の低下が認められる状態の者\n　ロ　当該サービスを継続しないことにより、口腔機能が低下するおそれのある者"]
[]
[null,"問8","（Ⅰ）（Ⅱ）\n　利用者ごとの口腔機能改善管理指導計画の進捗状況を定期的に評価している。"]
[]
[null,"問9","（Ⅱ）\n　利用者ごとの口腔機能改善管理指導計画等の内容等の情報をＬＩＦＥを用いて厚生労働省に提出し、口腔機能向上サービスの実施に当たって、当該情報その他口腔衛生の管理の適切かつ有効な実施のために必要な情報を活用している。"]
[]
[null,"問10","（Ⅰ）（Ⅱ）\n　対象の利用者は、次のイからハのいずれかに該当する者であって、口腔機能向上サービスの提供が必要と認められるものとしている。\n　イ　認定調査票における嚥下、食事摂取、口腔清潔の３項目のいずれかの項目に置いて「１」以\n　　外に該当する者\n　ロ　基本チェックリストの口腔機能に関連する（13）（14）（15）の３項目のうち、２項目以上が「１」\n　　に該当する者\n　ハ　その他口腔機能の低下している者又はそのおそれのある者"]
[]
[null,"問11","（Ⅰ）（Ⅱ）\n　歯科医療を受診している場合であって、次のイ又はロのいずれかに該当する場合にあっては、算定していない。\n　イ　医療保険において歯科診療報酬点数表に掲げる摂食機能療法を算定している場合\n　ロ　医療保険において歯科診療報酬点数表に掲げる摂食機能療法を算定していない場合であっ\n　　て、介護保険の口腔機能向上サービスとして「摂食・嚥下機能に関する訓練の指導若しくは実\n　　施」を行っていない場合"]
[]
[null,"問12","（Ⅰ）（Ⅱ）\n　定員超過利用・人員基準欠如に該当していない。"]
[]
[]
["（１０）　退院時共同指導加算"]
[null,"問1","　病院、診療所、介護老人保健施設又は介護医療院（以下、「病院等」とする。）に入院・入所中の者が退院・退所するに当たり、事業所の保健師、看護師（准看護師を除く。）、理学療法士、作業療法士、言語聴覚士が、当該者又はその看護に当たっている者に対して、病院等の主治医その他の職員と共同して、在宅での療養上必要な指導を行い、その内容を文書により提供した後に、当該者の退院・退所後に当該者に対する初回の訪問看護サービスを行った場合に算定している。"]
[]
[null,"問2","　利用者の退院・退所につき１回（特別な管理を必要とする利用者（特別管理加算の対象者）について、複数日に退院時共同指導を行った場合には２回）に限り算定している。"]
[]
[null,"問3","　２回の算定が可能である利用者に対して複数の定期巡回・随時対応型訪問介護看護事業所、看護小規模多機能型居宅介護事業所、訪問看護ステーションが退院時共同指導を行う場合にあたっては、１回ずつの算定をしている。"]
[]
[null,"問4","　複数の事業所が退院時共同指導を行う場合には、主治医の所属する保険医療機関、介護老人保健施設又は介護医療院に対し、他の事業所等における退院時共同指導の実施の有無について確認している。"]
[]
[null,"問5","　この加算を介護保険で請求した場合には、同月に訪問看護及び定期巡回・随時対応型訪問介護看護における退院時共同指導加算や、医療保険の訪問看護における退院時共同指導加算は算定していない（問３の場合を除く）。"]
[]
[null,"問6","　退院時共同指導を行った場合は、その内容を看護小規模多機能型居宅介護記録書に記録している。"]
[]
[]
["（１１）　緊急時訪問看護加算"]
[null,"問1","　利用者又はその家族等から電話等により看護に関する意見を求められた場合に常時対応できる体制（２４時間連絡体制）にある。"]
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[null,"問2","　計画的に訪問することとなっていない緊急時訪問を必要に応じて行っている。"]
[]
[null,"問3","　利用者に対して、問1、問2の体制にある場合にはこの加算を算定する旨を説明し、その同意を得ている。"]
[]
[null,"問4","　この加算を介護保険で請求した場合には、同月に訪問看護及び定期巡回・随時対応型訪問介護看護における緊急時訪問看護加算や、医療保険の訪問看護における24時間対応体制加算は算定していない。"]
[]
[null,"問5","　この加算は、１人の利用者に対し、１か所の事業所に限り算定できるとされていることから、利用者に説明するに当たって、当該利用者が他の事業所から緊急時訪問看護加算に係る訪問看護を受けていないか確認している。"]
[]
[null,"問6","　加算の算定は市が届出を受理した日以降に行っている。"]
[]
[]
["（１２）　特別管理加算（Ⅰ）（Ⅱ）"]
[null,"問1","　特別な管理を必要とする利用者（※）に対して、指定看護小規模多機能型居宅介護の実施に関する計画的な管理を行っている。（加算（Ⅰ）はイに該当する状態にある者、加算（Ⅱ）はロからホまでに該当する状態にある者）"]
[null,null,"　※特別な管理を必要とする利用者"]
[null,null,"イ","医科診療報酬点数表に掲げる在宅悪性腫瘍患者指導管理若しくは在宅気管切開患者指導管理を受けている状態又は気管カニューレ若しくは留置カテーテルを使用している状態"]
[null,null,"ロ","医科診療報酬点数表に掲げる在宅自己腹膜灌流指導管理、在宅血液透析指導管理、在宅酸素療法指導管理、在宅中心静脈栄養法指導管理、在宅成分栄養経管栄養法指導管理、在宅自己導尿指導管理、在宅持続腸圧呼吸療法指導管理、在宅自己疼痛管理指導管理又は在宅肺高血圧症患者指導管理を受けている状態"]
[null,null,"ハ","人工肛門又は人工膀胱を設置している状態"]
[null,null,"ニ","真皮を越える褥瘡の状態"]
[null,null,"ホ","点滴注射を週３日以上行う必要があると認められる状態"]
[null,"問2","　この加算を介護保険で請求した場合には、同月に訪問看護及び定期巡回・随時対応型訪問介護看護における特別管理加算や、医療保険の訪問看護における特別管理加算は算定していない。"]
[]
[null,"問3","　１人の利用者に対し、１か所の事業所に限り算定している。"]
[]
[null,"問4","　「真皮を越える褥瘡の状態」にある利用者に対してこの加算を算定する場合は、１週間に１回以上、褥瘡の状態の観察・アセスメント・評価（褥瘡の深さ、滲出液、大きさ、炎症・感染、肉芽組織、壊死組織、ポケット）を行い、褥瘡の発生部位及び実施したケア、利用者家族等に行う指導などについて訪問看護サービス記録書に記録している。"]
[]
[null,"問5","　「点滴注射を週３日以上行う必要がある」利用者に対してこの加算を算定する場合は、主治医から点滴注射が週３日以上必要な旨の指示を受け、看護職員が週３日以上の点滴を実施している。"]
[]
[null,"問6","　問5について、点滴注射が終了した場合その他必要な場合には、主治医に対して速やかに利用者の状態を報告するとともに、訪問看護サービス記録書に点滴注射の実施内容を記録している。"]
[]
[null,"問7","　訪問の際、症状が重篤であった場合には、速やかに医師による診療を受けることができるよう必要な支援を行っている。"]
[]
[]
["（１３）　ターミナルケア加算"]
[null,"問1","　ターミナルケアを受ける利用者について２４時間連絡体制を確保しており、かつ、必要に応じて、訪問看護を行うことができる体制を整備している。"]
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[null,"問2","　主治医との連携の下に、訪問看護におけるターミナルケアに係る計画及び支援体制について利用者及びその家族等に対して説明を行い、同意を得て、ターミナルケアを行っている。"]
[]
[null,"問3","　ターミナルケアの提供について利用者の身体状況の変化等必要な事項を適切に記録している。"]
[null,"問4","　在宅又は看護小規模多機能型居宅介護事業所で死亡した利用者に対して、その死亡日及び死亡日前１４日以内に２日（死亡日及び死亡日前１４日以内に末期の悪性腫瘍その他厚生労働大臣が定める状態にある者に対して訪問看護を行っている場合にあっては１日）以上ターミナルケアを行っている。\n\n※ターミナルケアを行った後、２４時間以内に在宅以外で死亡した場合を含む。\n※厚生労働大臣が定める状態にある者とは次のイ、ロいずれかに該当する場合を指す。\nイ　多発性硬化症、重症筋無力症、スモン、筋萎縮性側索硬化症、脊髄小脳変性症、ハンチントン病、\n　　進行性筋ジストロフィー症、パーキンソン病関連疾患（進行性核上性麻痺、大脳皮質基底核変性症\n　　及びパーキンソン病（ホーエン・ヤールの重症度分類がステージ３以上であって生活機能障害度が\n　　Ⅱ度又はⅢ度のものに限る。）をいう。）、多系統萎縮症（線条体黒質変性症、オリーブ橋小脳萎縮症\n　　及びシャイ・ドレーガー症候群をいう。）、プリオン病、亜急性硬化性全脳炎、ライソゾーム病、\n　　副腎白質ジストロフィー、脊髄性筋萎縮症、球脊髄性筋萎縮症、慢性炎症性脱随性多発神経炎、\n　　後天性免疫不全症候群、頚髄損傷及び人工呼吸器を使用している状態\nロ　急性増悪その他当該利用者の主治の医師が一時的に頻回の訪問看護が必要であると認める状態"]
[]
[null,"問5","　１人の利用者に対し、１か所の事業所に限り算定している。"]
[]
[null,"問6","　この加算を介護保険で請求した場合には、同月に定期巡回・随時対応型訪問介護看護及び訪問看護を利用した場合のターミナルケア加算並びに医療保険における訪問看護ターミナルケア療養費及び在宅ターミナルケア加算は算定していない。"]
[null,"問7","　ターミナルケアの提供においては、次に掲げる事項を看護小規模多機能型居宅介護記録書に記録している。　\n　ア　終末期の身体症状の変化及びこれに対する看護についての記録\n　イ　療養や死別に関する利用者及び家族の精神的な状態の変化及びこれに対するケアの経過に\n　　ついての記録\n　ウ　看取りを含めたターミナルケアの各プロセスにおいて利用者及び家族の意向を把握し、それに\n　　基づくアセスメント及び対応の経過の記録　\n\n※厚生労働省「人生の最終段階における医療・ケアの決定プロセスにかんするガイドライン」等の内容を踏まえ、利用者本人及びその家族等と話し合いを行い、利用者本人の意思決定を基本に、他の関係者との連携の上対応すること。"]
[null,"問8","　ターミナルケアの実施に当たっては、他の医療及び介護関係者と十分な連携を図るよう努めている。"]
[]
["（１４）  看護体制強化加算(Ⅰ)(Ⅱ)"]
[null,"問1","(Ⅰ)(Ⅱ)\n　算定日が属する月の前３月間において、指定看護小規模多機能事業所における利用者の総数のうち、主治の医師の指示に基づく看護サービスを提供した利用者の占める割合が１００分の８０以上である。"]
[null,"問2","(Ⅰ)(Ⅱ)\n　算定日が属する月の前３月間において、指定看護小規模多機能型居宅介護事業所における利用者の総数のうち、緊急時訪問看護加算を算定した利用者の占める割合が１００分の５０以上である。"]
