Visit Report

• Document No.

• Outcome 16 Visit Report

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Home Details

• Select date

  Date
• Add location
  Address

• Type of care provided

  Nursing

  Learning Disability

  Elderly Dementia

• Number of clients registered for

• Number of clients admitted

• Number of respite clients currently admitted

Service Users

• Complaints and safeguarding issues

  Yes

  No

  N/A

• Dates of previous and upcoming residents and relatives meetings

  Yes

  No

  N/A

• Care plan audits

  Yes

  No

  N/A

• Medication audits

  Yes

  No

  N/A

• Weight loss and pressure sores

  Yes

  No

  N/A

• Fee review (CHC/FNC funding eligibility)

  Yes

  No

  N/A

Environment

• Fire risk assessments and practices

  Yes

  No

  N/A

• Dates of previous and upcoming health and safety meetings. List issues requiring attention.

  Yes

  No

  N/A

• Security or account issues

  Yes

  No

  N/A

• Works completed following previous visit

  Yes

  No

  N/A

• Works now requiring attention

  Yes

  No

  N/A

Management

Staff

• Are sufficient staff on the rota?

  Yes

  No

  N/A

• Human resource issues- investigations and disciplinaries

  Yes

  No

  N/A

• Staff sickness

  Yes

  No

  N/A

• Staff file audit

  Yes

  No

  N/A

• PIN number check

  Yes

  No

  N/A

• DBS/CRB check

  Yes

  No

  N/A

• Supervisions

  Yes

  No

  N/A

• Dates of previous and upcoming meetings

  Yes

  No

  N/A

• Training

  Yes

  No

  N/A

Finances

• Petty cash check

  Yes

  No

  N/A

• Personal allowance check

  Yes

  No

  N/A

• Budgeting and overspends

  Yes

  No

  N/A

Accidents and Incidents

• Number of accidents/incidents

  Yes

  No

  N/A

• Number requiring hospital attention or admission

  Yes

  No

  N/A

• Accident forms/care plans/ CQC notifications completed

  Yes

  No

  N/A

Action Plan

• Previous action plan points completed/pending

  Yes

  No

  N/A

• New action plan points for the following month

  Yes

  No

  N/A

• Home Manager

  Sign

• Operations Manager

  Sign