OIDD Weekly Supervision Form R3 #1

OIDD Weekly Supervision Form
Support Coordinator's Name
Support Coordinator's Email
example@example.com
Supervisor's Name
Supervisor's email
example@example.com
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Annual Plan of Care Tracking

Review and put participant specific updates into the tracking chart.
Week under review?
Enter the Monday to Friday week being reviewed in the section below.
Number of plans due to supervisor this week?
Number of plans submitted late to supervisor this week.
Number of plans submitted late for approval, payment was lost.
These are only plans that are late due to SC, provider documents late, 90L late, etc. If a participant is in a group home, closing, or nursing home do not include them in this count.
Comments:
Use this section to provide any clarifications that will be relevant when reviewing for SC evaluation.
Initial Plan of Care Tracking
Total number of linkages assigned to SC
How many of these linkages require an exception request for the next waiver tier?
Total number of linkages due this week according to waiver policy?
Total number of linkages past due according waiver policy?
Total number of new linkages received this week?
Critical Incident Tracking

Upload CIR reports being reviewed
Total number of open Critical Incident Reports
CIR Review, each open CIR should be reviewed below
SCAR review

Attach the SCAR report reviewed during supervision
Total number of Criteria not met this week
Total number of participants on no PA list
Total number of participants pending closure
Children's Choice Bi-annual visits
Comments:
include any guidance, directives, etc. given during supervision
Revision requests
Revision Request
SCAR Upload

Upload the SCAR report reviewed in supervision
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Support Coordinator Calendar Review

SC should be using google calendar
Total number of quarterly meetings scheduled for current week?
Total number of annual meetings scheduled for the current week?
Total number of team meetings or other meetings held for the current week?
things like revision signatures, emergency meetings, etc.
Payolicy Overview

The following sections can be found in Paylocity
Support Coordinator Training review

Log into Paylocity, search for SC. Go to Career tab. Select Learning under the Career tab.
How many trainings assigned for this quarter are pending?
How many trainings assigned for this quarter are complete?
Are there any past due trainings?
List any past due trainings, if none place NA in the name section. Supervisor please explain to the SC that by not completing training timely they are out of licensing complaince and can result in disciplinary action.
Time Card Review

In this section review the SC time card to ensure time cards are being completed on a regular basis.
Does SC have time entered for the previous week?
Are there any errors that need to be corrected on the time card?
Does the SC have any pending time off request
If there are time off requests, has the Program Director been notifed if the PD completes time off requests? If the supervisor approves time off requests has the supervisor approved requests, discussed requests with PD, provided feedback to SC about requests?
If no request write NA
If supervisor approves time off request, have these request been added to SC and supervisor's or office time off calendar?

Other
Supervisor Coaching, Concerns, and Shout outs
Coaching and Concerns: In this section, note any areas of concern and provide coaching/training needs. List an additional trainings required or requested Attach any emails sent during the week.
Programmatic/technology concerns: Updates on program and technology changes. What's going wrong/right?
Support Coordinator Shout outs: Every week tell your SC what they did well no matter how small, every accomplishment should be celebrated. Be sure to add in ways they went above and beyond. Attach any shout out emails you sent this week.
Here you can upload any supporting documentation for disciplinary action, SC shout outs, ISR follow up requests, etc.

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Supervisor's Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Support Coordinator Certification of Supervision

I certify that the information provided above during waiver supervision is accurate and complete to the best of my knowledge.
Support Coordinator's Signature
This area is to upload any files that may not be included in any other sections

Cancelof
Should be Empty:

OIDD Weekly Supervision Form

Annual Plan of Care Tracking

Initial Plan of Care Tracking

Critical Incident Tracking

SCAR review

Revision requests

Support Coordinator Calendar Review

Payolicy Overview

Support Coordinator Training review

Time Card Review

Supervisor Coaching, Concerns, and Shout outs