Performance Review - Care Giver Staff

Performance Review - Care Giver Staff - Form 2

Goal - To deliver optimum quality care and assistance to the residents of Maida Vale in accordance with duty schedules, policies and in an attitude of caring, helpfulness and co-operation prioritising attendance to their needs and delivering the best care possible that meets each individual’s needs.
Date *

Day Month Year
Your Name *

First Name Last Name
Performance Competencies

To safely, efficiently and effectively deliver the best care possible according best nursing practice.

	Fail	Below Average	Average	Above Average	Excellent
Assist residents with all personal ADL's as identified on their individual care plan.
Follow instructions as directed by the Charge Nurse/Registered Nurse/Team Leader.
Responsible for assisting in keeping Care Plans up to date.
Responsible to report changes in residents well being.
Responsible for passing on accurate information to Charge Nurse/Registered Nurse/Team leader.
Documentation in residents notes to be clear,informative and stating only the facts.
No white out to be used.

Your Comments *

	Comments
Assist residents with all personal ADL's as identified on their individual care plan.
Follow instructions as directed by the Charge Nurse/Registered Nurse/Team Leader.
Responsible for assisting in keeping Care Plans up to date.
Responsible to report changes in residents well being.
Responsible for passing on accurate information to Charge Nurse/Registered Nurse/Team leader.
Documentation in residents notes to be clear,informative and stating only the facts.
No white out to be used.

	Comments
Understand and incorporate safety into all work practice.
Knowledge of your responsibilities under the health & safety at work act 2016.
Know and adhere to fire evacuation, and emergency procedures.
Adhere to no lifting policy.

	Comments
Follow procedures for Bio-hazard and household waste.
Follow sound basic hygiene principles in relation to hand washing and cross infection.

	Comments
Cleaning lockers, wardrobes, drawers & over bed tables
To ensure laundry duties are carried out.
Ensure Residents clothing is returned and put away neatly and is named.
Fill out request forms for Residents personal needs and clothing.
Perform kitchen duties as required
Perform cleaning duties as required.

	Comments
Assist in the design & implementation of Quality Management Systems for Nursing Care Services.
Provide input into Clinical Services Committee work.
Assist with audits.
Assist with the implementation of policies and procedures.
Assist with review of policies and procedures.

	Comments
Responsible for end of shift tidy up.
Responsible for passing on of accurate information to person in charge.
Responsible for update of Care Plans.
Responsible for accurate documentation.
Responsible for maintaining the Residents environment attractively.
To be punctual, correct recording of time sheets.
Follow the procedure for calling in sick & Holiday procedures.
Always maintain professional appearance and conduct.

	Comments
To have a signed employment contract and job description.

	Comments
Induction performance and knowledge.

	Comments
Participate in a performance review

	Comments
Do you attend 4 compulsory in-service sessions per year?
Do you attend 4 elective in-service sessions per year?

	Comments
External courses are to be negotiated with the Clinical Services Manager.
Financial assistance for the course to be negotiated with owners.

	Comments
Address residents by full name unless told otherwise by resident or/next of kin .
Correct telephone answering protocol.
Pass on accurate messages.
Communicate with staff and visitors, sharing relevant information with colleagues.
Maintain a good relationship with senior staff and management.

	Comments
To be an effective team member with consideration for other employees.
To be flexible, show initiative and be tolerant and understanding when duties are busy.
To be adaptable to change.

Performance Summary - Completed by Clinical Services Manager

Please proceed through the next set of questions to submit
List aspects of employee’s performance that require improvement for greater effectiveness.
List all aspects of employee’s performance that contribute to his or her effectiveness.
In what way is the employee ready for increased responsibility? What additional training will he/she need to be successful?

Goal Setting and Development Planning
List the employee’s performance goals for the coming year:
List the employee’s development goals for the coming year:
How do these align with departmental goals?
In the coming year, how will you provide guidance and assistance for the employee to accomplish his/her goals?
Should be Empty:

Now create your own Jotform - It's free! Create your own Jotform

	Fail	Below Average	Average	Above Average	Excellent
Follow procedures for Biohazard and household waste.
Follow sound basic hygiene principles in relation to hand washing and cross infection.

	Fail	Below Average	Average	Above Average	Excellent
Cleaning wardrobes, drawers & over bed tables.
To ensure laundry duties are carried out.
Ensure Residents clothing is returned and put away neatly and is named.
Fill out request forms for Residents personal needs and clothing.
Perform kitchen duties as required.
Perform cleaning duties as required.

	Fail	Below Average	Average	Above Average	Excellent
Attend 4 compulsory in-service sessions per year.
Attend 4 elective in-service sessions per year.

Performance Review - Care Giver Staff - Form 2