Home Health Aide (HHA) Performance Evaluation

Reflects understanding of essential performance standards as an agency employee and member of the home care team including :

Reporting to patient’s home on time and according to assigned schedule

Yes

Demonstrating respect for the patient and their privacy as well as for their home, belongings and family members—this includes being courteous in all interactions with patients, families and coworkers.

Yes

Contacts the office or supervisor if there are any patient care questions relative to the plan of care, emergent situations or any other patient related concerns.

Yes

Understands and follows infection control procedures/guidelines including hand washing and universal precautions in all areas of patient care provision.

Yes

Maintains daily/weekly visit productivity within expected range

Yes

Maintains client confidentiality/HIPAA

Yes

Is neat, clean and professional in appearance.

Yes

Follows agency guidelines and skills for providing home health aide services relative to :

Performing care as outlined on personal care/HHA assignment sheet

Yes

Bathing

Yes

Skin Care

Yes

Bed Positioning of Patient

Yes

Personal care including hair, mouth, shaving, nails and clothing

Yes

Toileting

Yes

Vital Signs

Yes

Assistance with ambulation, ROM and transfer

Yes

Care of home environment/light housekeeping

Yes

Meal assistance

Yes

Safety guidelines

Yes

Safe and effective use of equipment

Yes

Communicates effectively with patients, families and caregivers
Completes the following forms thoroughly, timely and accurately :

Time log/travel sheet

Yes

Home Health Aide Daily Activity Log

Yes

Inability to provide care in accordance with HHA plan of care is documented in the clinical record according to agency policy and reported

Yes

Observations and patient clinical changes are reported to supervisor and noted in the record according to agency policy

Yes

Communicates appropriately with the other members of healthcare team including :

Nurse

Yes

Physical Therapist

Yes

Speech-Language Pathologist

Yes

Occupational Therapist

Yes

Medical Social Worker

Yes

Other: (identify) :

Yes

My signature below does not imply my agreement with the content of this evaluation, but that the above evaluation has been reviewed with me.

Responsibility, Skill, or Procedure

Yes

No

Reflects understanding of essential performance standards as an agency employee and member of the home care team including :

Follows agency guidelines and skills for providing home health aide services relative to :

Communicates effectively with patients, families and caregivers
Completes the following forms thoroughly, timely and accurately :

Clearly communicates with supervisor regarding :

Communicates appropriately with the other members of healthcare team including :

Other areas/skills :

Ideal HomeHealth Care, LLC

Responsibility, Skill, or Procedure

Yes

No

Reflects understanding of essential performance standards as an agency employee and member of the home care team including :

Follows agency guidelines and skills for providing home health aide services relative to :

Communicates effectively with patients, families and caregivers Completes the following forms thoroughly, timely and accurately :

Clearly communicates with supervisor regarding :

Communicates appropriately with the other members of healthcare team including :

Other areas/skills :

Communicates effectively with patients, families and caregivers
Completes the following forms thoroughly, timely and accurately :