Care Certificate Competency Observation Assessment Record SUPERVISOR
Care Professional's Name:
Date of Assessment:
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Assessment Completed by:
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Standards Requiring Observational assessments
Select the Standards assessed
Standard 1: Understand Your Role
Standard 2: Your Personal Development
Standard 3: Duty of Care
Standard 4: Equality and Diversity
Standard 5: Work in a Person Centred Way
Standard 6: Communication
Standard 7: Privacy and Dignity
Standard 8 Fluids and Nutrition
Standard 10: Safeguarding Adults
Standard 11: Safeguarding Chldren
Standard 12: Basic Life Support
Standard 13: Health and safety
Standard 14: Handling Information
Infection Prevention and Control
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Evidence: detail how the care professional completed the task
Action Required: details if there are any additional areas of support or training needed
Outcome: document if the care professional demonstrated competency with the standard(s) being assessed
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Date Actions to be Completed by:
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Person(s) identified to complete actions
Date actions completed:
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Supervisors Signature:
Date Approved by Care Manager:
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Care manager signature:
Should be Empty: