Client QA
Client Name
*
First Name
Last Name
Date of Birth
*
/
Day
/
Month
Year
Date
Service User Type
*
Adult
Child
Private
Other
Service User Location
*
Manchester
Stockport
Rochdale
Trafford
Liverpool
Other
Please tick if QA can not be completed
QA Not possible
Reasons why QA cannot be completed
The individual has refused to participate in the QA process.
The client lacks mental capacity to engage, and no family member or next of kin (NOK) is available to provide input or consent.
The client or family have requested a delay or rescheduling of the QA review.
The client is currently in hospital or temporarily absent from the care setting.
Safe
Are the Carers Well Presented?
*
Worst
1
2
3
4
5
6
7
8
9
Best
10
1 is Worst, 10 is Best
Are the Carers Wearing the correct PPE?
*
Worst
1
2
3
4
5
6
7
8
9
Best
10
1 is Worst, 10 is Best
Are the carers Moving & Handling correctly?
*
Worst
1
2
3
4
5
6
7
8
9
Best
10
1 is Worst, 10 is Best
Effective
Has the care been beneficial?
*
Worst
1
2
3
4
5
6
7
8
9
Best
10
1 is Worst, 10 is Best
Are the carers arriving on time?
*
Worst
1
2
3
4
5
6
7
8
9
Best
10
1 is Worst, 10 is Best
Are the carers staying the correct length of time?
*
Worst
1
2
3
4
5
6
7
8
9
Best
10
1 is Worst, 10 is Best
Is the service from HG Care meeting your needs?
*
Worst
1
2
3
4
5
6
7
8
9
Best
10
1 is Worst, 10 is Best
Caring
Do you feel comfortable with your carers?
*
Worst
1
2
3
4
5
6
7
8
9
Best
10
1 is Worst, 10 is Best
Do the carers treat you with respect and dignity?
*
Worst
1
2
3
4
5
6
7
8
9
Best
10
1 is Worst, 10 is Best
Are you involved in the decision making? (asking what you would like to eat/drink)
*
Worst
1
2
3
4
5
6
7
8
9
Best
10
1 is Worst, 10 is Best
Responsive
Are your calls answered when you ring the office?
*
Worst
1
2
3
4
5
6
7
8
9
Best
10
1 is Worst, 10 is Best
Do you know how to raise a complaint against a staff member?
*
Worst
1
2
3
4
5
6
7
8
9
Best
10
1 is Worst, 10 is Best
Well-Led
Were you involved in the development of the care plan?
*
Worst
1
2
3
4
5
6
7
8
9
Best
10
1 is Worst, 10 is Best
Are you happy with the care plan that has been put in place?
*
Worst
1
2
3
4
5
6
7
8
9
Best
10
1 is Worst, 10 is Best
Medication
Do we support The Service User with Medication?
Yes
No
Are Medication being administered correctly and on time?
*
Worst
1
2
3
4
5
6
7
8
9
Best
10
1 is Worst, 10 is Best
Do you feel confident that your carers understand your medication needs?
*
Worst
1
2
3
4
5
6
7
8
9
Best
10
1 is Worst, 10 is Best
Are you medication records being recorded correctly?
*
Worst
1
2
3
4
5
6
7
8
9
Best
10
1 is Worst, 10 is Best
Do you know how to report concerns regarding medication?
*
Worst
1
2
3
4
5
6
7
8
9
Best
10
1 is Worst, 10 is Best
What do HG Care do well?
What can HG Care do better?
Back
Next
Client QA Form
Complete this section once QA has been completed
Action Plan
Anything rated 8 or below MUST have an action plan. Please state any actions required (both positive and negative actions). Do you need to speak with the carer regarding the issues? are you arranging a spot-check on them? Are you checking ECM data?
Identify Main Issues
*
Carer Punctuality (Lateness)
Carer not staying the full time
Carer Rushing
Missed Calls
Carer Competency
Carer Not Completing All Tasks in Support Plan
Office Staff (Rude Staff, not ringing back etc..)
Lack of Consistency with carers
No issues identified
Other
Classify Positive Feedback
*
Communication between carer and service user
Good Consistency with carers
Carer Punctuality
Carer going above and beyond
Office Staff (nice, friendly, helpful etc..)
No positive feedback
Other
Information Recorded By
*
Your Email Address
example@example.com
Date
*
/
Day
/
Month
Year
Date
Submit
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