Field Visit Form

To be completed by Operations Team member representing Kairos Care 

General Feedback

Travel and Transport

Name of Operations Team Officer

Date of Visit

Name of Participant Visited

Name of Support Worker

Did support worker arrive 5 mins early for the shift or even waiting in the car?

Check if the vehicle is the same listed on ShiftCare with the relevant documents matching

Check Maintenance Log Book if the car is regularly serviced & if there's an emergency kit inc a first aid kit flashlight and basic tools

Check that the car is clean with room for the participant and their belongings including mobility equipment placed in the boot of the car

Make sure the client has been safely secured in the vehicle with appropriate restraints

Check if SW discussed travel plans and planned route with participant ahead of time and has plans for traffic or road closures

Communicate with the client and their family members or caregivers to address any concerns or issues that may arise during the spot check

Personal Care

Name of Operations Team Officer

Date of Visit

Name of Participant Visited

Name of Support Worker

Check if client's personal hygiene needs are being met including bathing grooming and changing clothes

Check bathing area and health and safety measures taken whilst showering ( if client is showered)

Check if medications are stored and labelled and is the client taking them as prescribed with assistance from the support worker

Communicate with the client and their family members or caregivers to address any concerns or issues that may arise during the spot check

Domestic Assistance

Arrive towards the end of the shift to check on cleanliness of the house.

Name of Operations Team Officer

Date of Visit

Name of Participant Visited

Name of Support Worker

Check the cleanliness and tidiness of the home including living areas-bedrooms-and bathrooms

Check cleaning products- Note down any hygiene issues cockroach infestation etc

Check for any safety hazards in the home such as loose rugs- slippery floors or cluttered walkways

With client's approval-Check fridge for expired food

Communicate with the client and their family members or caregivers to address any concerns or issues that may arise during the spot check

Field Visit Form