Student Name

Student Number

ID:

Date

Student Declaration

I have been supplied with the learning materials.

I have completed the class and had time to learn and practice before assessment.

The Assessor has gone through the Instructions and checklist on page 2 and I understand that this is a formal assessment.

I understand I must answer all the questions in exam conditions

I understand I must demonstrate the skills or knowledge myself to prove this is my own work.

I will do it in the time allowed under supervision by the Assessor.

I have ticked the boxes on page 2 and I am ready for assessment and sign here.

Student

Signature

Short Answer Questions - WRITTTEN Results

Result (1^st attempt)

/

Satisfactory ( S)

Not Yet Satisfactory (NYS)

If NYS

Will 2^nd attempt be written or oral ?

Note gap questions /topics to be reassessed

Result (2^nd attempt)

Written /Oral

/

Satisfactory ( S)

Not Yet Satisfactory (NYS)

Assessors Name

Assessor's Signature

Date

Assessor comment

/feedback

Note feedback provided if NYS:

Candidate

Declaration

I have received the results and feedback for this written assessment

Student Signature

Date

1

Do you understand how this assessment ties into the training?

Y

N

2

When/where the assessment going to take place and the conditions of the assessment?

Y

N

3

Do you feel ready to do the assessment activity?

Y

N

4

Do you know that the assessment is not pass/fail? Do you know that you can do a re-sit if you are ready? The Assessor may set another time for gap assessment or follow up with open questions if there is doubt about your responses. We expect candidates to be successful at the second attempt.

Y

N

5

Do you know you can appeal the assessment decision if you think it is not fair?

Y

N

6

Do you have any special needs that we need to adjust for during this assessment?

Y

N

Student Name

Student Number

ID:

Date

Student Declaration

I have been supplied with the learning materials.

I have completed the class and had time to learn and practice before assessment.

The Assessor has gone through the Instructions and checklist on page 2 and I understand that this is a formal assessment.

I understand I must complete the project and submit it in class or upload I understand I must complete the case study and report and submit it in class or upload

I understand I must demonstrate the applied skills and knowledge myself, in my own words to prove this is my own work.

I will do it in the time allocated and submit by the due date.

I have ticked the boxes on page 2 and sign here.

Student

Signature

PROJECT AND CASE STUDY Results

Result (1^st attempt)

Satisfactory ( S)

Not Yet Satisfactory (NYS)

Note gaps to be reassessed

Result (2^nd attempt)

Satisfactory ( S)

Not Yet Satisfactory (NYS)

Assessor comment

/feedback

Note feedback provided if NYS :

Assessors Name

Assessor's Signature

Date

1

Do you understand how this assessment ties into the training?

Y

N

2

When/where the assessment going to take place and the conditions of the assessment?

Y

N

3

Do you feel ready to do the assessment activity?

Y

N

4

Do you know that the assessment is not pass/fail? Do you know that you can do a re-submit once you get the feedback within agreed time?

Y

N

5

Do you know you can appeal the assessment decision if you think it is not fair?

Y

N

6

Do you have any special needs that we need to adjust for during this assessment?

Y

N

Candidates Name:

Unit:

CHCCCS011 Meet personal support needs

Assessors Name:

Training Package:

Date of assessment:

1. What is Care Plan? Why is it important to review personal support care plan to understand the needs of patient?

2. If you find client is unable to transfer as directed in the care plan, what would you do?

3. What procedure would you follow if you notice equipment is faulty as per WHS

policy?

4. How will you assess the clients level of participation in meeting their personal needs?

5. Why is it important to provide support or assistance according to the personal care plan and organisation policies, protocols and procedures?

6. Perform work to the standard required by the organization. Give 3 examples of legislation and regulations that has to be followed at workplace.

7. What are some of the variations that needs to be taken into account when giving assistance with personal care needs?

8. Why is it important to Report variations and concerns about clients health to the

supervisor?

9. Name 3 three of the aids and processes outside the skills and knowledge of general caregivers.

Care Plus Aged Care Facility PROGRESS NOTES

NAME:

SURNAME:

DOB:

ROOM NO: MRN:

DATE/TIME

All entries must be signed and designation recorded

Student Name

Student ID

Date

Student Declaration

I have had time to practice before this assessment.

The Assessor has gone through the Instructions and checklist on page 2 and I understand that this is a formal assessment.

I understand I must demonstrate the skills myself and answer questions.

I will do the practical as a simulation under supervision of the Assessor.

