ADON/DON

Information

Name *

Last 4 digits of SSN *

Phone *

Email *

Proficiency Scale

1 = No Experience

2 = Need Training

3 = Able to perform with supervision

4 = Able to perform independently

Leadership Domain

Communicates effectively with residents, families, significant others and other team members *

Communicates effectively with peers, physicians, and State agencies *

Coordinates resident care to the multidisciplinary team via at-risk meetings, QA and A, rehab meetings, etc. *

Provides updated resident information to physician, resident, family, legal, consultants, State agencies in accordance with regulations and/or BHC standards *

Knowledgeable and able to execute human resource policies as applicable to a variety of people issues *

Delegates as appropriate *

Actions demonstrate excellent customer service skills and builds relationships with families and associates *

Monitors the progress of others and associates are held accountable *

Enforces regulatory and employee law compliance *

Technical Domain

Assesses and monitors staff compliance of infection control and safety programs *

Demonstrates excellent technical skills and judgment, as evidenced by: Daily Start up execution, Follow-up 24-hour report, Computer reports, Medicare Reports, 672/802 *

Assesses and monitors accuracy of Facility Scorecard and CMS quality indicator data and initiates corrective action as indicated *

Actively participates and contributes to facility QA & A meetings, QR/QRFU and process improvement activities *

Promotes survey preparedness at all times *

Demonstrates basic working knowledge of Computer i.e. ADT, PO's, MDS modules and management reports *

Demonstrates basic understanding of quality event investigating and reporting process *

Maintains a current knowledge of LTC Federal, state regulations including Medicare, Medicaid and JCAHO as applicable *

Ensure that RAI functions are completed timely for all residents, i.e. concurrent review, State submissions, care plan meetings, etc. *

Assess and ensure execution of Facility standards, protocols and policies *

Provides and monitors the effectiveness of clinical orientation and ongoing training to all associates *

Actively participates in recruiting, hiring and orientation of all associates *

Problem Solving Domain

Utilizes the nursing process to structure care to individual resident's needs *

Demonstrates the ability to assess and interpret data about the resident's status and ensure timely interventions are executed *

Collaborates with DNS/ Consultants on identified areas of noncompliance and implements necessary corrective actions *

Effectively troubleshoots and ensures allocation of staffing resources to meet the needs of the residents/patients *

Demonstrates understanding of census as it relates to HOL, expense control and budgeted PPD, i.e. nursing supplies *

Assess and monitors discharge, rehospitalization patterns and implements corrective actions as indicated *

Age Specific Competencies

Infant (Birth - 1 year) *

Preschooler (ages 2-5 years) *

Childhood (ages 6-12 years) *

Adolescents (ages 13-21 years) *

Young Adults (ages 22-39 years) *

Adults (ages 40-64 years) *

Older Adults (ages 65-79 years) *

Elderly (ages 80+ years) *

ADON/DON

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