[null,"問3","(Ⅰ)(Ⅱ)\n　算定日が属する月の前３月間において、指定看護小規模多機能型居宅介護事業所における利用者の総数のうち、特別管理加算を算定した利用者の占める割合が１００分の２０以上である。"]
[null,"問4","(Ⅰ)\n　算定日が属する月の前12月間において、指定看護小規模多機能型居宅介護事業所におけるターミナルケア加算を算定した利用者が1名以上である。　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　"]
[null,"問5","(Ⅰ)\n　登録特定行為事業者又は登録喀痰吸引等事業者として届出している。"]
[null,"問6","(Ⅰ)(Ⅱ)\n　看護師等が、当該加算の内容について利用者又はその家族への説明を行い、同意を得ている。"]
[null,"問7","(Ⅰ)(Ⅱ)\n　継続的に問１～４までの基準を維持し、その割合又は人数については、台帳等により毎月記録している。"]
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["（１５）　訪問体制強化加算"]
[null,"問１","　訪問サービス（訪問看護サービスを除く）を担当する常勤の従業者（保健師、看護師、准看護師、理学療法士、作業療法士及び言語聴覚士を除く。）を２名以上配置している。"]
[]
[null,"問２","　　事業所における全ての登録者に対する訪問サービスの提供回数が１月（暦月）当たり延べ２００回以上である。"]
[null,null,null,"　事業所と同一の建物に集合住宅（養護老人ホーム、軽費老人ホーム若しくは有料老人ホーム又はサービス付き高齢者向け住宅）を併設する場合は、以下のいずれも満たすこと。\n　①　同一建物居住者以外の者の占める割合が１００分の５０以上である。\n　②　同一建物居住者以外の者に対する延べ訪問回数が１月当たり２００回以上である。"]
[null,"問３","　提供した訪問サービスの内容を記録している。"]
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[]
["（１６）　総合マネジメント体制強化加算（Ⅰ）、（Ⅱ）"]
[null,"問１","総合マネジメント体制強化加算（Ⅰ）\n利用者の心身の状況又はその家族等を取り巻く環境の変化に応じ、随時、介護支援専門員、看護師、准看護師、介護職員その他の関係者が共同し、看護小規模多機能型居宅介護計画の見直しを行っている。"]
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[null,"問２","　総合マネジメント体制強化加算（Ⅰ）\n　利用者の地域における多様な活動が確保されるよう、日常的に地域住民等との交流を図り、利用者の状態に応じて、地域の行事や活動等に積極的に参加している。"]
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[null,"問３","　総合マネジメント体制強化加算（Ⅰ）\n　日常的に利用者と関わりのある地域住民等の相談に対応する体制を確保している。"]
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[null,"問４","　総合マネジメント体制強化加算（Ⅰ）\n　必要に応じて、多様な主体により提供される登録者の生活全般を支援するサービスが包括的に提供されるような居宅サービス計画を作成していること。"]
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[null,"問５","　総合マネジメント体制強化加算（Ⅰ）\n　次に掲げる基準のいずれかに適合すること。"]
[null,null,null,"地域住民等との連携により、地域資源を効果的に活用し、利用者の状態に応じた支援を行っていること。"]
[null,null,null,"障害福祉サービス事業所、児童福祉施設等と協働し、地域において世代間の交流の場の拠点となっていること。"]
[null,null,null,"地域住民等、他の指定居宅サービス事業者が当該事業を行う事業所、他の指定地域密着型サービス事業者が当該事業を行う事業所等と共同で事例検討会、研修会等を実施していること。"]
[null,null,null,"市町村が実施する通いの場や介護予防に資する取組、他のサービス事業所、医療機関との連携等を行っている。"]
[null,"問６","　総合マネジメント体制強化加算（Ⅱ）\n　問１及び問２に適合していること。"]
[]
[]
["（１８）　褥瘡マネジメント加算（Ⅰ）（Ⅱ）"]
[null,"問１","（Ⅰ）（Ⅱ）\n　利用者ごとに褥瘡の発生と関連のあるリスクについて、利用開始時に評価し、その後少なくとも３月に１回評価するとともに、その評価結果等の情報をＬＩＦＥを用いて厚生労働省に提出し、褥瘡管理の実施に当たって、当該情報その他褥瘡褥瘡管理の適切かつ有効な実施のために必要な情報を活用している。"]
[]
[null,"問２","（Ⅰ）（Ⅱ）\n　問１の評価の結果、褥瘡が発生するリスクがあるとされた利用者ごとに、医師、看護師、介護職員、管理栄養士、介護支援専門員その他の職種の者が共同して、褥瘡管理に関する褥瘡ケア計画を作成している。"]
[]
[null,"問３","（Ⅰ）（Ⅱ）\n　利用者ごとの褥瘡ケア計画に従い褥瘡管理を実施するとともに、その管理の内容や利用者の状態について定期的に記録している。"]
[]
[null,"問４","（Ⅰ）（Ⅱ）\n　問１の評価に基づき、少なくとも３月に１回利用者ごとに褥瘡ケア計画を見直している。"]
[]
[null,"問５","（Ⅱ）\n　問１の評価の結果、褥瘡の認められた入所者等について、当該褥瘡が治癒したこと、または利用開始時に褥瘡が発生するリスクがあるとされた利用者について、褥瘡の発生がない。"]
[]
[null,"問６","（Ⅰ）\n　原則として要介護度３以上の利用者全員を対象として利用者ごとに要件を満たした場合に、当該事業所の要介護度３以上の利用者全員（褥瘡マネジメント加算（Ⅱ）を算定している者を除く。）に対して算定している。"]
[]
[null,"問８","（Ⅰ）（Ⅱ）\n　褥瘡ケア計画に基づいたケアを実施する際には、褥瘡ケア・マネジメントの対象となる利用者又はその家族に説明し、その同意を得ている。"]
[]
[null,"問９","（Ⅰ）（Ⅱ）\n　問４における褥瘡ケア計画の見直しは、褥瘡ケア計画に実施上の問題（褥瘡管理の変更の必要性、関連職種が共同して取り組むべき事項の見直しの必要性等）があれば直ちに実施している。"]
[]
[]
["（１９）　排せつ支援加算（Ⅰ）（Ⅱ）（Ⅲ）"]
[null,"問1","（Ⅰ）（Ⅱ）（Ⅲ）\n　利用者ごとに、要介護状態の軽減の見込みについて、医師又は医師と連携した看護師が利用開始時に評価し、その後少なくとも６月に１回評価するとともに、その評価結果等の情報をＬＩＦＥを用いて厚生労働省に提出し、排せつ支援の実施に当たって、当該情報その他排せつ支援の適切かつ有効な実施のために必要な情報を活用している。"]
[]
[null,"問2","（Ⅰ）（Ⅱ）（Ⅲ）\n　問１の評価の結果、、排せつ介護を要する利用者であって、適切な対応を行うことにより、要介護状態の軽減が見込まれるものについて、医師、看護師、介護支援専門員その他の職種の者が共同して、当該利用者が排せつ介護を要する原因を分析し、それに基づいた支援計画を作成し、当該支援計画に基づく支援を継続して実施している。"]
[]
[null,"問3","（Ⅰ）（Ⅱ）（Ⅲ）\n　問１の評価に基づき、少なくとも３月に１回、利用者ごとに支援計画を見直している。"]
[]
[null,"問4","（Ⅱ）\n　次のいずれかに適合している。"]
[null,null,"イ","　問１の評価の結果、要介護状態の軽減が見込まれる者について、利用開始時と比較して、排尿又は排便の状態の少なくとも一方が改善するとともにいずれにも悪化がない。"]
[]
[null,null,"ロ","　問１の評価の結果、利用開始時におむつを使用していた者であって要介護状態の軽減が見込まれるものについて、おむつを使用しなくなった。"]
[]
[null,"問5","（Ⅲ）\n　問4イ及びロのいずれにも適合している。"]
[]
[null,"問6","（Ⅰ）\n　原則として要介護度３以上の利用者全員を対象として利用者ごとに問1から問3の要件を満たした場合に、当該事業所の要介護度３以上の利用者全員（排せつ支援加算（Ⅱ）又は（Ⅲ）を算定している者を除く。）に対して算定している。"]
[]
[null,"問7","（Ⅱ）（Ⅲ）\n　他の事業所が提供する排せつ支援に係るリハビリテーションを併用している利用者に対して、看護小規模多機能型居宅介護事業所が当該他の事業所と連携して排せつ支援を行っていない場合は、当該利用者を排せつ支援加算（Ⅱ）又は（Ⅲ）の対象に含めていない。"]
[]
[null,"問8","（Ⅰ）（Ⅱ）（Ⅲ）\n　問１の評価を医師と連携した看護師が行った場合は、その内容を支援の開始前に医師へ報告している。"]
[]
[null,"問9","（Ⅰ）（Ⅱ）（Ⅲ）\n　問１の評価を医師と連携した看護師が行う際、利用者の背景疾患の状況を勘案する必要がある場合等は、医師に相談している。"]
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[null,"問10","（Ⅰ）（Ⅱ）（Ⅲ）\n　問2における支援計画の実施にあたっては、計画の作成に関与した者が、利用者及びその家族に対し、排せつの状態及び今後の見込み、支援の必要性、要因分析並びに支援計画の内容、当該支援は利用者及びその家族がこれらの説明を理解した上で支援の実施を希望する場合に行うものであること、及び支援開始後であってもいつでも利用者及びその家族の希望に応じて支援計画を中断又は中止できることを説明し、利用者及びその家族の理解と希望を確認した上で行っている。"]
[]
[null,"問11","（Ⅰ）（Ⅱ）（Ⅲ）\n　問3における支援計画の見直しは、支援計画に実施上の問題（排せつ支援計画の変更の必要性、関連職種が共同して取り組むべき事項の見直しの必要性等）があれば直ちに実施している。"]
[]
[]
["（２０）　生産性向上推進体制加算"]
[null,"問１","　生産性向上推進体制加算（Ⅰ）（Ⅱ）共通\n利用者の安全並びに介護サービスの質の確保及び職員の負担軽減に資する方策を検討するための委員会において、次に掲げる事項について必要な検討を行い、及び当該事項の実施を定期的に確認している。\n（一）　業務の効率化及び質の向上又は職員の負担の軽減に資する機器（以下「介護機器」という。）を活用する場合における利用者の安全及びケアの質の確保\n（二）　職員の負担の軽減及び勤務状況への配慮\n（三）　介護機器の定期的な点検\n（四）　業務の効率化及び質の向上並びに職員の負担軽減を図るための職員研修"]
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[]
[null,"問２","　生産性向上推進体制加算（Ⅰ）\n問１の取組及び介護機器の活用による業務の効率化及びケアの質の確保並びに職員の負担軽減に関する実績がある。"]
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[]
[]
[null,"問３","　生産性向上推進体制加算（Ⅰ）\n介護機器を複数種類活用していること。"]
