The Care Plan is a tool done at the time of admission and quarterly when someone is in Long term care. It is also done is Assisted Living and is done yearly and called the Service Plan. It is also done in short term rehab much more frequently to set goals and update all involved in how the Client is doing regarding meeting those goals to return to their primary residence. I am educating on the care plan process and who is involved and how best to prepare yourself for the ultimate Care Plan for you or your loved one.