PA Monthly QA

PA Monthly QA

Please Fill out This Form:

Program Administrator Details

Name
Name
First Name
Last Name

General Home Safety

Carbon Detector & Smoke Detectors Working
Fire Extinguisher Charged
Fire Evacuation Map Posted
Fire Drill Log Up To Date
On Call # Posted
Staff Schedule Posted
DRM & Rights Information Posted
No Outstanding Maintenance Requests
Labor Laws Posted in Office
License Posted
Employee handbook signed by all staff
Residential Policy Signed by All Staff
Reportable Event Policy signed by all staff
Grievance Policy signed by all staff

Food QA

Meal plan & Activity Posted
Mileage & Activity Log Current
No expired foods in the fridge
Foods not in original containers labeled/dated
No food products on counter
Food separated by resident

Medical QA

Person Name

CRMA Med Policy Signed by all staff
Vital Information Complete & Current
Emergency Data Form is Current
MAR Complete, no blanks
CRMA Signatures on MAR
Previous 2 months MAR
Side Effects for Every Med w/ CRMA Signatures
Current Order for Each Med
Current Consent for Each Med
Current OTC Order
Internal & External Meds Separate
Discontinued & Expired Meds in Destroy Box
Control Book Up To Date
After Visit Summaries for Med Appointments
Doctor appointment

House QA

Bedroom

Clean & organized
Lights working
Floor, Windows, Walls in good repair
Door lock
Phones working
Reflect the person personality

Bathrooms

Clean & organized
Lights working
Floor, Windows, Walls in good repair
Tub/shower clean
Hygiene products organized and separated by

Laundry Area & Basement

Clean & organized
No evidence of water/moisture
Items stored 4 inches off the floor

Living Area & Hallways

Clean & organized
Lights working
Floor, Windows, Walls in good repair
Couches and chairs clean
TV working
Internet working
Phones working

Kitchen

Clean & organized
Refrigerator clean and appropriate temperature
Oven/stove clean
Lights working
Fire extinguisher checked and working
Floor, Windows, Walls in good repair

Clinical Book

Current Rental agreement up to date
Current Authorization to release
Current photo Release
Current permission to administer medication
Current guardianship letter
Current Consent to administration medication
Current Functional Assessment
Current Person Center Plan