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[]
[null,"問４","　生産性向上推進体制加算（Ⅰ）\n委員会において、職員の業務分担の明確化等による業務の効率化及びケアの質の確保並びに負担軽減について必要な検討を行い、当該検討を踏まえ、必要な取組を実施し、及び当該取組の実施を定期的に確認している。"]
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[null,"問５","　生産性向上推進体制加算（Ⅰ）\n事業年度ごとに、問１、３、４についての取組に関する実績を厚生労働省に報告している。"]
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[]
[null,"問６","　生産性向上推進体制加算（Ⅱ）\n介護機器を活用していること"]
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[]
[null,"問７","　生産性向上推進体制加算（Ⅱ）\n事業年度ごとに、問１、６についての取組に関する実績を厚生労働省に報告している。"]
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[]
[]
["（２１）　科学的介護推進体制加算"]
[null,"問1","　利用者ごとのＡＤＬ値、栄養状態、口腔状態、認知症の状況その他の利用者の心身の状況等に係る基本的な情報を、ＬＩＦＥを用いて厚生労働省に提出している。"]
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[null,"問2","　必要に応じて看護小規模多機能型居宅介護計画を見直すなど、指定看護小規模多機能型居宅介護の提供に当たって、問1の情報その他指定看護小規模多機能型居宅介護を適切かつ有効な実施のために必要な情報を活用している。"]
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[]
["（２２）　サービス提供体制強化加算(Ⅰ)(Ⅱ)(Ⅲ)"]
[null,"問1","（Ⅰ）\n　次のいずれかに適合すること。"]
[null,null,"イ","　事業所の介護従業者（保健師、看護師又は准看護師を除く。）の総数のうち、介護福祉士の占める割合が、前年度(３月を除く)の平均で100分の70以上である。"]
[]
[null,null,"　　○前年度実績が６か月以上の事業所(前年度4月～2月の平均)"]
[null,null,"　　　　介護従業者総数　　　　　　人　介護福祉士員数　　　　　　人　　割合　　　　　　　（％）"]
[]
[null,null,"　　○前年度実績が６か月未満の事業所(算定開始前3か月の平均)"]
[null,null,"　　　　介護従業者総数　　　　　　人　介護福祉士員数　　　　　　人　　割合　　　　　　　（％）"]
[]
[null,null,"ロ","　事業所の介護従業者（保健師、看護師又は准看護師を除く。）の総数のうち、勤続年数10年以上の介護福祉士の占める割合が前年度(３月を除く)の平均で100分の25以上である。"]
[]
[null,null,"　　○前年度実績が６か月以上の事業所(前年度4月～2月の平均)"]
[null,null,"　　　　介護従業者総数　　　　　　人　介護福祉士員数　　　　　　人　　割合　　　　　　　（％）"]
[]
[null,null,"　　○前年度実績が６か月未満の事業所(算定開始前3か月の平均)"]
[null,null,null,"　介護従業者総数　　　　　　人　介護福祉士員数　　　　　　人　　割合　　　　　　　（％）"]
[null,"問2","（Ⅱ）\n　事業所の介護従業者（保健師、看護師又は准看護師を除く。）の総数のうち、介護福祉士の占める割合が、前年度(３月を除く)の平均で100分の50以上である。"]
[]
[]
[null,null,"　○前年度実績が６か月以上の事業所(前年度4月～2月の平均)"]
[null,null,"　　介護従業者総数　　　　　　人　介護福祉士員数　　　　　　人　　割合　　　　　　　（％）"]
[]
[null,null,"　○前年度実績が６か月未満の事業所(算定開始前3か月の平均)"]
[null,null,"　　介護従業者総数　　　　　　人　介護福祉士員数　　　　　　人　　割合　　　　　　　（％）"]
[null,"問3","（Ⅲ）\n　次のいずれかに適合すること。"]
[null,null,"イ","　事業所の介護従業者（保健師、看護師又は准看護師を除く。）の総数のうち、介護福祉士の占める割合が、前年度(３月を除く)の平均で100分の40以上である。"]
[]
[]
[null,null,"　　○前年度実績が６か月以上の事業所(前年度4月～2月の平均)"]
[null,null,"　　　介護従業者総数　　　　　　人　介護福祉士員数　　　　　　人　　割合　　　　　　　（％）"]
[]
[null,null,"　　○前年度実績が６か月未満の事業所(算定開始前3か月の平均)"]
[null,null,"　　　介護従業者総数　　　　　　人　介護福祉士員数　　　　　　人　　割合　　　　　　　（％）"]
[]
[null,null,"ロ","　事業所の介護従業者の総数のうち、常勤職員の占める割合が、前年度(３月を除く)の平均で100分の60以上である。"]
[]
[]
[null,null,"　　○前年度実績が６か月以上の事業所(前年度4月～2月の平均)"]
[null,null,"　　　介護従業者総数　　　　　　人　常勤職員数　　　　　　人　　割合　　　　　　　（％）"]
[]
[null,null,"　　○前年度実績が６か月未満の事業所(算定開始前3か月の平均)"]
[null,null,"　　　介護従業者総数　　　　　　人　常勤職員数　　　　　　人　　割合　　　　　　　（％）"]
[null,null,"ハ","　事業所の介護従業者の総数のうち、勤続年数７年以上の者の占める割合が、前年度(３月を除く)の平均で100分の30以上である。"]
[]
[]
[null,null,"　　○前年度実績が６か月以上の事業所(前年度4月～2月の平均)"]
[null,null,"　　　介護従業者総数　　　　　　人　勤続年数７年以上の介護従業者数　　　　　　人　　割合　　　　　　　（％）"]
[]
[null,null,"　　○前年度実績が６か月未満の事業所(算定開始前3か月の平均)"]
[null,null,null,"介護従業者総数　　　　　　人　勤続年数７年以上の介護従業者数　　　　　　人　　割合　　　　　　　（％）"]
[null,"問4","（Ⅰ）（Ⅱ）（Ⅲ）\n　前年度実績が６か月未満の事業所においては、届出を行った月以降も直近３月間の職員の割合につき、所定の割合を維持し、毎月記録をしている。"]
[]
[null,"問5","（Ⅰ）（Ⅱ）（Ⅲ）\n　全ての従業者に対し、従業者ごとに研修計画を作成し、研修（外部における研修を含む。）を実施又は実施を予定している。"]
[]
[null,"問6","（Ⅰ）（Ⅱ）（Ⅲ）\n　利用者に関する情報若しくはサービス提供に当たっての留意事項の伝達又は従業者の技術指導を目的とした会議をおおむね月１回以上開催している。"]
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[null,"問7","（Ⅰ）（Ⅱ）（Ⅲ）\n　問６の会議について、従業者の全てが参加している。\n\n※複数のグループに分けて開催することは可能"]
[]
[null,"問8","（Ⅰ）（Ⅱ）（Ⅲ）\n　問６の会議の開催状況について、概要を記録している。"]
[]
[null,"問9","（Ⅰ）（Ⅱ）（Ⅲ）\n　問６の利用者に関する情報若しくはサービス提供の当たっての留意事項について、下記の事項に関して、その変化の動向を含め、記載している。\n　・　利用者のＡＤＬや意欲\n　・　利用者の主な訴えやサービス提供時の特段の要望\n　・　家庭環境\n　・　前回のサービス提供時の状況\n　・　その他サービス提供に当たっては必要な事項"]
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[null,"問10","（Ⅰ）（Ⅱ）（Ⅲ）\n　定員超過利用・人員基準欠如に該当していない。"]
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["（１４）　介護職員等処遇改善加算"]
[null,"①介護職員等処遇改善加算(Ⅰ)"]
[null,"問１","　月額賃金改善要件Ⅰ（月給による賃金改善）として、新加算Ⅳの加算額の２分の１以上を基本給又は決まって毎月支払われる手当（基本給等）の改善に充てている。\n　また、新加算Ⅰ～Ⅲまでのいずれかを算定する場合にあっては、仮に新加算Ⅳを算定する場合に見込まれる加算額の２分の１以上を基本給等の改善に充てている。　\n\n※令和６年度中は猶予（令和７年度から適用）"]
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[null,"問２","　月額賃金改善要件Ⅱ（旧ベースアップ等加算相当の賃金改善）として、前年度と比較し、旧ベースアップ等加算相当の加算額の３分の２以上の新たな基本給等の改善（月給の引上げ）を行っている。\n\n※新加算Ⅰ～Ⅳまでのいずれかの算定以前に、「旧ベースアップ等加算」又は「新加算Ⅴ(2)、(4)、(7)、(9)若しくは(13)」を算定していた事業所については適用しない。"]
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[null,"問３","　キャリアパス要件Ⅰ（任用要件・賃金体系の整備等）の内容を書面で整備し、全ての介護職員に周知している。"]
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[null,"問４","　キャリアパス要件Ⅱ（研修の実施等）を全ての介護職員に周知している。"]
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[null,"問５","　キャリアパス要件Ⅲ（昇給の仕組みの整備等）の内容を書面で整備し、全ての介護職員に周知している。"]
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[null,"問６","　キャリアパス要件Ⅳ（改善後の年額賃金要件）として、経験・技能のある介護職員のうち、１人以上は、賃金改善後の賃金の見込額（新加算を算定し実施される賃金改善の見込額を含む）が年額440万円以上となっている。\n\n※令和６年度中は月額8万円の改善でも可能"]
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[null,"問７","　キャリアパス要件Ⅴ（介護福祉士等の配置要件）として、サービス種類ごとに、「サービス提供体制強化加算」、「特定事業所加算」、「入居継続支援加算」又は「日常生活支援加算」の各区分の届出を行っている。"]
