* = Required Information
Lead Counselor Daily Update for PD's
House Worked
*
Date Now
*
First Name
*
Last Name
*
What was the condition of the site upon arrival inside?
Poor
Fair
Excellent
What was the condition of the site upon arrival outside?
Poor
Fair
Excellent
Please describe specifics noted on the condition of the common areas (living room, kitchen, basement, bathrooms, ect.) and outside (yard, appearance of the house):
Please describe the condition of each individual's room:
Were work orders submitted?
Yes
No
Please Describe:
List of community activities that occurred from the last time you were present at the site, until current. Include location of activity and who partipated and date/time:
List of appointments that occurred today (name of the individual, type of appointment/reason for the appointment):
Were there medication changes at the appointment?
Yes
No
* Homecare sites must notify the nurse.
Which medication change occurred? Please select from the following:
Please select
Medication 1
Medication 2
Medication 3
Medication 4
Medication 5
Describe the medication change below, if applicable:
Were the medication changes added or removed from the MAR?
Please select
Medication 1
Medication 2
Medication 3
Medication 4
Medication 5
Was an injection administered today?
Yes
No
If yes, please note the name of the individual who received the injection and the name and dose of the injection:
List medical/psychiatric concerns and follow up required for each individual:
Did anyone go to the ER or Urgent Care today? Note if this occurred over the weekend.
Yes
No
Please explain reason for the ER/Urgent Care and note who transported the individual:
Were any activities or appointments missed?
Yes
No
If an appointment/activity was missed, please explain why AND list the date of the rescheduled appointment/activity:
What is your plan to ensure that the next appointment is not missed?
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 review the MARs today?
Yes
No
Are there any medication discrepancies? Please describe follow up needed:
Have you submitted the activity and staff schedules for the week?
Yes
No
* Must be sent every Thursday
Note the date the activity and staff schedules were submitted:
List the individuals who met with their primary today (name of individual and primary staff):
Were the primary counselor checklists completed?
Yes
No
Why weren’t the primary check in completed:
Did you receive complaints, concerns or requests from any individuals served? Please describe and include follow up needed:
Did you receive any complaints or concerns from any team members (case managers, guardians, probation, MSOP, family members, treatment, therapists, etc)? Describe and include follow up needed:
Did you receive any complaints or concerns from neighbors? Describe and include follow up needed:
What are your plans/recommendations for the above complaints or concerns?:
Are there any security concerns with the facility, residents or staff? Explain.
Did you observe any staff performance problems, including; arriving late, leaving early, concerning interactions with individuals, no call/no show, call off for shift, or not completing a portion of their job responsibilities? Explain.
Were verbals submitted for above concerns?
Yes
No
N/A
Were communications logs sent to you at the end of each shift?
Yes
No
Please describe any important information reported by staff in the shift report and include follow up needed.
Are there any staffing vacancies? Any training needed for staff? Describe.
Current Openings Form submitted to HR this week?
Yes
No
Note date submitted
Were staff meeting minutes submitted after meeting?
Yes
No
Note date submitted
Was the 25th paperwork?
Yes
No
Please list 25th paperwork items that were not submitted and why.
Have you updated the individual ledgers today?
Yes
No
Was the 25th paperwork submitted today?
Yes
No
N/A
Have you completed LOA's for the week?
Yes
No
Note date completed
Please describe any additional questions or concerns you may have, and any recommendations for program improvement.
Submit