Third shift ends at 07:00. The incoming first-shift staff has four minutes before morning meds need to be pulled. The outgoing note says "slept well, no issues." Whether that's accurate or abbreviated matters — because if the client refused a medication at 03:00, first shift needs to know before they approach with the morning dose.
The 24-Hour Structure
The log is organized by shift, not by category. Third shift covers overnight behavior, sleep quality, and hygiene. First shift captures morning medications, daytime participation, and appointments. Second shift handles afternoon activities, evening medications, hygiene, and behavioral events through end of day.
Each shift closes with an electronic signature and credentials field — the mechanism that makes the log a compliance document rather than informal notes. The signature doesn't just authenticate the record; it establishes accountability for the accuracy of that shift's data.
Medication Tracking Across the Day
Morning meds and evening meds are tracked as discrete events with structured outcomes: taken without incident, refused one or more, off grounds, or no medications scheduled. The distinction between "refused" and "off grounds" is clinically significant — one requires a behavior note, the other requires a location log.
Neither field is a checkbox. They're multi-select, because a client can be off grounds for the morning medication window and then return to take a refused midday dose. The medication record reflects what actually happened, not a single summary status.
Behavior and Participation
Significant positive events and significant negative behaviors are tracked in parallel — not because balance requires it, but because behavioral health charting requires documentation of both for treatment planning. A week of records showing consistent role-model behavior informs a privilege review. A cluster of negative behavior entries on specific days flags a pattern for the clinical team.
Participation fields — morning community, meals, chores, recreation, ADL completion — provide the functional status picture that medication records alone can't give. A client who took all medications but refused breakfast, skipped chores, and didn't participate in afternoon rec is not having the same day as someone who did all four.
Supervisor Review
The Reviewed by field at the end of the log is the director or supervisor sign-off. In licensed residential facilities, daily note review is a regulatory requirement, not an optional quality check. The field exists to document that review happened, on which record, and by whom.
Facility tracking (Winterhaven vs. Skyline) keeps multi-site organizations from aggregating records incorrectly when reviewing by client across locations.