I am ready for assessment and sign here.

Student

Signature

PRACTICAL Assessment Results

Assessor initials

Result

Detail here main heading/part in checklist

(S)

(NYS)

(S)

NYS)

(S)

NYS)

(S)

(NYS)

(S)

(NYS)

Result (1^st attempt)

YES NO Did student complete the tasks to satisfactory standard at 1st attempt?

Result (2^nd attempt)

YES NO Did student complete the gap tasks to satisfactory standard at 2nd attempt? Please note items that were assessed at 2nd attempt

Result NYS

Note feedback provided if NYS:

Assessors Name

Assessor's Signature

Date

Assessor Comment:

Student Declaration

I have received the results and feedback for this practical assessment

Student Signature

Date

Key:

Satisfactory (S)

Not Yet Satisfactory (NYS)

1

Do you understand how this assessment ties into the training?

Y

N

2

When/where the assessment going to take place and the conditions of the assessment?

Y

N

3

Are the WHS checks satisfactory and equipment ready for the assessment?

Y

N

4

Do you feel ready to do the assessment activity?

Y

N

5

Do you know that the assessment is not pass/fail? Do you know that you can do a re-sit if you are ready? The Assessor may set another time for gap assessment or follow up with open questions if there is doubt about your responses or demonstration of skills and knowledge in this practical.

We expect candidates to be successful at the second attempt.

Y

N

6

Do you know you can appeal the assessment decision if you think it is not fair?

7

Do you have any special needs that we need to adjust for during this assessment?

Y

N

Candidates Name:

Unit:

CHCCCS011 Meet personal support needs

Assessors Name:

Date of assessment:

Observation Assessment Instructions:

Read the scenario that typifies what occurs in an Aged Care Facility. When you believe you understand the scenario, you will be asked to role play this with your fellow students.

Your assessor will provide you with further instructions prior to carrying this assessment

You must demonstrate appropriate behaviours to all the tasks to achieve a satisfactory result for this assessment. Refer to the observation sheet to get an understanding of what is required

If you do not achieve this you will be asked to re do the task

You should be able to complete this role play in 15 minutes

Aged Care Facility

Nursing Care Plan

Name:

Robert

Surname:

Smith

DOB

12/11/1945

Section

C

Room No

13; BED : 1

MRN/CRN

100434312

Diabetic

Communication

Preferred name: Mr Smith

Care needs: Visual impairment

Goal: (expected outcome) Effective vision is maintained

Vision

Hearing

Aids

glasses magnifying glasses

Clean and fit glasses daily

Prompt to clean own glasses

Aids

hearing aids ( right /left ) Adjust volume daily

Check batteries and clean aids daily

Place objects in range of vision

Read aloud menus/letters/documents

Gain attention before speaking Speak loudly, clearly and directly Allow extra time for response

Give step-by-step instructions

Assist to write

Assist to use telephone

Use repetition when difficulty persists

Other

Other

Eye care required Observe for eye discharge

Ear care required

Speech and language

Comprehension issues (For example: inappropriate responses)

Language/s spoken English

Orientate Mr Smith to time and place

Speech disorder/s

Translate for resident Take time to listen Initiate conversation Use language cards

Use picture cards

Other

Mobility

Care needs: Impaired mobility

Goal: (expected outcome) To maintain safe movement

Ambulation (walking)

Transfers

ambulant (able to walk) non-ambulant (unable to walk)

independent weight bearing (able to stand) non-weight bearing (unable to stand)

1-staff assist 2-staff assist

hip replacement knee replacement amputee ( left right )

Aids

walking stick Zimmer frame

wheelchair quad stick

wheeled walker

Aids

bed rail slide sheet gait belt hoist standing hoist

Hoist sling type and position of loop

Other

Other

Provide direction Supervise movement

Encourage to maintain mobility

Other

Toileting and continence

Care needs: Urinary incontinence

Continence

Bladder control

continent incontinent catheter ( occasionally frequently total incontinence )

Bladder management

fluid balance chart toilet (times 0800 1200 1600 2000 )

Other Prefers male care worker with toileting assistance

Bowel control

continent incontinent constipation colostomy ( occasionally frequently total incontinence )

Bowel management

high fibre diet encourage fluid intake aperients bowel chart

Continence aids

Day

Night

Toileting

Toileting aids

commode urinal Uridome kylie bed pan

Other Urinal to be used at night

Toileting regime

independent supervise some assistance/prompt fully assist Adjust clothing Position on toiletEncourage self-care Clean perianal area

