Care and Support at Home

Enham Trust

Care and Support at Home

Assessment Pack

Enham Trust

Care and Support at Home

Assessment

Date: / Current Photo of Service User
Full Name:
Preferred form of address:
Date of Birth:
Current Home Address:
Telephone:
Nature of Impairment:
Marital Status: / No of Children:
N.I Number:
Religion:
Ethnicity:
Next of Kin:
Address:
Telephone:
Main Carer
Name:
Address:
Tel No.

Family Details

How many brothers/sisters do you have?
Do you live with your family? Yes/No If not, where do you live?
Are your family supportive of your plans/wishes etc?
Any other useful information:
Parents:
Address:
Tel No:
Brother/Sister:
Address:
Tel No:
Brother/Sister:
Address:
Tel No:
Friend or Advocate
Name:
Address:
Tel No.
Do you have in place a Lasting Power of Attorney: Yes/No
Do you have in place an Enduring Power of Attorney: Yes/No
GP:
Address:
Tel:
Fax:
Name & Address of Social Services:
Admitted from:
Referred by:
Name of Social Services Care Manager:
Address:
Tel:
Fax:
Details of other professional/agencies involved:
Name: / Name:
Address: / Address:
Tel: / Tel
Key worker: Designation:
Date:
Do you have a Health Action Plan in Place? Yes/No
If Yes, please attach a copy
Current Prescribed Medication and Usual times of Administration
Prescribed by: AM / M/D / EVE / N
Ability to self-medicate? Yes / No
Risk Factors:

Education:

Name of Secondary School/College, ERC Training Centre etc / Dates
From To / Qualifications obtained, examinations passed.
Employers/Community Programmes/ Work Experience/YTS / Dates
From To / Brief description of post and duties and reason for leaving.
Name and Town
Name and Town
Name and Town
Brief history and other information about yourself.

Self – Picture/Self – Assessment

How would you describe yourself/your character?
What is your understanding of your impairment/disability and how do you feel this affects you?
Can you direct your care?
(Please attach Care Management and Moving and Handling Plans)
What skills/abilities/talents do you have?

Hobbies and Interests:

What particularly hobbies and interests do your have?
Are you a member of any clubs/associations?

Interests and Experience:

Have you attended any previous assessment programmes?
If so when?
Where did this assessment take place?
What was the outcome of the assessment?

Guidelines for Compiling Strengths and Needs Assessments

Carry out your assessment through user consultation, professional observation, objective interpretation.
The compiled strengths and needs assessment should reflect a positive and holistic approach towards the individual service user, and not categorise, label or stigmatise the individual. It should also respect the service user’s dignity and privacy and include their full involvement.
Filter the information you gather and leave unnecessary information out.
This list is not exhaustive, additions are welcome…..

The areas of our assessments should include the following items.

1. MOBILITY
-general mobility
-uses of wheelchair (electric/manual)
-use of public transport / -use of stairs
-transferring
-getting in/out of bed/chair
-driver/passenger of car / -use of special aids
-use of hoists, slides, etc
-Road safety
-balance
2. MOTOR SKILLS
-dexterity
-co-ordination / -fine motor skills (fingers) / -gross motor skills

ASPECTS OF PERSONAL

CARE
-bathing/showering
-cleaning teeth/dentures
-choice of clothes
-use of aids / -washing
-toileting
-cleaning of glasses
-use of shower chair / -shaving
-dressing/undressing
-putting on make-up
-personal grooming

ASPECTS OF MEDICAL

CARE
-medical conditions
-self administration
-where kept
-escort needs for appointments / -prescribed medication
-administration by staff
controlled drugs / -prescribed cream/other
-security measures
-ordering of medication
5. LIFE SKILLS
-cooking oven/microwave
-dusting
-cleaning surfaces
-use of washing machine
-dealing with electrical appliances
-use of any aids / -washing up
-mopping floors
-cleaning fridges
-use of tumble drier
-amount of support and
supervision needed / -tidying up
-hoovering
-defrosting freezer
-sorting clothes

6. EATING AND DRINKING

-use of a straw
-cut up food
-food allergies / -use of plate
-texture
-chewing/swallowing / -use of other aids
-special diets
-speech therapy needs

SOCIAL SKILLS/

INTERACTION
-interaction with one person
-extrovert/introvert
-aggressive behaviour / - relationships/sexuality
-interaction in group
-dealing with isolation
-aids needed for
interaction / -introverted
-challenging behaviour
-art/drama school input
- ability to use transport
8. COMMUNICATION
-verbal communication
-use of light writer/aids
-numerical skills
-‘key-word-communicator’ / -makaton
-other signs/symbols/sounds
-understanding of complex communications
-assertiveness / - British sign language
- literacy skills
- comprehension
- correspondence
9. EMOTIONAL STABILITY
-emotional balance
-dealing with stress
-aggressive behaviours / -anxieties
-dealing with isolation
-is the person shy, withdrawn, etc / -depressive episodes
-challenging behaviour
10. FINANCIAL SKILLS
-understanding of value of
money
-budgeting bigger amounts (£30- +)
-dealing with bills/rent/etc / -budgeting small amounts (up to £30-)
-managing DSS, DLA etc

11. LEISURE ACTIVITIES

-spontaneity
-participation on offered
activities
-time management / -pro-active
-routines
-encouragement needed / -own initiative
-hobbies

12. NIGHT-TIME SUPPORT

-sleeping difficulties / -support required through the night. / -medication required

13. ORIENTATION

-finding your way around
-knowledge of your surroundings / - managing time

14. CULTURAL

-knowledge of background / -special events,
-birthdays, anniversaries

15. RELIGIOUS BELIEFS

-practising religion
-attendance of churches. mosques, synagogue etc / -religious events
-special needs i.e. diet etc.

