2019-02-22_stephaniem_Caregiver Performance Evaluation PDF (1).pdf

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Rev 6/2017  1   Caregiver Performance Evaluation    Employee: Start Date: Review Period: Manager/Supervisor:  Caregiver Responsibilities ü Assist clients with ADL care, which includes bathing, dressing, toileting, grooming and transferring. ü Prepare meals following clients prescribed dietary restrictions and the Balanced Care Method. ü Change bed linens, wash and iron laundry, and clean clients’ homes. ü Conduct basic errands, such as grocery shopping. ü Provide companionship to clients in a caring manner. ü Incorporate aspects of the Balanced Care Method into your clients’ care. ü Provide transportation services. ü Maintain a detailed record of services provided and clients’ current conditions. ü Validate your on-time arrival and departure for every shift utilizing our telephony system. ü Alert your Care Manager / Staffing manager about major changes or incidents during your work. ü Adhere to all policies and procedures set forth in the Employee Manual. ü Maintain your working schedule and alert your manager of any planned absence. ü Provide adequate notice for time off - 2 weeks. ü Provide other duties as assigned by your supervisors. General Instructions This form should be reviewed in a scheduled employee and manager performance review meeting. Evaluate this individual’s progress toward career goals from previous year. ü Review Supervisory Visit Reports ü Review Clear Care Telephony Report ü Review any incident reports

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Rev 6/2017  2 Rating Used when Significantly Exceeds Expectations (SE) Employee regularly exceeded expectations for the position demonstrating extraordinary performance in major aspects of the position going beyond the scope of the position, including achievement of objectives and/or responsibilities and mastery of critical skills. Exceeds Expectations (EE) Employee exceeded performance standards for his/her position overall. Employee exceeded performance even in the most difficult and complex parts of the position, including taking on responsibility for extra or unique tasks. Performed duties and responsibilities with very little need for direction. Decisions and recommendations were always sound and often in unstructured, non-routine areas of position responsibilities. Employee was often innovative; initiated, planned for, and accomplished worthwhile objectives, whether self-initiated or established by others. Meets Expectations (ME) Employee thoroughly met the performance standards for the position. No improvement or very little is needed in order to be considered fully successful in all aspects of the position. Employee's performance was fully competent and reliable, maintained with only general directions and a minimum of supervision. Decisions and recommendations were always sound in the routine areas of position responsibilities and were generally sound in the less structured, non-routine areas of position responsibilities. Employee demonstrated initiative and accomplished established objectives. Employee is new to the position. While employee has not assumed total responsibility for the position, has met reasonable expectations given length of time in position. Below Expectations (BE) Employee did not always complete or consistently meet one or more of the performance standards for the position. Employee did not always complete assignments on time or comprehensively, therefore, employee did not thoroughly meet required standards of performance. A greater- than-expected level of supervision was required for position objectives to be met. Improvement is required in the areas where deficiencies are noted. Employee is new to the position. While employee has not assumed total responsibility for the position, performance is below reasonable expectations given length of time in position. Fails to Meet (FM) Employee did not meet the performance standards for the position. Position objectives were not met. Performance was unreliable and assignments were submitted late, incomplete, or not at all. Decisions and recommendations were not sound. Employee required excessive direction and/or close supervision in order to complete assignments. Performance at this level requires counseling with the employee. There is a need for employee to demonstrate immediate improvement in performance in the areas where deficiencies were noted.

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Rev 6/2017  3    Company Values How well does this employee represent the values of Home Care Assistance? Our Mission and Purpose  Appreciates older adults and is interested in Client's life. Accepts the role of our Client's family. Interested in improving skills and knowledge. Excited to be part of Home Care Assistance and our mission to Change the Way the World Ages. Understands that we're there for the journey... and this profession is not always easy. Rating: FM (1) BE (2) ME (3) EE (4) SE (5) Comments/Examples: Professionalism  Professional attire by following dress code. Well- groomed hair, nails, cleanliness. Follows universal safety precautions. Drives cautiously with Clients. Leaves personal problems "at home." Energizes Clients. Makes smart and appropriate decisions without requiring much input. Never talks to Clients directly about time off or changing schedules. Respects confidentiality. Rating: FM (1) BE (2) ME (3) EE (4) SE (5) Comments/Examples: 
Decision-Making  Makes smart and appropriate decisions without requiring much input. When needs of Client deviate from Care Plan or other instructions, makes best decision for Client and communicates that to Office. Can be trusted to always "do what's right" for the company, self, and Client. Knows when to ask for assistance and feedback. Rating: FM (1) BE (2) ME (3) EE (4) SE (5) Comments/Examples: Work Quality Follows Plan of Care. Demonstrates a consistent focus on high quality standards. Holds skills needed for the Clients assigned. Uses time effectively while in the Client's home. Follows through on tasks. Maintains accurate and helpful care notes. Always open to training when suggested or offered. Produces appropriate amount of quality work in a cost-efficient manner. Rating: FM (1) BE (2) ME (3) EE (4) SE (5) Comments/Examples:

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Rev 6/2017  4 Teamwork Works effectively with other Caregivers and the Office Team. Fills openings when needed and substitute when asked. Displays professional attitude toward job and the company. Shares information with the Office staff about Clients. Shows initiative and a sense of fairness. Rating: FM (1) BE (2) ME (3) EE (4) SE (5) Comments/Examples: Communication and Accountability Contacts the Office with Client concerns. Accepts suggestions well and implements them. Reads and responds to company communications. Presents ideas and recommendations to Client care team. Responds appropriately to Client's family members Requires very little intervention from Office Team. Shows leadership and has a high degree of integrity. Rating: FM (1) BE (2) ME (3) EE (4) SE (5) Comments/Examples: 
Attendance/Punctuality  Rarely calls off. Always on time. Stays for entire shift. Is fully ready to work at beginning of each shift and continues giving fully until workday is complete. Alerts Office in plenty of time for needed days off and if a late arrival is inevitable. Rating: FM (1) BE (2) ME (3) EE (4) SE (5) Comments/Examples: Balanced Care Method  Understands Home Care Assistance's Balanced Care Method. Promotes the elements of BCM. Encourages Clients to engage in our concept of health span as well as lifespan. Ensures Clients have physical activity, healthy diet, mental stimulation, social ties, and a sense of purpose every day the Client is served. Rating: FM (1) BE (2) ME (3) EE (4) SE (5) Comments/Examples: OVERALL RATING Add all ratings and indicate overall rating based on the range indicated in the adjacent table.      Rating: FM (1) BE (2) ME (3) EE (4) SE (5) Comments/Examples:

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Rev 6/2017  5   Changing the Way the World Ages Share any examples of the caregiver going above and beyond the call of duty to better serve our clients – whether it’s filling in for a last-minute opening, helping the client embrace our Balanced Care Method, connecting with the client to build a deeper relationship, or anything else that is extraordinary.  1. 2. 3.   Goals Please list up to three, and any specific job assignments in the upcoming year which could help in reaching these goals.  1. 2. 3.  Recommendations:           Employee Signature Date Manager/Supervisor Signature Date