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[null,"問８","　職場環境要件として、従前（旧３加算）の職場環境等の改善に係る取組を実施し、その内容を全ての介護職員に周知しており、当該取組についてホームページへの掲載等により公表している。"]
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[null,"②介護職員等処遇改善加算(Ⅱ)"]
[null,"問１","　月額賃金改善要件Ⅰ（月給による賃金改善）として、新加算Ⅳの加算額の２分の１以上を基本給又は決まって毎月支払われる手当（基本給等）の改善に充てている。\n　また、新加算Ⅰ～Ⅲまでのいずれかを算定する場合にあっては、仮に新加算Ⅳを算定する場合に見込まれる加算額の２分の１以上を基本給等の改善に充てている。　\n\n※令和６年度中は猶予（令和７年度から適用）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"-"]
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[null,"問２","　月額賃金改善要件Ⅱ（旧ベースアップ等加算相当の賃金改善）として、前年度と比較し、旧ベースアップ等加算相当の加算額の３分の２以上の新たな基本給等の改善（月給の引上げ）を行っている。\n\n※新加算Ⅰ～Ⅳまでのいずれかの算定以前に、「旧ベースアップ等加算」又は「新加算Ⅴ(2)、(4)、(7)、(9)若しくは(13)」を算定していた事業所については適用しない。"]
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[null,"問３","　キャリアパス要件Ⅰ（任用要件・賃金体系の整備等）の内容を書面で整備し、全ての介護職員に周知している。"]
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[null,"問４","　キャリアパス要件Ⅱ（研修の実施等）を全ての介護職員に周知している。"]
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[null,"問５","　キャリアパス要件Ⅲ（昇給の仕組みの整備等）の内容を書面で整備し、全ての介護職員に周知している。"]
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[null,"問６","　キャリアパス要件Ⅳ（改善後の年額賃金要件）として、経験・技能のある介護職員のうち、１人以上は、賃金改善後の賃金の見込額（新加算を算定し実施される賃金改善の見込額を含む）が年額440万円以上となっている。\n\n※令和６年度中は月額8万円の改善でも可能"]
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[null,"問７","　職場環境要件として、従前（旧３加算）の職場環境等の改善に係る取組を実施し、その内容を全ての介護職員に周知しており、当該取組についてホームページへの掲載等により公表している。"]
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[null,"③介護職員等処遇改善加算(Ⅲ)"]
[null,"問１","　月額賃金改善要件Ⅰ（月給による賃金改善）として、新加算Ⅳの加算額の２分の１以上を基本給又は決まって毎月支払われる手当（基本給等）の改善に充てている。\n　また、新加算Ⅰ～Ⅲまでのいずれかを算定する場合にあっては、仮に新加算Ⅳを算定する場合に見込まれる加算額の２分の１以上を基本給等の改善に充てている。　\n\n※令和６年度中は猶予（令和７年度から適用）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"-"]
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[null,"問２","　月額賃金改善要件Ⅱ（旧ベースアップ等加算相当の賃金改善）として、前年度と比較し、旧ベースアップ等加算相当の加算額の３分の２以上の新たな基本給等の改善（月給の引上げ）を行っている。\n\n※新加算Ⅰ～Ⅳまでのいずれかの算定以前に、「旧ベースアップ等加算」又は「新加算Ⅴ(2)、(4)、(7)、(9)若しくは(13)」を算定していた事業所については適用しない。"]
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[null,"問３","　キャリアパス要件Ⅰ（任用要件・賃金体系の整備等）の内容を書面で整備し、全ての介護職員に周知している。"]
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[null,"問４","　キャリアパス要件Ⅱ（研修の実施等）を全ての介護職員に周知している。"]
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[null,"問５","　キャリアパス要件Ⅲ（昇給の仕組みの整備等）の内容を書面で整備し、全ての介護職員に周知している。"]
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[null,"問６","　職場環境要件として、従前（旧３加算）の職場環境等の改善に係る取組を実施し、その内容を全ての介護職員に周知しており、当該取組についてホームページへの掲載等により公表している。"]
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[null,"④介護職員等処遇改善加算(Ⅳ)"]
[null,"問１","　月額賃金改善要件Ⅰ（月給による賃金改善）として、新加算Ⅳの加算額の２分の１以上を基本給又は決まって毎月支払われる手当（基本給等）の改善に充てている。\n　また、新加算Ⅰ～Ⅲまでのいずれかを算定する場合にあっては、仮に新加算Ⅳを算定する場合に見込まれる加算額の２分の１以上を基本給等の改善に充てている。　\n\n※令和６年度中は猶予（令和７年度から適用）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"-"]
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[null,"問２","　月額賃金改善要件Ⅱ（旧ベースアップ等加算相当の賃金改善）として、前年度と比較し、旧ベースアップ等加算相当の加算額の３分の２以上の新たな基本給等の改善（月給の引上げ）を行っている。\n\n※新加算Ⅰ～Ⅳまでのいずれかの算定以前に、「旧ベースアップ等加算」又は「新加算Ⅴ(2)、(4)、(7)、(9)若しくは(13)」を算定していた事業所については適用しない。"]
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[null,"問３","　キャリアパス要件Ⅰ（任用要件・賃金体系の整備等）の内容を書面で整備し、全ての介護職員に周知している。"]
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[null,"問４","　キャリアパス要件Ⅱ（研修の実施等）を全ての介護職員に周知している。"]
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[null,"問５","　職場環境要件として、従前（旧３加算）の職場環境等の改善に係る取組を実施し、その内容を全ての介護職員に周知しており、当該取組についてホームページへの掲載等により公表している。"]
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["● 減　算　　（減算すべき事実が生じていない場合も承知していれば○を記載）"]
["（１）　人員基準欠如による減算"]
[null,"問1","（介護従業者の人員基準欠如）\n　人員基準上必要とされる員数から１割を超えて減少した場合にはその翌月から人員基準欠如が解消されるに至った月まで、１割の範囲内で減少した場合にはその翌々月から人員基準欠如が解消されるに至った月まで、すべての利用者について基本単位数の70/100で算定している。"]
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[null,"問2","（看護師・准看護師の人員基準欠如）\n　人員基準欠如開始月の翌々月から人員基準欠如が解消されるに至った月まで、すべての利用者について基本単位数の70/100で算定している。"]
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[null,"問3","（介護支援専門員の人員基準欠如）\n　人員基準上必要とされる員数から減少した場合又は必要な研修を修了していない介護支援専門員を配置している場合にはその翌々月から人員基準欠如が解消されるに至った月まで、すべての利用者について基本単位数の70/100で算定している。"]
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["（２）　定員超過利用による減算"]
[null,"問1","　月平均の利用者数が運営規程に定められている利用定員を超える場合、定員超過利用になった翌月から、定員超過利用が解消されるに至った月まで、すべての利用者について基本単位数の70/100で算定している。（やむを得ない措置等による定員の超過を除く）"]
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["（３）　身体拘束廃止未実施減算"]
[null,"問1","「２．運営基準について」の「（１２）身体的拘束廃止」について、問４、問５、問６、問７、問１０、問１２、問１４のいずれかに×が記載されている。\n  ※「○」の場合は、改善計画書を提出し、その翌月から減算をし、改善計画書を提出した３月後に改善報告書を提出して、改善が確認できるまで減算が続きます。"]
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["（４）　高齢者虐待防止措置未実施減算"]
[null,"問1","　虐待の防止のための対策を検討する委員会（テレビ電話装置等の活用可能）を定期的に開催するとともに、その結果について、従業者に周知徹底を図っている。"]
[null,"問2","　虐待の防止のための指針を整備している。"]
[null,"問3","　従業者に対し、虐待の防止のための研修を定期的に実施している。"]
[null,"問4","　高齢者虐待防止措置を実施するための担当者を設置している。"]
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["（５）　業務継続計画未策定減算"]
[null,"問1","　感染症や非常災害の発生時において、利用者に対するサービスの提供を継続的に実施するための、及び非常時の体制で早期の業務再開を図るための計画（業務継続計画）を策定している。"]
[null,"問2","　業務継続計画に従い必要な措置を講じている。"]
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["（６）　過少サービスに対する減算"]