Other Prefers male care worker to assist with toileting

Showering, dressing and grooming

Care needs: Inability to manage own shower and dressing

Goal: (expected outcome) To maintain optimum hygiene levels

Shower and washing

independent supervise some assistance/prompt fully assist shower bath spa bath bed sponge flannel wash Frequency Daily Preferred time 0800

Adjust water temperature Encourage to optimise self care

Other Prefers male care worker for showering assistance

Transfer

walk to shower wheelchair Other :Pelican Belt

Showering aids

bath trolley shower chair Other

Toiletries

normal soap deodorant aqueous cream moisturiser ( am 8pm )

Other

Hair care

wash in shower wash in bath Preferred days: 2^nd daily

Dressing and undressing

independent supervise some assistance/prompt fully assist

callipers splints Other

Cultural dressing

N/A

Dressing assistance

bra singlet buttons belt zips stockings socks jewellery make-up shoes

Assist with selecting clothing Other

Grooming

Hair care

independent supervise some assistance/prompt fully assist

Hairdresser

Facial hair wet shave dry shave Frequency Daily

Hair removal Frequency

Nail/foot care

independent supervise some assistance/prompt fully assist

Podiatry visits 6 weekly. Do not cut nails RN or podiatrist only

Teeth

none some ( upper lower ) all

Cleaning routine Toothbrush and paste: in morning after breakfast, in evening before bed

Dentures

none partial full ( upper lower ) Night in out

Cleaning routine

Pressure area and skin care

Care needs:

Goal: (expected outcome)

Norton Scale

Score [ ] low risk [ ] medium risk [ ] high risk

Pressure relief aids

bed cradle sheepskin cushion bedrail/protectors Other

Pressure area regime

Reposition in bed Reposition in chair Frequency

special mattress (type ) personal chair

Other/specific orders

Skin care

emollient cream to dry skin areas ( daily twice daily ) Preferred time/s 2000

Eating and drinking

Care needs: To maintain blood sugar at optimal levels

Goal: (expected outcome) Blood sugar levels will be within normal range for Mr Smith

Eating

independent supervise some assistance/prompt fully assist

right-handed left-handed

Preferred place to eat

dining room bedroom Other

Type of diet

normal soft modified soft (minced) puree

Special diet

high fibre diabetic enteral feeding (PEG/NGT)

Special instructions

Aids

modified crockery modified cutlery bowl lipped plate

built up cutlery clothing protector Other

Drinking

independent supervise some assistance/prompt fully assist

right-handed left-handed

Aids

modified cup clothing protector

Thickened fluids

level 1 level 2 level 3

Type of thickener to be used

Sleep and settling routines

Care needs:

Goal: (expected outcome)

Usual time to rise 0700 Usual time to bed 2030 Rest time ( am 1pm

)

Preferred sleeping position Pillows required

Sleep Aids

massage music hot packs Other

Room

light on door open door closed bedrail/protectors Other

Night-time patterns

Other preferences (For example: hot drinks or

snacks)

Night checks

every hour every 2 hours Other

Specialised care plans

Refer to specialised care plans for

[X] Medications [ ] Pain management [ ] Wound care

[ ] Therapy [ ] Restraint management

Social and human needs/activities

Care needs:

Goal: (expected outcome)

Frequency of visit/contact by family/friends Family visit every weekend. Frequent visits by friends intermittently during the week also.

Religion beliefs/practices Anglican

Pastoral requirements Attends place of worship (attends Anglican service at Care Plus Aged Care Facility)

Cultural needs

Hobbies/interests Reading, chess, classical music Employment history Retired Bank Manager

Behaviour

Care needs: Episodes of short term memory loss and confusion related to diagnosis of dementia

Goal: (expected outcome) To reduce periods of confusion

Forgets meal times

Orientate Mr Smith to time and place Gain attention before speaking Speak loudly, clearly and directly Allow extra time for response

Give step-by-step instructions

Use repetition when difficulty persists

Additional comments (For example: special needs, restraint, routines, pain, palliative care, pacemaker)

Terminal care recorded Yes No

Date care plan evaluated (document in progress notes)

Signature

Interventions current and effective, nil changes made to care plan

Date: /. /.