Strengths & Needs Assessment

Name

Birth Date

MY STRENGTHS / MY NEEDS

Things where I do not require support

Things where I would require staff support

1. MOBILITY

*Please remember to attach a copy of your Moving and Handling Plan

MY STRENGTHS / MY NEEDS
2. MOTOR SKILLS / 2. MOTOR SKILLS
MY STRENGTHS / MY NEEDS
3. ASPECTS OF PERSONAL CARE /

3. ASPECTS OF PERSONAL CARE

MY STRENGTHS / MY NEEDS
4. ASPECTS OF MEDICAL CARE /

4. ASPECTS OF MEDICAL CARE

MY STRENGTHS / MY NEEDS

5. LIFE SKILLS

MY STRENGTHS / MY NEEDS
6. EATING & DRINKING / 6. EATING & DRINKING
MY STRENGTHS / MY NEEDS
7. SOCIAL SKILLS/INTERACTION / 7. SOCIAL SKILLS/INTERACTION
MY STRENGTHS / MY NEEDS
8. COMMUNICATION /

8. COMMUNICATION

MY STRENGTHS

/ MY NEEDS

9. EMOTIONAL STABILITY

/ 9. EMOTIONAL STABILITY
MY STRENGTHS / MY NEEDS
10. FINANCIAL SKILLS /

10. FINANCIAL SKILLS

MY STRENGTHS / MY NEEDS
11. LEISURE ACTIVITIES / 11. LEISURE ACTIVITIES
MY STRENGTHS / MY NEEDS
12. NIGHT-TIME SUPPORT / 12. NIGHT-TIME SUPPORT
MY STRENGTHS / MY NEEDS
13. ORIENTATION / 13. ORIENTATION
MY STRENGTHS / MY NEEDS
14. CULTURAL / 14. CULTURAL
MY STRENGTHS / MY NEEDS
15. RELIGIOUS BELIEFS / 15. RELIGIOUS BELIEFS
MY STRENGTHS / MY NEEDS

ADDITIONAL INFORMATION

Signature Service User

Date

Signature Key Worker

Date

Date of review of this document

EQUIPMENT: Please list below any equipment you use regularly to meet your needs:

i.e: Overhead hoist, slings (what type), manual or electronic wheelchair,

eating/drinking equipment, equipment to assist with personal care needs, etc.

Overhead hoist (please put in type) ………………………………………………..

…………………………………………………………………………………………..

Manual hoist (please put in type)……………………………………………………

…………………………………………………………………………………………..

Slings: (please put in type and number) …….……………………………………..

…………………………………………………………………………………………..

Bed: (please put in type of bed ie adjustable, profiling) ……… … ……………..

…………………………………………………………………………………………..

Bumpers/Wedges/Bed rails: ……………………………….………………………

…………………………………………………………………………………………..

Shower/toileting chair: …..…………………………………………………………..

…………………………………………………………………………………………..

Eating/Drinking equipment/Specialist cutlery: …………………………………..

…………………………………………………………………………………………..

Wheelchair/s/Chargers (please note type): ….…………………………………..

…………………………………………………………………………………………..

Access/Exit adaptations to building/flat:: .. ………………………………………..

…………………………………………………………………………………………..

Aidcall equipment/adaptations: (to summon assistance) ………………………..

…………………………………………………………………………………………..

Communication equipment/aids/adaptations: ……………………………………..

…………………………………………………………………………………………..

Sensory equipment/adaptations: …………………………………………………..

…………………………………………………………………………………………..

Any other equipment/adaptations not noted above: ……………………………

…………………………………………………………………………………………..

DEVELOPMENT ACTIVITIES:

Please note any specialist adaptations/software applications that you currently

use and find helpful in your day to day learning and development/work activities:

…………………………………………………………………………………………..

Please note any special instructions regarding the use of any items of equipment below.

……………………………………………………………………………………

Please note who is responsible for replacement and/or maintenance of your equipment ie wheelchair

……………………………………………………………………………………

…………………………………………………………………………………..

……………………………………………………………………………………

HEALTH NEEDS

NAME:

Height & Weight

Medication

Eyesight

Hearing Impairments

Speech

Allergies

Dietary Requirements

Continence/Elimination

Sleep

Exercise

Mobility

Physiotherapy

Mental Health

Nature of Disability

Signed by:
KEYWORKER:

If you require detailed medical information, please contact the service user’s GP – see page 2 for contact details.