• Document No.

  • Outcome 16 Visit Report

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Home Details

  • Select date

  • Add location
  • Type of care provided

  • Number of clients registered for

  • Number of clients admitted

  • Number of respite clients currently admitted

Service Users

  • Complaints and safeguarding issues

  • Dates of previous and upcoming residents and relatives meetings

  • Care plan audits

  • Medication audits

  • Weight loss and pressure sores

  • Fee review (CHC/FNC funding eligibility)


  • Fire risk assessments and practices

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

  • Security or account issues

  • Works completed following previous visit

  • Works now requiring attention



  • Are sufficient staff on the rota?

  • Human resource issues- investigations and disciplinaries

  • Staff sickness

  • Staff file audit

  • PIN number check

  • DBS/CRB check

  • Supervisions

  • Dates of previous and upcoming meetings

  • Training


  • Petty cash check

  • Personal allowance check

  • Budgeting and overspends

Accidents and Incidents

  • Number of accidents/incidents

  • Number requiring hospital attention or admission

  • Accident forms/care plans/ CQC notifications completed

Action Plan

  • Previous action plan points completed/pending

  • New action plan points for the following month

  • Home Manager

  • Operations Manager

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.