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* 2. Rounding Date

Date
Time

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* 3. Name of team member conducting the round.

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* 4. Shift

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* 5. Units covered:

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* 6. PUPS "program & client schedules" accurate and being followed?

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* 7. Shift reports and shift assignments are complete, and huddles are being utilized throughout the shift as needed.

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* 8. Unit has the required staffing ratio (yes or no).

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* 9. Staff are actively engaged with clients.

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* 10. Staff are pleasant and polite (mood and morale are positive).

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* 11. Staff can identify the clients on precaution.

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* 12. Staff can verbalize what they would do if a client was thought to be increasing in risk.

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* 13. All staff have a working/charged two-way radio and are actively communicating with coworkers (yes or no).

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* 14. Observation sheet/log is current (does not contain missing or early entries).

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* 15. Unit leaders are actively engaged with clients and staff.

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* 16. Ukeru pads clean, accessible, and being used appropriately.

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* 17. Common areas (including kitchen) are clean, sanitary, and odor free with no safety hazards?

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* 18. Bedrooms are clean, sanitary and odor free with no safety hazards.

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* 19. Bathrooms are clean, sanitary and odor free with no safety hazards.

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* 20. The furniture is in good shape (free of damage and stains).

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* 21. Units have furnishings (wall hangings / decorations) that are tamper resistant, in good repair and appropriate.

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* 22. Are lights, appliances, and water fixtures all in good operating condition?

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* 23. Are there any holes, cracks or damages in the home that need attention? (if yes, please contact MMYTC Maintenance)

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* 24. Clients interviewed/observed (at least 1) - use client INITIALS. Also, do they know where the Grievance forms are kept, in the event they need one? Are Grievance resources posted and available? "Where Applicable"

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* 25. Staff interviewed/observed (at least 1). Also, in what ways do you incorporate clients' rights and education, specifically the Grievance procedure, into regular interactions or when needed?

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* 26. Name of supervisor any concerning findings were reported to.

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* 27. Describe any issues observed and the area in which they were observed.

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