[null,"問1","　事業所が提供する通いサービス、訪問サービス及び宿泊サービスの算定月における提供回数について、登録者１人当り平均回数が週４回に満たない場合は、基本単位数の70/100で算定している。"]
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["（７）　訪問看護体制減算"]
[null,"問2","次のイ、ロ、ハ全てに適合している場合、利用者の介護度に応じて所定単位数を減算している。"]
[null,null,"イ","　算定日が属する月の前３月間において、指定看護小規模多機能事業所における利用者の総数のうち、主治の医師の指示に基づく看護サービスを提供した利用者の占める割合が１００分の３０未満であること。"]
[null,null,"ロ","　算定日が属する月の前３月間において、指定看護小規模多機能型居宅介護事業所における利用者の総数のうち、緊急時訪問看護加算を算定した利用者の占める割合が１００分の３０未満であること。"]
[null,null,"ハ","　算定日が属する月の前３月間において、指定看護小規模多機能型居宅介護事業所における利用者の総数のうち、特別管理加算を算定した利用者の占める割合が１００分の５未満であること。"]
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["(８）サテライト体制未整備減算"]
[null,"問１","　サテライト事業所又は当該サテライト事業所の本体事業所において（４）訪問看護体制減算の届出をしている場合にあっては、サテライト体制未整備減算として、サテライト事業所及び本体事業所が共に1月につき所定単位数の100分の97に相当する単位数を算定している。"]
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["（９）－１　主治医の特別な指示があった場合"]
[null,"問1","　指定看護小規模多機能型居宅介護を利用しようとする者の主治の医師が、当該者が末期の悪性腫瘍その他別に※厚生労働大臣が定める疾病等により訪問看護を行う必要がある旨の指示を行った場合、要介護状態区分に応じた所定単位数を減算している。\n\n※看護サービスは主治の医師による指示若しくは主治の医師の判断に基づいて交付された指示書の有効期間内に行われるものを指す。"]
[null,null,null,"※厚生労働大臣が定める疾病等\n多発性硬化症、重症筋無力症、スモン、筋萎縮性側索硬化症、脊髄小脳変性症、ハンチントン病、進行性筋ジストロフィー症、パーキンソン病関連疾患（進行性核上性麻痺、大脳皮質基底核変性症及びパーキンソン病（ホーエン・ヤールの重症度分類がステージ３以上であって生活機能障害度がⅡ度又はⅢ度のものに限る。）をいう。）、多系統萎縮症（線条体黒質変性症、オリーブ橋小脳萎縮症及びシャイ・ドレーガー症候群をいう。）、プリオン病、亜急性硬化性全脳炎、ライソゾーム病、副腎白質ジストロフィー、脊髄性筋萎縮症、球脊髄性筋萎縮症、慢性炎症性脱髄性多発神経炎、後天性免疫不全症候群、頚髄損傷及び人工呼吸器を使用している状態"]
[null,"問2","　月途中から医療保険の給付の対象となる場合又は月途中から医療保険の給付の対象外となる場合には、医療保険の給付の対象となる期間に応じて単位数を減算している。\n※医療保険の給付の対象となる期間については、主治の医師による指示に基づくものとする。"]
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["（９）－２　主治医の特別な指示があった場合"]
[null,"問1","　指定看護小規模多機能型居宅介護を利用しようとする者の主治の医師（介護老人保健施設及び介護医療院の医師を除く）が、当該者が急性増悪等により一時的に頻回の訪問看護を行う必要がある旨の特別の指示を行った場合、要介護状態区分に応じた所定単位数を減算している。\n\n※看護サービスは主治の医師による指示若しくは主治の医師の判断に基づいて交付された指示書の有効期間内に行われるものを指す。"]
[null,"問2","　問1の特別指示又は特別指示書の交付があった場合は、交付の日から14日間を限度として医療保険の訪問看護の給付対象となるものであり、当該月における当該特別指示の日数に応じて減算している。"]
[null,"問3","　問1の医療機関における特別指示については、頻回の訪問看護が必要な理由、その期間等について、診療録に記載している。"]
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[null,"●","介護報酬の請求に不適切又は不正な内容が認められた場合、指定基準等の違反として監査等の対象となります。なお、重大な違反状態の場合には、指定取り消しとなる場合もありますので、十分な注意が必要です。"]
[null,"●","運営状況点検書でできていなかったものについては、事業所で改善してください。"]
[null,"●","添付書類を忘れずに作成し添付して下さい。"]
[null,null,"・様式１　勤務形態一覧表"]
[null,null,"・様式２　利用者数実績計算書"]
[null,null,"・様式３　介護職員人欠確認表"]
[null,null,"・様式４　定員超過確認表"]
[]
[null,"～この点検書は、運営指導時等で拝見することがあります～"]
[null,"　　　　　　　　"]

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[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"シフト記号"]
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[null,"(14) 宿直①　（上記における該当者のNoを記載）"]
[null,"(14) 宿直②　（上記における該当者のNoを記載）"]
[null,"(15) 日ごとの通いサービスの実利用者数"]
[null,"(16) 日ごとの宿泊サービスの実利用者数"]
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[null,"(18) 介護従業者の夜間・深夜の勤務時間の合計",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(SUMIF($G$21:$G$68,\"介護従業者\",U21:U68)=0,\"\",SUMIF($G$21:$G$68,\"介護従業者\",U21:U68))","v":""},"","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",{"$f":"IF($BC$3=\"４週\",SUM(U176:AV176),IF($BC$3=\"暦月\",SUM(U176:AY176),\"\"))","v":0}]

{"sheet":"記号表","index":2,"n_rows":52,"n_cols":28,"rows_kept":52,"cut":false,"hidden":false,"merged":[[3,5,3,11],[3,13,3,15],[3,17,3,23],[3,27,4,27]]}
[null,"≪要 提出≫"]
[null,"■シフト記号表（勤務時間帯）"]
[null,"※24時間表記",null,null,null,"休憩時間1時間は「1:00」、休憩時間45分は「00:45」と入力してください。"]
[null,null,null,null,null,"勤務時間",null,null,null,null,null,null,null,"日中の時間帯",null,null,null,"日中の勤務時間",null,null,null,null,null,null,null,"夜間及び深夜",null,"自由記載欄"]
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[]
[null,null,"・職種ごとの勤務時間を「○：○○～○：○○」と表記することが困難な場合は、No18～33を活用し、勤務時間数のみを入力してください。"]
[null,null,"・No18～33以外は始業時刻・終業時刻・休憩時間等を入力すると勤務時間数が計算されますが、入力の補助を目的とするものですので、結果に誤りがないかご確認ください。"]
[null,null,"・シフト記号が足りない場合は、適宜、行を追加してください。"]
[null,null,"・シフト記号は、適宜、使いやすい記号に変更していただいて構いません。"]

{"sheet":"記入方法","index":3,"n_rows":70,"n_cols":13,"rows_kept":70,"cut":false,"hidden":false,"merged":[[3,5,4,10]]}
[null,"≪提出不要≫"]
[null,"従業者の勤務の体制及び勤務形態一覧表　記入方法　（看護小規模多機能型居宅介護）"]
[]
[null,null,"・・・直接入力する必要がある箇所です。",null,null,"下記の記入方法に従って、入力してください。"]
[null,null,"・・・プルダウンから選択して入力する必要がある箇所です。"]
[null,"　なお、「従業者の勤務の体制及び勤務形態一覧表」に「シフト記号表（勤務時間帯）」も必ず添付して提出してください。"]
[]
[null,"　・最初に「年月欄」「サービス種別」「事業所名」を入力してください。"]
[]
[null,"　(1) 「計画」・「実績」のいずれかを選択してください。"]
[null,"　　  指定基準の確認に際しては、「計画」を選択し、４週分の勤務時間を入力してください。"]
[null,"　　  実績を表す場合は、「実績」を選択し、暦月分で勤務時間を入力してください。"]
[]
[null,"　(2) 事業所における常勤の従業者が勤務すべき時間数を入力してください。"]
[]
[null,"　(3) 事業所における日中、夜間及び深夜の時間帯の区分を入力してください。"]
[]
[null,"　(4) 事業所の定員数を入力してください。"]
[]
[null,"　(5) 通いサービスの利用者数を入力してください。利用者数は、前年度の平均値（前年度の全利用者等の延数を当該前年度の日数で除して得た数。小数点第2位以下を切り上げ）を入力してください。"]
[null,"　　  新規又は再開の場合は、推定数を入力してください。"]
[]
[null,"　(6) 従業者の職種について、下記のうち該当する職種をプルダウンより選択してください。"]
[null," 　　 記入の順序は、職種ごとにまとめてください。"]
[]
[null,null,"No","職種名"]
[null,null,1,"管理者"]
[null,null,2,"介護従業者","（正式名称：小規模多機能型居宅介護従事者）"]
[null,null,3,"介護支援専門員"]
[null,null,4,"計画作成担当者","（サテライトの場合に選択）"]
[]
[null,"　(7) 従業者の勤務形態について、下記のうち該当する区分の記号をプルダウンより選択してください。"]
[null," 　　 記入の順序は、各職種の中で勤務形態の区分ごとにまとめてください。"]
