Amanda Minneapolis, Queen, Oliver, Washburn, Christian Park, Century, Carriage Oaks Form

* = Required Information

Lead Counselor Daily Update for PD's - Hawo

Minneapolis and St. Paul
TO BE COMPLETED AT THE END OF EVERY SHIFT LEAD SHIFT WORKED

Lead Counselor Name *

Date *

House Worked

*Inside & outside inspection*

How did the house appear upon arrival (condition of bedrooms and common areas)?

Were Work Orders sent in for concerns?

List the activities that occurred since you were last at the site, including dates, times and initials of who participated in the community activity.

What appointments and/or scheduled injections occurred on your shift?

Were any activities or appointments missed? If so, please explain why. If the appointment has been rescheduled, when? *

If there was an appointment, please state the individual, who the appointment was with, and what it was for.

If there was a medical appointment, were there any medication changes?

Were they added or removed on the MAR?

Were there any Over-The-Counter (OTC) and/or PRN medications passed today? If you are returning from a day off (weekend or vacation) please review MARS for passed OTC medications for those days. If Yes, which OTC medications were passed and to whom?

Did you hear any complaints or concerns from individuals, case managers, guardians, family members, neighbors, etc? Please call the PD regarding any complaints from any of the above, and document a description below.

What are your plans/recommendations for the above complaints or concerns?

Did you observe any staff performance problems, including; arriving late, leaving early, concerning interactions with individuals, or not completing a portion of their job responsibilities? (your response is confidential)

Have you updated the individuals ledgers today?

Are there any security concerns with the facility or residents?

Please describe any additional questions or concerns you may have, and any recommendations for program improvement.