The following pages will be

utilized during orientation.

M:\Caregiver Forms & Info\Caregiver Process\B - Hire\(B)1-Orientation Packets\CNA

Hire Packet\(2B)CNA13 - Property Return.doc

PROPERTY RETURN AGREEMENT

I, _____________________, agree to have the following amounts deducted from my check if:

Any of the items need to be replaced during my employment

Or

Items are not returned when my employment with Comfort Keepers is ended:

1. $10.00 for Comfort Keepers Employee Badge 2. $15.00 for Comfort Keepers Tote Bag 3. $20.00 for Comfort Keepers Employee Manual 4. $15.00 for Gait Belt (CNA’s only)

I, ______________________, acknowledge that I have received the following items at the time of orientation with Comfort Keepers:

___ Comfort Keepers Employee badge ___ Comfort Keepers Tote Bag

___ Comfort Keepers Employee Manual ___ Gait Belt (CNA’s Only)

__________________________ _______________ Employee Signature Date ____________________________ _______________ CK Representative Signature Date

M:\Caregiver Forms & Info\Caregiver Process\B - Hire\(B)1-Orientation Packets\CNA Hire Packet\(2B)CNA14 - Employee Information Sheet.doc

CONFIDENTIAL

EMPLOYEE INFORMATION DATA

Name: ___________________________________________ DOH: ______________ Social Security #: _____________________ DOB: _________________ Address: ______________________________________________________________ Home Phone: (____) _________________ Cell Phone: (____) ________________

EMERGENCY CONTACT INFORMATION

Primary Contact: __________________________ Relationship: ________________ Phone: (____) ____________________ Phone: (____) _____________________ Secondary Contact: _________________________ Relationship: ________________ Phone: (____) ____________________ Phone: (____) _____________________ Physician: ___________________________ Phone: (____) ____________________ Hospital of Choice: ______________________________________________________ Known Allergies: ________________________________________________________ Significant Medical History: ________________________________________________ Employee Signature: _____________________________ Date: _________________ It is within my rights to withhold any medical information and I choose to do so. Employee Initials: _____________ Date: ___________

Confidentiality Notice: This information is confidential, intended only for the purpose of communication with medical personnel in the event of a medical emergency while working for Comfort Keepers. This document may contain information that is privileged or exempt from disclosure under applicable law. If you are not the intended recipient(s), you are notified that dissemination, distribution, or copying of this information is strictly prohibited.

Macintosh HD:Users:ssmagill:Desktop:New Hire Packets:(B)1-Orientation Packets:Stop Packets:x(2B)CNA15 - Employee Handbook ACKNOWLEDGEMENT.doc

ACKNOWLEDGEMENT

The Employee Handbook was reviewed with me, and I have received a copy of it. I also acknowledge that I have been given the opportunity to ask questions and express concerns. Additionally, I understand and support the following:

1. This Employee Handbook is intended as a guide and not an employment agreement that creates a contractual relationship.

2. The employment relationship may be terminated at the will of either party at any time with or without notice.

3. The changing needs of the business will require alteration in method, practices and policies, and the company will unilaterally revise these, as necessary, to meet these changing needs.

4. I agree to advise my supervisor promptly of any change in my personal data such as phone number, address, email address, emergency notification, etc.

5. I am responsible for the information provided herein and will, upon my separation from Comfort Keepers, return this handbook and all company property to my supervisor.

___________________________________ Employee Name (Print)

____________________________________ _________________ Employee Signature Date

Name ______________________________

Date _______________________________

What would l like a

client to say about me?

Page 1 of 2

Updated August 2006

NEW EMPLOYEE ORIENTATION CHECKLIST

Employee Name:_____________________________ Date of Hire:__________ Date of Orientation:___________________ Topics:

Welcome

Agenda

Introduction of Orientees

History/What Makes Us Different

Mission/Vision Statement

Introduction of Staff/Organizational Chart

Work We Do/Job Description-Duties and Responsibilities

Work We Don’t Do

Expectations-Yours and Ours

Treating You Right

Review of Employee Manual-Includes Personnel Policies and Procedures:

Client assignment

Care Plans

Dress Code

Smoking

Gift Policy

Use of phone

Client’s Money

Behavioral

Discipline

Client Rights (NE and IA)

Confidentiality/Hippa

Abuse (Review NE requirements)

Page 2 of 2

Updated August 2006

Complaints

Grievance

Client Safety/Emergency/Disaster

My Safety/Ergonomics:

Disposal Precautions

Injury’s

Incident Reports

Drug Free

Client Choices

Ongoing training expectations-Silver Chair

Other information

Client Care Policies and Procedures-Where they can be accessed

Show copies of all required Federal, State, County employer postings-

Tour office

Silver Chair Follow-up-Closing/Next Steps

By signing below, I acknowledge that I have completed the Comfort Keepers new employee orientation. I have reviewed and agree to abide by all employee policies, procedures and other standards that I am expected to adhere to as conditions to my employment with Comfort Keepers. I have received Comfort Keepers Employee Manual. I understand that the manual and all related material (caregiver and client) is the property of Comfort Keepers. It is loaned to me for the duration of my employment. All information within it is considered confidential; I will not distribute or make copies of any portion of the Employee Manual. I will immediately return the Employee Manual, ID Badge, and any other Comfort Keepers information to Comfort Keepers upon termination of my employment.