Care Plus Aged Care Facility use only

Entered in progress notes

Date

Signed

Review date every 3 months

Print name

Position title

Hand washing (Knowledge & Skills Demonstration)

Instructions for demonstration

You are required to demonstrate the correct hand washing technique, in accordance with infection control and organisational procedures.

Materials and equipment

Hand basin, Paper towel dispenser & cleansing agent as per organisational procedures

Observation

During the demonstration of skills, did the candidate:

Yes

No

Assessors Comments

Organise the equipment and environment?

o

o

Remove all jewellery from hands and/or wrists

o

o

Turn taps on, and adjust water temperature and flow rate?

o

o

Wet hands and wrists prior to applying cleansing solution?

o

o

Ensure hands are positioned higher than the elbow and fingers upwards at all times?

o

o

Apply a generous amount of cleansing agent?

o

o

Lather soap using a rotary motion on hands for 30 seconds?

o

o

Wash back and front of both hands?

o

o

Clean between and around each individual finger?

o

o

Clean each fingernail?

o

o

Ensure wrists were the last part to be cleansed before rinsing?

o

o

Avoid touching sink or taps throughout procedure?

o

o

Rinse hand and wrists thoroughly ensuring hands are above elbows at all times?

o

o

Turn off tap without contaminating hands

o

o

Pat hands completely dry with paper towel in a downward motion from fingertips to wrists to avoid recontamination of hands & wrists?

o

o

Discard towel appropriately?

o

o

The candidates overall performance met the required standard:

Yes

q No q

ORAL ASSESSMENT Answered Appropriately:

Yes

No

Why do you wash your hands? Assessor to note answer given:

o

o

Comments/observations/feedback:

Student signature:

Assessor signature:

Date:

MANUAL HANDLING: USE OF A MECHANICAL LIFTER (KNOWLEDGE & SKILLS DEMONSTRATION)

Instructions for demonstration

Materials and equipment

Mechanical lifter (also known as Stand Aid lifter, pixel lifter, &/or patient hoist), Patient, Bed, Chair, and assistant if required.

PLEASE INDICATE TYPE OF MECHANICAL LIFTER USED:

Observation

During the demonstration of skills, did the candidate:

Yes

No

Assessors Comments

Check client care plan and select appropriate lift type?

o

o

Explain how you identify the appropriate sling to use

o

o

Use an assistant at all times throughout the procedure?

o

o

Wash hands as per infection control procedures?

o

o

Introduce himself or herself to the client?

o

o

Organise equipment & ensure surrounding environment is uncluttered?

o

o

Explain the procedure to the client &/or assistant?

o

o

Ensure the client has given consent to the procedure?

o

o

Provide privacy and dignity throughout the procedure?

o

o

Adjust the bed to the correct height before commencing?

o

o

Maintain Manual Handling principles at all times throughout the procedure; i.e. Bent knees, straight back, load close?

o

o

Check working order of lifter prior to lift?

o

o

Place the mechanical lifter sling on the client correctly?

o

o

Co-ordinate the transfer and instructions with the client & assistant throughout the procedure?

o

o

Respond to the clients needs

throughout the procedure?

o

o

Reassure client throughout the procedure?

o

o

Leave the client comfortable at the end of the procedure?

o

o

Wash hands according to infection control procedures?

o

o

Remove and store equipment appropriately on completion of the procedure?

o

o

Report any appropriate changes in

clients condition?

o

o

ORAL ASSESSMENT Answered appropriately: Yes No

1. Give an example of a mechanical lifting device other than the one you have used today, and give an example of a situation in which you would need to use it. Assessor to note answer given

q

q

2. Give an example of another situation where you might require the equipment you have used today? Assessor to note answer given

q

q

3. If you noticed the mechanical lifter was broken what would you do? Assessor to note answer given

q

q

The candidates overall performance met the required standard: Yes q No q

Comments/observations/feedback:

Student signature:

Assessor signature:

Date:

Showering (Knowledge & Skills Demonstration)

Instructions for demonstration

Materials and equipment

Towels, clients clothing, face washer, toiletries, Shower cubicle, commode chair (if applicable), and personal items.

