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
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Year
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Your Name
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First Name
Last Name
Performance Competencies
To safely, efficiently and effectively deliver the best care possible according best nursing practice.
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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
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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.
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To safely, efficiently and effectively carry out all duties meeting the needs of the health & safety at work act 2016
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Fail
Below Average
Average
Above Average
Excellent
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.
Your Comments
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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.
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Infection Control
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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.
Your Comments
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Comments
Follow procedures for Bio-hazard and household waste.
Follow sound basic hygiene principles in relation to hand washing and cross infection.
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Domestic Duties
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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.
Your comments
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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.
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To have a commitment to Total Quality Management
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Fail
Below Average
Average
Above Average
Excellent
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.
Your Comments
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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.
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Accountability
General
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Fail
Below Average
Average
Above Average
Excellent
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.
Your comments
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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.
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To adhere to the conditions of employment set out in your individual contract, be guided and comply with Maida Vale House Rules
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Fail
Below Average
Average
Above Average
Excellent
To have a signed employment contract and job description.
Your comments
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Comments
To have a signed employment contract and job description.
Orientation
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Fail
Below Average
Average
Above Average
Excellent
Induction performance and knowledge.
Your comments
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Comments
Induction performance and knowledge.
Apprasial
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Fail
Below Average
Average
Above Average
Excellent
Participate in a performance review
Your comments
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Comments
Participate in a performance review
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In-service – to have a commitment to ongoing education in Care of the Older Person
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Fail
Below Average
Average
Above Average
Excellent
Attend 4 compulsory in-service sessions per year.
Attend 4 elective in-service sessions per year.
Your comments
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Comments
Do you attend 4 compulsory in-service sessions per year?
Do you attend 4 elective in-service sessions per year?
External Education Ongoing Learning
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Fail
Below Average
Average
Above Average
Excellent
External courses are to be negotiated with the Clinical Services Manager.
Financial assistance for the course to be negotiated with owners.
Your comments
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Comments
External courses are to be negotiated with the Clinical Services Manager.
Financial assistance for the course to be negotiated with owners.
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Communication – to maintain good communication, treating residents, staff and visitors as individuals with respect and dignity
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Fail
Below Average
Average
Above Average
Excellent
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.
Your comments
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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.
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To be an effective team worker with consideration for other employees
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Fail
Below Average
Average
Above Average
Excellent
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.
Your comments
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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.
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What are you planning for your ongoing education following this appraisal?
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What improvements could be made to your present job?
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Your identified Strengths
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Your identified Weaknesses
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What are you planning for your ongoing education following this appraisal?
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Objectives determined for next evaluation
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Next evaluation date
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Month
Year
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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?
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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?
Submit
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