[]
[null,null,"記号","区分"]
[null,null,"A","常勤で専従"]
[null,null,"B","常勤で兼務"]
[null,null,"C","非常勤で専従"]
[null,null,"D","非常勤で兼務"]
[]
[null,null,"（注）常勤・非常勤の区分について"]
[null,null,"　　　当該事業所における勤務時間が、当該事業所において定められている常勤の従業者が勤務すべき時間数に達していることをいいます。雇用の形態は考慮しません。"]
[null,null,"　　（例えば、常勤者は週に40時間勤務することとされた事業所であれば、非正規雇用であっても、週40時間勤務する従業者は常勤扱いとなります。）"]
[]
[null,"　(8) 従業者の保有する資格について、該当する資格名称をプルダウンより選択してください。"]
[null," 　　 保有資格を全て記入するのではなく、人員基準上、求められる資格等を入力してください。"]
[null,"       ※選択した資格及び研修に関して、必要に応じて、資格証又は研修修了証等の写しを添付資料として提出してください。"]
[]
[null,"　(9) 従業者の氏名を記入してください。"]
[]
[null,"　(10) 申請する事業に係る従業者（管理者を含む。）の1ヶ月分の勤務時間数を入力してください。（別シートの「シフト記号表」を作成し、シフト記号を選択または入力してください。）"]
[null,"　　  ※指定基準の確認に際しては、4週分の入力で可とします。実績を表す場合には、暦月で入力ください。"]
[]
[null,"　(11) 従業者ごとに、合計勤務時間数が自動計算されますので、誤りがないか確認してください。"]
[null," 　　 ※入力することができる勤務時間数は、当該事業所において常勤の従業者が勤務すべき勤務時間数を上限とします。"]
[]
[null,"　(12) 従業者ごとに、週平均の勤務時間数が自動計算されますので、誤りがないか確認してください。"]
[]
[null,"　(13) 申請する事業所以外の事業所・施設との兼務がある場合は、兼務先の事業所・施設の名称、兼務する職務の内容、兼務時間数について記入してください。"]
[null,"　　　 同一事業所内の兼務についても兼務する職務の内容を記入してください。"]
[]
[null,"　(14) 宿直の従業者の「No（ナンバー）」（本一覧表におけるNo）を記載してください。入力すると従業者の該当の日付のセルが",null,null,null,null,null,null,null,null,null,null,"に色づけされます。"]
[]
[null,"　(15) 通いサービスの利用者数を入力してください。"]
[]
[null,"　(16) 宿泊サービスの利用者数を入力してください。"]
[]
[null,"　(17) 介護従業者の日中の勤務時間の合計が自動計算されますので、誤りがないか確認してください。"]
[]
[null,"　(18) 介護従業者の夜間・深夜の勤務時間の合計が自動計算されますので、誤りがないか確認してください。"]

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[null,"１．サービス種別"]
[]
[null,"No","サービス種別"]
[null,1,"看護小規模多機能型居宅介護"]
[null,2,"（サテライト型）看護小規模多機能型居宅介護"]
[null,3]
[null,4]
[null,5]
[null,6]
[null,7]
[]
[null,"２．職種名・資格名称"]
[]
[null,"職種名","管理者","介護従業者","看護職員","介護支援専門員","計画作成担当者"]
[null,"資格","認知症対応型サービス事業管理者研修修了","介護福祉士","保健師","小規模多機能型サービス等計画作成担当者研修修了","小規模多機能型サービス等計画作成担当者研修修了","ー","ー","ー","ー","ー"]
[null,null,"保健師","理学療法士","看護師","ー","ー","ー","ー","ー","ー","ー"]
[null,null,"看護師","作業療法士","准看護師","ー","ー","ー","ー","ー","ー","ー"]
[null,null,"ー","言語聴覚士","ー","ー","ー","ー","ー","ー","ー","ー"]
[null,null,"ー","ー","ー","ー","ー","ー","ー","ー","ー","ー"]
[null,null,"ー","ー","ー","ー","ー","ー","ー","ー","ー","ー"]
[null,null,"ー","ー","ー","ー","ー","ー","ー","ー","ー","ー"]
[null,null,"ー","ー","ー","ー","ー","ー","ー","ー","ー","ー"]
[null,null,"ー","ー","ー","ー","ー","ー","ー","ー","ー","ー"]
[]
[null,null,"※看護小規模多機能型居宅介護従業者（正式名称）"]
[null,null,"※介護従業者のうち、保健師、看護師、准看護師の資格を持つ者は職種名を看護職員とします。"]
[null,null,"※計画作成担当者　⇒　サテライトの場合。（サテライトではない場合は介護支援専門員が計画を作成）"]

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[null,null,"（標準様式1）",null,null,null,null,null,null,null,"従業者の勤務の体制及び勤務形態一覧表　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"サービス種別（","看護小規模多機能型居宅介護",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"令和",6,null,"(",{"$f":"IF(AA2=0,\"\",YEAR(DATE(2018+AA2,1,1)))","v":2024},null,")","年",4,null,"月",null,null,null,null,null,null,"事業所名（","○○サービス",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(1)","４週"]
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[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(3) 事業所における常勤の従業者が勤務すべき時間数",null,null,null,null,null,null,null,null,null,null,null,40,null,"時間/週",null,160,null,"時間/月"]
[]
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[]
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[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(5) 日中／夜間及び深夜の時間帯の区分"]
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[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"夜間及び深夜の時間帯",null,null,null,null,null,null,null,null,"20:00:00",null,null,"～","07:00:00"]
[]
[null,"No","(6) \n職種",null,null,null,null,"(7)\n勤務\n形態","(8) 資格",null,null,null,"(9) 氏　名",null,null,"日中／夜間及び深夜\nの区分",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(10)",null,null,null,null,"（宿直   ･･･",null,null,null,"）",null,null,null,null,null,null,null,{"$f":"IF(BC3=\"計画\",\"(11)1～4週目の勤務時間数合計\",\"(11)1か月の勤務時間数　合計\")","v":"(11)1か月の勤務時間数　合計"},null,"(12)\n週平均\n勤務時間数",null,"(13) 兼務状況\n（兼務先/兼務する職務の内容）等"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"1週目",null,null,null,null,null,null,"2週目",null,null,null,null,null,null,"3週目",null,null,null,null,null,null,"4週目",null,null,null,null,null,null,"5週目"]
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[null,34,"ag",null,"：","07:00:00","～","09:30:00","（","00:00:00","）",{"$f":"IF(OR(F39=\"\",H39=\"\"),\"\",(H39+IF(F39>H39,1,0)-F39-J39)*24)","v":2.49999999999998},null,"07:00:00","～","20:00:00",null,{"$f":"IF(F39=\"\",\"\",IF(F39<N39,N39,IF(F39>=P39,\"\",F39)))","v":"07:00:00"},"～",{"$f":"IF(H39=\"\",\"\",IF(H39>F39,IF(H39<P39,H39,P39),P39))","v":"09:30:00"},"（","00:00:00","）",{"$f":"IF(R39=\"\",\"\",IF((T39+IF(R39>T39,1,0)-R39-V39)*24=0,\"\",(T39+IF(R39>T39,1,0)-R39-V39)*24))","v":2.49999999999998},null,{"$f":"IF(X39=\"\",L39,IF(OR(L39-X39=0,L39-X39<0),\"-\",L39-X39))","v":"-"}]
[null,null,"-",null,"：","16:30:00","～","20:00:00","（","00:00:00","）",{"$f":"IF(OR(F40=\"\",H40=\"\"),\"\",(H40+IF(F40>H40,1,0)-F40-J40)*24)","v":3.4999999999999898},null,"07:00:00","～","20:00:00",null,{"$f":"IF(F40=\"\",\"\",IF(F40<N40,N40,IF(F40>=P40,\"\",F40)))","v":"16:30:00"},"～",{"$f":"IF(H40=\"\",\"\",IF(H40>F40,IF(H40<P40,H40,P40),P40))","v":"20:00:00"},"（","00:00:00","）",{"$f":"IF(R40=\"\",\"\",IF((T40+IF(R40>T40,1,0)-R40-V40)*24=0,\"\",(T40+IF(R40>T40,1,0)-R40-V40)*24))","v":3.4999999999999898},null,"-"]