Observation

During the demonstration of skills, did the candidate:

Yes

No

Assessors Comments

Check client care plan for client capability and/or specific needs required?

o

o

Wash hands as per infection control procedures?

o

o

If there is a risk of exposure to bodily fluids wear gloves, wash hands, and remove waste as per infection control policy?

o

o

Introduce himself or herself to the client and explain status (i.e. AIN)?

o

o

Organise appropriate equipment?

o

o

Explain the procedure to the client?

o

o

Ensure the client has given informed consent to the procedure?

o

o

Involve client in procedure through offering choice and encouraging independence throughout?

o

o

Provide privacy and dignity throughout the procedure?

o

o

Ask for assistance from another colleague if required for lifts or transfer as per Manual Handling policy?

o

o

Assist client to shower cubicle appropriately, whilst maintaining dignity and privacy?

o

o

Communicate appropriately with client throughout procedure?

o

o

Ensure water is at an appropriate temperature, and comfortable for resident before using?

o

o

Sets up client appropriately for shower?

o

o

Respond to the clients needs

throughout the procedure and maintain client safety at all times?

o

o

Ensure that independence was encouraged at all times?

o

o

Observe client for skin breakdown and reports any changes to appropriate person where applicable?

o

o

Shower client according to assistance required commencing from face and washing groin areas last?

o

o

Towel dry client completely before dressing as per assistance required?

o

o

Dress in appropriate clothing according to client choice, and weather conditions?

o

o

Allow resident to assist with own activities of daily living including grooming, brushing teeth/dentures, make-up?

o

o

Leave the client comfortable at the end of the procedure?

o

o

Wash hands according to infection control procedures?

o

o

Return &/or discard bed linen correctly and store client personal belongings & toiletries at end of the procedure?

o

o

Report any appropriate changes in

clients condition?

o

o

ORAL ASSESSMENT Answered Appropriately: Yes No

1. Why might you not leave a client alone in the shower? Assessor to note answer given.

q

q

2. A client who has suffered from a stroke is asking for the water to be hotter. When you check the water you notice that it is already really hot, and would possibly burn them if turned up. What is your response and why? Assessor to note answer given.

q

q

The candidates overall performance met the required standard: Yes q No q

Comments/observations/feedback

Student signature:

Assessor signature: Date:

Feeding a Resident

Instructions for demonstration

Observation

During the demonstration of skills, did the

candidate:

Yes

No

Assessors Comments

Review resident records to check type of

diet(i.e. Pureed, cutup etc) and level of assistance needed prior to commencement

o

o

Wash hands as per infection control procedures?

o

o

Introduce himself or herself to the resident?

o

o

Gives clear & relevant explanation to resident?

o

o

Positions resident appropriately?

o

o

Ensures residents clothing is protected appropriately?

o

o

Facilitates independent effort by the resident?

o

o

Places tray and food within easy reach (where appropriate)?

o

o

Ensures food temperature is appropriate

o

o

Sits with resident?

o

o

Paces procedure to suit resident?

o

o

Cuts food into bite size pieces (where appropriate diet type)

o

o

Leaves resident clean & tidy?

o

o

Re-positions resident appropriately?

o

o

Ends encounter appropriately?

o

o

Returns tray to mobile trolley or kitchen area?

o

o

Washes hands?

o

o

Report observations to RN?

o

o

Documents accurately in resident notes

o

o

ORAL ASSESSMENT Answered Appropriately: Yes No

1. Why is it important that a clients fluid and nutritional intake are

monitored daily? Assessor to note answer given.

q

q

2. How can you encourage fluid/food intake? Assessor to note answer given.

q

q

3. If a residents family member or carer asked you if they could feed

them, how would you respond? Assessor to note answer given.

q

q

The candidates overall performance met the required standard: Yes q No q

Comments/observations/feedback:

Student signature:

Assessor signature: Date:

Continence Assessment Chart

Continence Record

Resident name/ID

Facility ID

ACFI appraiser identification details

Appraiser name

Appraiser profession

Signature

Date

Code Description

1 incontinent of urine

2 Pad change for incontinence of urine

3 Pad has increased wetness

4 Passed urine during scheduled toileting

5 Incontinent of faeces

6 Pad change for incontinence of faeces

7 bowel open during scheduled toileting

Hour Starting @

Urinary Record Date

Hour starti ng @

Bowel Record Date

0600

/ /

/ /

/ /

0600

/ /

/ /

/ /

/ /

/ /

/ /

0700

0600

0700

0800

0700

0800

0900

0800

0900

1000

0900

1000

1100

1000

1100

1200

1100

1200

1300

1200

1300

1400

1300

1400

1500

1400

1500

1600

1500

1600

1700

1600

1700

1800

1700

1800

1900

1800

1900

2000

190

0

2000

2100

200

0

2100

2200

210

0

2200