QAPI Program Utilization_Manual

PERSONAL FILES AUDIT Report to BD / QA PI Committee Audit conducted by: ______________________________________________________ Date: ______________ Quarterly: 9 I (Jan - Mar) 9 II (April - June) 9 III (July - Sep) 9 IV (Oct - Dec) Summary of Audit: _____ Total Staff files audited/reviewed Discipline Involved: 9 SN 9 Aide 9 Therapy (PT-OT-ST) 9 MSW 9 Office Staff Summary of review/audit: ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ Staff Contacted for missing documents: 9 Yes 9 No More common missing documents: 9 Initial Interview 9 Verification of citizenship or authorization to work in the US (I-9 Form) 9 Reference Checks (two(2) for all staff, including office, owners, etc) 9 Personnel credentialing, license, education (Diploma if required) 9 Ethic Conduct form (Licensure verification at hire and annually, Verification of Qualifications) 9 Job Description (signed by employee and supervisor, dated) 9 Alzheimer’s Initial information 9 National Sex Offender check 9 OIG’S exclusion List check 9 Orientation (topics per the discipline) 9 Confidentiality Agreement, HIPAA oath 9 Competency Assessments all disciplines (writing/practice at hire, practice part annually) 9 (2) Glucometer Competencies 9 Other: _______________________________________________________________________________________________ Confidential: 9 Criminal Background Check (at hire and every 5 years) 9 Physical Exam/TB Screening (At hire and 9 Medical Questionnaire annually Medical Certificate) Evaluations: 9 Probation Period (90 days) (use first page of Evaluation, all disciplines, including Office staff) 9 Goals settings/met date 9 Annual Evaluation: 9 Joint Visit by DON or qualified designee (Annual observation of job duties) 9 Practical Part of Competency (Reflect Positive and/or Negative Outcomes) 9 Self Evaluation (by each employee) 9 Goals settings/met date 9 Discussion Job Description, duties, responsibilities 9 Other: __________________ 9 If leader, leader evaluation (Administrator and Alternate Competency) In-Service ORIENTATION REQUIREMENTS compliance summary: ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ Required by License, State regulations (12 hrs annually) 9 Up to date 9 Missing for some staff Comments: ___________________________________________________________________________________ ____________________________________________________________________________________________ Auditor Signature:____________________________________________________ Date: ___________________ 130