[null,null,"-",{"$f":"C39","v":"ag"},"：","-","～","-","（","-","）",{"$f":"IF(OR(L39=\"\",L40=\"\"),\"\",L39+L40)","v":5.9999999999999698},null,"-","～","-",null,"-","～","-","（","-","）",{"$f":"IF(OR(X39=\"\",X40=\"\"),\"\",X39+X40)","v":5.9999999999999698},null,"-",null,"1日に2回勤務する場合"]
[null,null,"ah",null,"：",null,"～",null,"（","00:00:00","）",{"$f":"IF(OR(F42=\"\",H42=\"\"),\"\",(H42+IF(F42>H42,1,0)-F42-J42)*24)","v":""},null,"07:00:00","～","20:00:00",null,{"$f":"IF(F42=\"\",\"\",IF(F42<N42,N42,IF(F42>=P42,\"\",F42)))","v":""},"～",{"$f":"IF(H42=\"\",\"\",IF(H42>F42,IF(H42<P42,H42,P42),P42))","v":""},"（","00:00:00","）",{"$f":"IF(R42=\"\",\"\",IF((T42+IF(R42>T42,1,0)-R42-V42)*24=0,\"\",(T42+IF(R42>T42,1,0)-R42-V42)*24))","v":""},null,""]
[null,35,"-",null,"：",null,"～",null,"（","00:00:00","）",{"$f":"IF(OR(F43=\"\",H43=\"\"),\"\",(H43+IF(F43>H43,1,0)-F43-J43)*24)","v":""},null,"07:00:00","～","20:00:00",null,{"$f":"IF(F43=\"\",\"\",IF(F43<N43,N43,IF(F43>=P43,\"\",F43)))","v":""},"～",{"$f":"IF(H43=\"\",\"\",IF(H43>F43,IF(H43<P43,H43,P43),P43))","v":""},"（","00:00:00","）",{"$f":"IF(R43=\"\",\"\",IF((T43+IF(R43>T43,1,0)-R43-V43)*24=0,\"\",(T43+IF(R43>T43,1,0)-R43-V43)*24))","v":""},null,""]
[null,null,"-",{"$f":"C42","v":"ah"},"：","-","～","-","（","-","）",{"$f":"IF(OR(L42=\"\",L43=\"\"),\"\",L42+L43)","v":""},null,"-","～","-",null,"-","～","-","（","-","）",{"$f":"IF(OR(X42=\"\",X43=\"\"),\"\",X42+X43)","v":""},null,"",null,"1日に2回勤務する場合"]
[null,null,"ai",null,"：",null,"～",null,"（","00:00:00","）",{"$f":"IF(OR(F45=\"\",H45=\"\"),\"\",(H45+IF(F45>H45,1,0)-F45-J45)*24)","v":""},null,"07:00:00","～","20:00:00",null,{"$f":"IF(F45=\"\",\"\",IF(F45<N45,N45,IF(F45>=P45,\"\",F45)))","v":""},"～",{"$f":"IF(H45=\"\",\"\",IF(H45>F45,IF(H45<P45,H45,P45),P45))","v":""},"（","00:00:00","）",{"$f":"IF(R45=\"\",\"\",IF((T45+IF(R45>T45,1,0)-R45-V45)*24=0,\"\",(T45+IF(R45>T45,1,0)-R45-V45)*24))","v":""},null,""]
[null,36,"-",null,"：",null,"～",null,"（","00:00:00","）",{"$f":"IF(OR(F46=\"\",H46=\"\"),\"\",(H46+IF(F46>H46,1,0)-F46-J46)*24)","v":""},null,"07:00:00","～","20:00:00",null,{"$f":"IF(F46=\"\",\"\",IF(F46<N46,N46,IF(F46>=P46,\"\",F46)))","v":""},"～",{"$f":"IF(H46=\"\",\"\",IF(H46>F46,IF(H46<P46,H46,P46),P46))","v":""},"（","00:00:00","）",{"$f":"IF(R46=\"\",\"\",IF((T46+IF(R46>T46,1,0)-R46-V46)*24=0,\"\",(T46+IF(R46>T46,1,0)-R46-V46)*24))","v":""},null,""]
[null,null,"-",{"$f":"C45","v":"ai"},"：","-","～","-","（","-","）",{"$f":"IF(OR(L45=\"\",L46=\"\"),\"\",L45+L46)","v":""},null,"-","～","-",null,"-","～","-","（","-","）",{"$f":"IF(OR(X45=\"\",X46=\"\"),\"\",X45+X46)","v":""},null,"",null,"1日に2回勤務する場合"]
[]
[null,null,"・職種ごとの勤務時間を「○：○○～○：○○」と表記することが困難な場合は、No18～33を活用し、勤務時間数のみを入力してください。"]
[null,null,"・No18～33以外は始業時刻・終業時刻・休憩時間等を入力すると勤務時間数が計算されますが、入力の補助を目的とするものですので、結果に誤りがないかご確認ください。"]
[null,null,"・シフト記号が足りない場合は、適宜、行を追加してください。"]
[null,null,"・シフト記号は、適宜、使いやすい記号に変更していただいて構いません。"]

{"sheet":"様式２　利用者数実績計算書","index":7,"n_rows":18,"n_cols":29,"rows_kept":18,"cut":false,"hidden":false,"merged":[[16,18,16,23],[17,0,17,30],[15,0,15,3],[15,4,15,9],[15,11,15,16],[16,0,16,3],[16,4,16,10],[16,11,16,16],[13,0,13,3],[13,4,13,9],[13,11,13,16],[14,0,14,3],[14,4,14,9],[14,11,14,16],[11,0,11,3],[11,4,11,9],[11,11,11,16],[12,0,12,3],[12,4,12,9],[12,11,12,16],[9,0,9,3],[9,4,9,9],[9,11,9,16],[10,0,10,3],[10,4,10,9],[10,11,10,16],[4,0,4,3],[4,4,4,9],[4,11,4,16],[4,18,15,24],[5,0,5,3],[5,4,5,9],[5,11,5,16],[6,0,6,3],[6,4,6,9],[6,11,6,16],[7,0,7,3],[7,4,7,9],[7,11,7,16],[8,0,8,3],[8,4,8,9],[8,11,8,16],[0,0,0,3],[1,15,1,24],[2,0,2,8],[2,10,2,24],[3,0,3,3],[3,4,3,10],[3,11,3,17],[3,18,3,24]]}
["（様式２）"]
[]
["利用者数実績計算書（看護小規模多機能型居宅介護）　　　　　　　　　",null,null,null,null,null,null,null,null,null,"事業所名（　　　　　　    　　　　　　　　　　　　）"]
["前年度",null,null,null,"月平均登録者数",null,null,null,null,null,null,"通いサービスを利用した\n全利用者の延べ日数",null,null,null,null,null,null,"前年度の平均利用者数\n合計延べ日数（Ａ）÷前年度の日数\n（小数点第２位以下切り上げ）"]
["令和　　年　　月",null,null,null,null,null,null,null,null,null,"人",null,null,null,null,null,null,"日",null,null,null,null,null,null,null,null,null,null,"　"]
["令和　　年　　月",null,null,null,null,null,null,null,null,null,"人",null,null,null,null,null,null,"日"]
["令和　　年　　月",null,null,null,null,null,null,null,null,null,"人",null,null,null,null,null,null,"日"]
["令和　　年　　月",null,null,null,null,null,null,null,null,null,"人",null,null,null,null,null,null,"日"]
["令和　　年　　月",null,null,null,null,null,null,null,null,null,"人",null,null,null,null,null,null,"日"]
["令和　　年　　月",null,null,null,null,null,null,null,null,null,"人",null,null,null,null,null,null,"日"]
["令和　　年　　月",null,null,null,null,null,null,null,null,null,"人",null,null,null,null,null,null,"日"]
["令和　　年　　月",null,null,null,null,null,null,null,null,null,"人",null,null,null,null,null,null,"日"]
["令和　　年　　月",null,null,null,null,null,null,null,null,null,"人",null,null,null,null,null,null,"日"]
