Centrum Customer File Audit

• Document No.

• Audit Title

• Customer name

• Conducted on

  Date

• Prepared by

• Location
  Address

Customer file

• Name of customer

• Front page completed correctly

  Yes

  No

  N/A

• Detailed directions to customer's home

  Yes

  No

  N/A

• Access details on PASS and StaffPlan

  Yes

  No

  N/A

• 3 emergency contacts given

  Yes

  No

  N/A

• Support plan completed with detail

  Yes

  No

  N/A

• Customer guide declaration of receipt signed

  Yes

  No

  N/A

• Risk assessments completed with detail

  Yes

  No

  N/A

• Evidence of equipment checks being carried out

  Yes

  No

  N/A

• Medication support plan completed and signature of consent obtained

  Yes

  No

  N/A

• Customer consent form signed

  Yes

  No

  N/A

• Visit notes being completed correctly on PASS

  Yes

  No

  N/A

• MAR sheet information being completed correctly on PASS

  Yes

  No

  N/A

• Evidence for lasting powers of attorney present

  Yes

  No

  N/A

• Confirmation of instructions / purchase order form present

  Yes

  No

  N/A

• Terms of business fully signed and charge rates for care given

  Yes

  No

  N/A

• Signed by customer

  Yes

  No

  N/A

• Signed by assessor

  Yes

  No

  N/A

• Review conducted in last 6 months

  Yes

  No

  N/A

• Review evident on StaffPlan

  Yes

  No

  N/A

• Customer details correct on StaffPlan

  Yes

  No

  N/A

• Customer details correct on Highrise

  Yes

  No

  N/A

• Customer details correct on PASS System

  Yes

  No

  N/A

• Audit conducted by

  Sign