Information

  • Audit Title

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

STAFF DETAILS

  • Name of Supervisee:

  • Job Title:

  • Supervision Number:

TRAINING MATRIX CHECK

  • Date of last 'Moving & Handling' training:

  • Date of last 'Safeguarding' training:

  • Date of last 'Infection Control' training:

  • Date of last 'First Aid' training:

  • Date of last 'Food Hygiene' training:

  • Date of last 'Health & Safety' training:

  • Date of last 'Dementia' training:

  • Date of last 'Equality & Diversity' training:

  • Are any of the above 'out of date'?

  • List subjects and inform Manager

  • Highest Qualification

  • Which NCFE's have been completed?

Observe and Discuss with the Staff Member, the Following:

APPEARANCE, FIRST AID & PPE

  • Are they 'Dressed Appropriately' in accordance with Company Policy? (uniform, footwear, nails, jewellery etc)

  • Details:

  • Do they know how to access Gloves in the Home?

  • Do they know how to access Aprons in the Home?

  • Do they have adequate supply of personal 'Anti-Bacterial Hand Gel'?

  • General Notes:

ATTITUDE & APPROACH

  • Do they 'Communicate Clearly and Effectively' with the Residents?

  • Do they 'Communicate Clearly and Effectively' with Colleagues and Visitors?

  • Are Residents, Visitors and Colleagues treated with Respect, Dignity and a professional approach at all times?

  • Do they approach all tasks in an Organised and Professional Manner and in accordance with Procedures and Care Plans?

SUPPORT AND CARE

  • Is the way in which General Support and Care is delivered in accordance with Residents wishes and Care Plan? <br><br><br><br>

  • List interactions observed:

  • Detail concerns:

  • Do they deliver 'Personal Care' in a way that Promotes Respect and Dignity and in accordance with Residents wishes and Care Plan? Record Tasks Observed

  • List interactions observed:

  • Detail concerns:

  • Do they Encourage and Promote the Residents to participate in all aspects of their Care?

  • Do they complete the relevant documentation in an appropriate manner? (factual, legible etc)

  • Do they select the correct PPE for tasks as required and in accordance with Procedures?

  • Are any 'Special' Infection Controls Measures in place at present?

  • Are they being followed according to procedures?

  • Details:

  • General Notes:

MEDICATION

  • Was Medication given?

  • Do they Correctly Identify and Select the required Medication in accordance with Procedures and Care Plans?

  • Details:

  • BOOK FOR RETRAINING....

  • Is the Medication Dispensed and Administered in the correct way and in accordance with Procedures and Care Plans?

  • Details:

  • BOOK FOR RETRAINING....

  • Was the MAR Chart completed correctly?

  • Details:

  • BOOK FOR RETRAINING....

  • PEG Feeding guidance been followed at all times?

  • General Notes:

TASKS OBSERVED DURING SUPERVISION

  • Record any tasks observed including Clinical etc:

STAFF CONCERNS

  • Does they have any Concerns or Issues they wish to discuss?

  • Do they wish to discuss them now? If 'NO' make an appointment for a meeting.

  • Arrange a suitable date and time for a one to one meeting:

OTHER RELEVANT INFORMATION or COMMENTS

  • Safeguarding/MCA and DOLS discussed?

  • Staff member knows the consequence of Safeguarding issues?

  • undefined

  • Does the Staff member 'Agree with all Recorded Information'?

  • Details:

  • NEXT SUPERVISION WILL BE:

  • DATE FOR NEXT SUPERVISION

  • Supervisee Signature

  • Supervisor Signature

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.