ADON and DNS SKILLS CHECKLIST - Maun-Lemke

1 ADON and DNS SKILLS CHECKLISTA ssociate Name: _____Today s Date: _____Facility: _____Date of Hire: _____*Executive Direcdtor to complete Leadership Domain section EvaluationMentor EvaluationDomain/ Related Task/SkillAble to PerformNeeds Further DevelopmentReviewed Educational Material and Policy/ ProcedureDirect ObservationReturn DemonstrationCommentsLeadership Domain*Communicates effectively with residents, families, significant others and other team effectively with peers, physicians, and State resident care to the multidisciplinary team via at risk meetings, QA and A, rehab meetings, updated resident information to physician, resident, family, legal, consultants.

2 State agencies in accordance with regulations and/or BHC and able to execute human resource policies as applicable to a variety of people as and DNS SKILLS CHECKLISTA ssociate Name: _____Today s Date: _____Facility: _____Date of Hire: _____*Executive Direcdtor to complete Leadership Domain section EvaluationMentor EvaluationDomain/ Related Task/SkillAble to PerformNeeds Further DevelopmentReviewed Educational Material and Policy/ ProcedureDirect ObservationReturn DemonstrationCommentsActions demonstrate excellent customer service SKILLS and builds relationships with families and the progress of others and associates are held regulatory and employee law DomainAssesses and monitors staff compliance of infection control and safety excellent technical SKILLS and judgment, as evidenced by.

3 Daily Start up execution Follow-up 24 hour report Computer reports Medicare Reports 672/802 Assess and monitors accuracy of Facility Scorecard and CMS quality indicator data and initiates ADON and DNS SKILLS CHECKLISTA ssociate Name: _____Today s Date: _____Facility: _____Date of Hire: _____*Executive Direcdtor to complete Leadership Domain section EvaluationMentor EvaluationDomain/ Related Task/SkillAble to PerformNeeds Further DevelopmentReviewed Educational Material and Policy/ ProcedureDirect ObservationReturn DemonstrationCommentscorrective action as participants and contributes to facility QA &A meetings, QR/QRFU and process improvement survey preparedness at all basic working knowledge of Computer ADT, PO s, MDS modules and management basic understanding of quality event investigating and reporting processMaintains a current knowledge of LTC Federal.

4 State regulations including Medicare, Medicaid and JCAHO as that RAI functions are ADON and DNS SKILLS CHECKLISTA ssociate Name: _____Today s Date: _____Facility: _____Date of Hire: _____*Executive Direcdtor to complete Leadership Domain section timely for all residents, concurrent review, State submissions, careplan meetings, and ensure execution of Facility standards, protocols and and monitors the effectiveness of clinical orientation and ongoing training to all participates in recruiting, hiring and orientation of all Solving DomainUtilizes the nursing process to structure care to individual resident s the ability to assess and interpret data about the resident s status and ensure timely interventions are with DNS/ Consultants on identified areas of noncompliance and implements necessary corrective troubleshoots and ensure allocation of staffing resources to meet the needs of the ADON and DNS SKILLS CHECKLISTA ssociate Name: _____Today s Date: _____Facility: _____Date of Hire.

5 _____*Executive Direcdtor to complete Leadership Domain section understanding of census as it relates to HOL, expense control and budgeted PPD, nursing and monitors discharge, rehospitalization patterns and implements corrective actions as OF REVIEWERDATE INITIALSSIGNATURE/CREDENTIALS OF REVIEWERCLINICAL SKILLS CHECKLIST ACTION PLANName: _____ RN LPN MDS CoordinatorFacility_____ DNS ADNS Staff DevelopmentAssessment Area/TopicAction Plan For TrainingBy WhomBy WhenDateOutcomeSupervisor/Director