Employee Signature____________________________________Date________

Plan of CareForm

Date: ___/___/____

Customer Name: Jane Doe Training 

Customer Agreement #:  

Comfort Keepers' Office #:__________________ 

Primary Contact: Client     Contact Person__________________

Advance Directives:  Yes   No  Location:  

DNR:  Yes   No  Location:  

Disaster Priority Code:  

Companionship   Extended Instructions

Communication  per Request Hearing, Vision or other communication challenges. Do they wearhearing aides, do they wear glasses?

Dressing Assistance  per Request Do they need help with dressing.

Environmental  per Request Who do they live with?

Errand & Grocery Shopping  perRequest Will we be taking them to run errands, get groceries, etc?

Hobbies & Interests  per Request What do they enjoy doing? What can we do for interactive caregiving?

Laundry & Linen Washing  perRequest

Where are their laundry facilities located? Do we need to help themwith laundry?

Light Housekeeping  per Request What kind of housekeeping assistance do they need?

Meal Preparation  per Request Do they have any dietary restrictions? Do we need to prepare mealsfor them? Do they receive Meals on Wheels?

Medical Concerns/DX  per Request Medical problems they have

Memory Support  per Request Are they confused? What can we do to help with dementia?

Transportation Services  perRequest

Do they need us to transport them? Do they have a vehicle we will bedriving or will we be driving our vehicle?

Documentation   Extended Instructions

Daily Routine  per Request What is their typical routine? What is a typical day for the ComfortKeeper

Emergency Response System  perRequest

Do they have an Emergency Response System? Do they need one?Are they interested in one?

Nurse Administrator  Required Chad

Timesheets  per Request are there specifics that need to be completed on the time sheet?

Personal Cares   Extended Instructions

Bathing  per Request What kind of assistance do they need with bathing or showering?Frequency of bathing?

Hygiene Cares  per Request Do they need assistance with hygiene cares such as shaving, washingface, brushing teeth, etc?

Incontinence Cares  per Request Are they incontinent? Can they manage this themselves? Do theyneed peri care? Do they wear depends?

Medication Reminders  per Request Do they need reminders to take their medications?

Mobility Assistance  per RequestDo they need help with transfers? What kind of assistive devices dothey use (walkers, w/c,etc), Do they need help with repositioning? Arethey a fall risk?

Skilled Services  per Request Do they have a skilled provider coming to help them with therapy,nursing, etc?

Toileting Assistance  per Request Do they need help getting on/off the toilet? Do they need help withreminders to go to the bathroom?

 

TEST YOUR UNDERSTANDING OF ELDER ABUSE AND NEGLECT

NAME___________________________________________ DATE________________ 1. Elder abuse is complex because:

A. Some diseases and chronic illnesses can mask or mimic the visible

signs of abuse

B. The victim and the abuser may hide the abuse

C. No single characteristic identifies an abuser

D. All of the above

2. Understanding the complexities of elder abuse is important because:

A. It can help you to identify elder abuse

B. You would know how to intervene and fix the problem yourself

C. How you respond to an abuser could help the abuser to justify the abuse

D. Both A and C

E. The signs and symptoms of each form of abuse are the same.

3. One of the signs and symptoms of neglect is:

A. Yelling at the elder

B. Pulling Hair

C. Untreated bedsores

D. Bloody underclothing

4. Risk factors for elder abuse include:

A. Mental illness

B. Poor nutrition

C. Ageism

D. Both A and C

5. Some examples of physical abuse include:

A. Force feeding

B. Physical restraints

C. Inappropriate use of drugs

D. All of the above

6. One of the general signs that may indicate abuse is occurring is:

A. An elder has more than one caregiver

B. A sudden change in an elder’s behavior

C. An elder with dementia who repeats him or herself

D. A caregiver with no medical background

7. Stressed caregivers will always be abusive to elders.

True False

8. According to the National Center on Elder Abuse, family members account for a

small percentage of abuse against elders.

True False

9. Violence is a learned behavior that in some families is passed on from one

generation to the next.

True False

10. Most elders who are victims of abuse will report it.

True False

11. Most health care professionals who work with the elderly are mandatory reporters

and must report all cases of suspected abuse according to their state guidelines.

True False

12. It is the responsibility of the home care agency to investigate suspected

elder abuse.

True False

13. Some victims of sexual abuse will give clues that they are being abused. We need

to be aware of these clues and ask further questions.

True False

14. Elder abuse is never pre-meditated and deliberate.

True False