OAC 173-39-02.12(F) · Supervisory Visit Documentation

Supervisory Visit Tracking Log

Dulla Care Home Healthcare

Maintained by the Operations Manager · Records audited every 60 days to ensure compliance

0

Total Visits Logged

0

Open Findings

0

Resolved Findings

0

Overdue Audits

Operations Manager

Audit Cycle

Log Date

Next 60-Day Audit Due

#Consumer
Name
Caregiver
Name
Service
Type
Visit
Date
Visit
Type
Supervisor
Name
Findings
(Observations)
Corrective
Action Taken
Follow-Up
Date
60-Day
Audit Status
Resolved?Notes
1—
2—
3—
4—
5—
6—
7—
8—
9—
10—

📋 60-Day Audit Protocol (Operations Manager)

  1. The Operations Manager conducts supervisory visits for each consumer/caregiver assignment per OAC 173-39-02.12(F) requirements.
  2. Each visit is documented in this log with: consumer name, caregiver name, visit type, date, supervisor name, findings, and any corrective actions taken.
  3. Records are audited by the Operations Manager every 60 days to ensure all required visits have been completed and documented.
  4. Visit records older than 60 days without a follow-up audit are flagged amber (approaching) or red (overdue) in the audit status column above.
  5. Any findings or deficiencies identified during a supervisory visit must have a documented corrective action with a follow-up date.
  6. Open findings are tracked until resolved — resolved findings are marked with a checkmark and retained for compliance review.
  7. This log is available for review by ODA, ODM, MCO auditors, or CMS upon request, and is retained for a minimum of 6 years.

Operations Manager Signature

Signature & Date

Administrator Approval

Signature & Date

Dulla Care Home Healthcare · Supervisory Visit Tracking Log · OAC 173-39-02.12(F) · 60-Day Audit Cycle · Confidential

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