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ADON Or DON Skills Checklist

Fill Out and Submit your Skills Checklist
Skills Checklist
Instructions: This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below.
Proficiency Scale:
1No Experience
2Need Training
3Able to perform with supervisione
4Able to perform independently
Leadership Domain
Communicates effectively with residents, families, significant others and other team members
0
Communicates effectively with peers, physicians, and State agencies
0
Coordinates resident care to the multidisciplinary team via “at risk meetings, QA and A, rehab meetings, etc.
0
Provides updated resident information to physician, resident, family, legal, consultants, State agencies in accordance with regulations and/or BHC standards
0
Knowledgeable and able to execute human resource policies as applicable to a variety of people issues.
0
Delegates as appropriate
0
Actions demonstrate excellent customer service skills and builds relationships with families and associates.
0
Monitors the progress of others and associates are held accountable
0
Enforces regulatory and employee law compliance
0
Technical Domain
Assesses and monitors staff compliance of infection control and safety programs
0
Demonstrates excellent technical skills and judgment, as evidenced by: Daily Start up execution, Follow-up 24 hour report, Computer reports, Medicare Reports, 672/802
0
Assess and monitors accuracy of Facility Scorecard and CMS quality indicator data and initiates corrective action as indicated
0
Actively participants and contributes to facility QA &A meetings, QR/QRFU and process improvement activities
0
Promotes survey preparedness at all times
0
Demonstrates basic working knowledge of Computer i.e. ADT, PO’s, MDS modules and management reports
0
Demonstrates basic understanding of quality event investigating and reporting process
0
Maintains a current knowledge of LTC Federal, state regulations including Medicare, Medicaid and JCAHO as applicable
0
Ensure that RAI functions are completed timely for all residents, i.e. concurrent review, State submissions, careplan meetings, etc
0
Assess and ensure execution of Facility standards, protocols and policies
0
Provides and monitors the effectiveness of clinical orientation and ongoing training to all associates
0
Actively participates in recruiting, hiring and orientation of all associates
0
Problem Solving Domain
Utilizes the nursing process to structure care to individual resident ‘s needs
0
Demonstrates the ability to assess and interpret data about the resident’s status and ensure timely interventions are executed
0
Collaborates with DNS/ Consultants on identified areas of noncompliance and implements necessary corrective actions
0
Effectively troubleshoots and ensure allocation of staffing resources to meet the needs of the residents/patients
0
Demonstrates understanding of census as it relates to HOL, expense control and budgeted PPD, i.e. nursing supplies
0
Assess and monitors discharge, rehospitalization patterns and implements corrective actions as indicated
0
Age Specific Competencies
Infant (Birth - 1 year)
0
Preschooler (ages 2-5 years)
0
Childhood (ages 6-12 years)
0
Adolescents (ages 13-21 years)
0
Young Adults (ages 22-39 years)
0
Adults (ages 40-64 years)
0
Older Adults (ages 65-79 years)
0
Elderly (ages 80+ years)
0

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