["令和　　年　　月",null,null,null,null,null,null,null,null,null,"人",null,null,null,null,null,null,"日"]
["令和　　年　　月",null,null,null,null,null,null,null,null,null,"人",null,null,null,null,null,null,"日"]
["令和　　年　　月",null,null,null,null,null,null,null,null,null,"人",null,null,null,null,null,null,"日"]
["合計",null,null,null,null,null,null,null,null,null,null,"（Ａ）",null,null,null,null,null,"日",null,null,null,null,null,null,"人"]
["※　前年度の実績で作成してください。"]

{"sheet":"様式３　介護職員人欠確認表","index":8,"n_rows":40,"n_cols":35,"rows_kept":40,"cut":false,"hidden":false,"merged":[[40,24,40,26],[40,27,40,29],[40,30,40,32],[40,33,40,34],[41,24,41,26],[41,27,41,29],[41,30,41,32],[41,33,41,34],[36,13,36,14],[36,16,36,18],[38,9,38,11],[38,13,38,14],[38,16,38,18],[30,27,33,27],[30,28,33,29],[30,30,33,30],[30,31,33,31],[33,9,33,21],[33,23,33,24],[21,1,21,2],[22,1,22,2],[23,1,23,23],[26,1,27,14],[30,9,30,21],[30,23,30,24]]}
[]
[null,"＜チェック！＞　毎月確認してください！！"]
[null,"①　人員基準の遵守　…　各サービス提供日に必要な勤務延時間数は確保されていますか。毎月確認してください。"]
[null,"②　減算の有無　　　　…　計算結果（ｃ）が０．９を下回っていないですか。→０．９を下回っている場合、当該月の次の月から人員基準欠如が解消されるに至った月の介護"]
[null,"　　　　　　　　　　　　　　　　報酬について減算する必要があります。"]
[null,"　　　　　　　　　　　　　 …　計算結果（ｃ）が０．９以上１未満となっていないですか。→０．９以上１未満となっている場合、当該月の翌々月から人員基準欠如が解消されるに"]
[null,"　　　　　　　　　　　　　　　　至った月の介護報酬について減算する必要があります（ただし、翌月の末日において人員基準を満たすに至っている場合を除く）。"]
[null,"※常に必要員数を上回る介護職員の配置がある場合は、以下の表による計算は不要です。"]
[]
[null,"＜介護職員配置一覧表＞",null,null,null,null,null,null,null,null,null,null,"（　",null,"年",null,"月分）",null,null,"サービス種類　　  （　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　）",null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,null,null,null,null,"事業所番号（　１４　　　　　　　　　　　　　　　　　）　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　",null,null,null,null,null,null,null,null,"事業所名（　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　",null,null,null,null,null,null,null,null,null,"）"]
[]
[null,"○　所定の人員配置ができなかった日がある月について作成してください。"]
[]
[null,"サービス提供時間：　　　　時間　　　　分　　"]
[]
[null,"　　　介護職員配置人数",null,null,"通いサービス提供時間中に勤務した介護職員配置時間の合計（※１）、必要介護職員数を記載してください。"]
[]
[null,null,null,1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,"月の"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"合計"]
[null,"通いサービスの利用者数"]
[null,"通いサービスにおける介護職員の\n　　　　　　　　合計勤務時間数（※２）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"（a）"]
[null,"確保すべき通いサービスにおける介護職員の\n　　　　　　　　　　　　　　合計勤務時間数（※３）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"（ｂ）"]
[null,"※１　通いサービス提供時間中に勤務した介護職員配置時間の合計とは、利用者の生活サイクルに応じて事業所ごとに定める夜間及び深夜の時間帯以外の時間帯に指定認知症対応型共同生活介護の提供に当たる介護従業者の合計勤務時間を指します。"]
[null,"※２　介護職員勤務時間数については、小数点以下の端数処理は行いませんが、上掲のチェック表では便宜上小数点以下第1位までを記載してください。（例　「10分」は、10÷60＝0.1666…→0.1）"]
[]
[null,"※３　確保すべき通いサービスにおける介護職員の合計勤務時間数は、次の手順で計算してください。\n　　　　手順１　利用者数÷３＋１＝配置すべき常勤職員の数（小数点以下、繰上げ）　\n　　　　手順２　配置すべき常勤職員の数（小数点以下、繰上げ）×常勤職員が1日に勤務すべき時間数　　　"]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,"当該月に配置された通いサービスにおける介護職員の勤務延時間数",null,null,null,null,null,null,null,null,null,null,null,null,null,"（a）",null,null,null,"＝","（ｃ）",null,"＜",1]
[]
[]
[null,null,null,null,null,null,null,null,null,"当該月に配置すべき通いサービスにおける介護職員の勤務延時間数",null,null,null,null,null,null,null,null,null,null,null,null,null,"（b）"]
[]
[null,"　　　　"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"（ｃ）",null,null,"＜　０．９",null,null,"＝","当該月の次の月から人員基準欠如が解消されるに至った月の介護報酬について減算"]
[]
[null,null,null,null,null,null,null,null,null,"０．９　≦",null,null,null,"（ｃ）",null,null,"＜　１",null,null,"＝","当該月の翌々月から人員基準欠如が解消されるに至った月の介護報酬について減算"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"（ただし、翌月の末日において人員基準を満たすに至っている場合を除く）"]

{"sheet":"様式４　定員超過確認表","index":9,"n_rows":19,"n_cols":35,"rows_kept":19,"cut":false,"hidden":false,"merged":[[1,23,1,28],[12,2,12,4],[12,17,12,28],[12,32,12,33],[15,2,15,34]]}
[]
[null,"＜登録定員超過確認表＞",null,null,null,null,null,null,null,null,null,null,"（　",null,"年",null,"月分）",null,null,"サービス種類　　  （　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　）",null,null,null,"（介護予防）小規模多機能型居宅介護",null,null,null,null,null,"）"]
[null,null,null,null,null,null,null,null,null,null,"事業所番号（　１４　　　　　　　　　　　　　　　　　）　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　",null,null,null,null,null,null,null,null,"事業所名（　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　",null,null,null,null,null,null,null,null,null,"）"]
[null,"○　定員を超える受け入れを行った日のある月について作成してください。"]
[]
[]
[null,"○　登録者数",null,"看護小規模多機能型居宅介護事業所に登録している登録者数を記入してください。"]
[]
[null,null,null,1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,"月の"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"合計"]
[null,"登録者数　","（ａ）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"（ｂ）"]
[]
[null,"　　定員：",null,null,null,"名","(ｃ)",null,null,null,null,null,null,null,null,null,null,"   月平均登録者数：月の登録者合計数（ｂ）÷サービス提供日数　　　　　　",null,null,null,null,null,null,null,null,null,null,null,null,"日","＝",null,null,"人     (ｄ)"]
[]
[null,"備考：①　サービス提供していない日については斜線等を引いてください。"]
[]
[null,"＜チェック！＞"]
[null,"①　登録定員の遵守　…　各日の登録者数（ａ）が定員（ｃ）を超えていませんか。"]
[null,"②　減算の有無　　　　…　月平均利用者数(ｄ)が定員（ｃ）を超えていませんか？　→　超えている場合、当該月の次の月の介護報酬について減算する必要があります。"]