Form – Carer Competence Check PAC – Carer Competence Check – Staff Observation PAC – Carer Competence Check – Staff Observation Client Name Client Name First First Last Last Client Address Client Address Client Address Client Address City City State/Province State/Province Zip/Postal Zip/Postal Country AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCôte d'IvoireCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthelemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Name of assessor Name of assessor First First Last Last Name of carer attending during check Name of carer attending during check First First Last Last Date of check * Time of check * 121234567891011 : 0030 AMPM Carer arrival time * 121234567891011 : 0030 AMPM Carer departure time * 121234567891011 : 0030 AMPM Section One – Privacy and dignity upheald Did the carer announce themselves on arrival * YesNo Comment Used preferred form of address * YesNo Comment Caring attitude * YesNo Comment Section Two – Is the carer well prepared Toiletries * YesNo Comment Towels * YesNo Comment Clothing * YesNo Comment Section Three – Safe working practices Does the Care Worker wash their hands before and after providing care and support? * YesNo Comment Does the Care Worker use PPE correctly? * YesNo Comment Is the Care Worker vigilant for hazards in the home? * YesNo Comment Is any food handled correctly and hygienically? * YesNo Comment Is the working area kept clean and tidy and is any PPE disposed of correctly? * YesNo Comment Section Four – Medication Is the MAR completed correctly? * YesNo Comment Does the Care Worker follow the 6 Rights of Medication correctly? * YesNo Comment Section Five – Attitude and Behaviour Does the Care Worker communicate well with the Service User and evidence compassionate care? * YesNo Comment Does the Care Worker respect the privacy of the Service User? * YesNo Comment Does the Care Worker respect the dignity of the Service User? * YesNo Comment Does the Care Worker allow the Service User to make their own choices? * YesNo Comment Does the Care Worker work in an enabling way? * YesNo Comment Section Six – Recording Does the Care Worker accurately record on the care records the activities that have been undertaken? * YesNo Comment Does the Care Worker log out correctly if electronic monitoring is used? * YesNo Comment Section Seven – Service user feedback Do you know which Care Worker will be coming to visit you? * YesNo Comment Does the Care Worker usually wear identification? * YesNo Comment Does your Care Worker come on time? * YesNo Comment Does the Care Worker respect your privacy and treat you with dignity? * YesNo Comment Does the Care Worker usually wear gloves and plastic aprons for personal care? * YesNo Comment Does the Care Worker make you feel comfortable and safe? * YesNo Comment Do you feel in control of your care service? (Can you make your own choices?) * YesNo Comment Do you know how to make a complaint? * YesNo Comment If you have made a complaint, was it resolved? * YesNo Comment Are you happy with the care you receive from Passionate About Care Limited? * YesNo Comment Is there anything else you want to tell me about your care? * YesNo Comment Section Eight – Coronavirus Does the Care Worker enter the client’s home, undertaking the necessary COVID-19 precautions? i.e. social distancing, handwashing, correct PPE etc. * YesNo Comment Does the Care Worker wear the correct COVID-19 PPE when supporting the Service User? * YesNo Comment Are the correct COVID-19 processes followed throughout the Service User’s visit? * YesNo Comment Section Nine – Actions Action Points Recorded Date Expected Completion Action Points Recorded Date Expected Completion Action Points Recorded Date Expected Completion Action Points Recorded Date Expected Completion Action Points Recorded Date Expected Completion Carer email for copy of assessment If you are human, leave this field blank. 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