<p>Enham Trust</p><p>Care and Support at Home</p><p>Assessment Pack Enham Trust</p><p>Care and Support at Home</p><p>Assessment </p><p>Date: Current Photo of Service User Full Name: Preferred form of address: Date of Birth: Current Home Address:</p><p>Telephone: Nature of Impairment:</p><p>Marital Status: No of Children: N.I Number: Religion: Ethnicity: Next of Kin: Address:</p><p>Telephone:</p><p>Main Carer Name: Address:</p><p>Tel No.</p><p>Family Details How many brothers/sisters do you have? Do you live with your family? Yes/No If not, where do you live? </p><p>Are your family supportive of your plans/wishes etc?</p><p>1 Any other useful information:</p><p>Parents: Address:</p><p>Tel No:</p><p>Brother/Sister: Address:</p><p>Tel No:</p><p>Brother/Sister: Address:</p><p>Tel No:</p><p>Friend or Advocate Name: Address:</p><p>Tel No.</p><p>Do you have in place a Lasting Power of Attorney: Yes/No Do you have in place an Enduring Power of Attorney: Yes/No</p><p>GP: Address:</p><p>Tel: Fax:</p><p>Name & Address of Social Services:</p><p>Admitted from: Referred by: Name of Social Services Care Manager: Address:</p><p>Tel: Fax:</p><p>Details of other professional/agencies involved: Name: Name: Address: Address:</p><p>2 Tel: Tel</p><p>Key worker: Designation: Date: </p><p>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</p><p>Ability to self-medicate? Yes / No</p><p>Risk Factors:</p><p>Education: Name of Secondary Dates Qualifications obtained, School/College, ERC Training From To examinations passed. Centre etc</p><p>Employers/Community Dates Brief description of post and Programmes/ Work From To duties and reason for leaving. Experience/YTS Name and Town</p><p>Name and Town</p><p>Name and Town</p><p>3 Brief history and other information about yourself.</p><p>Self – Picture/Self – Assessment How would you describe yourself/your character?</p><p>What is your understanding of your impairment/disability and how do you feel this affects you?</p><p>Can you direct your care? (Please attach Care Management and Moving and Handling Plans)</p><p>What skills/abilities/talents do you have?</p><p>Hobbies and Interests: What particularly hobbies and interests do your have?</p><p>4 Are you a member of any clubs/associations?</p><p>Interests and Experience: Have you attended any previous assessment programmes? If so when?</p><p>Where did this assessment take place?</p><p>What was the outcome of the assessment?</p><p>5 Guidelines for Compiling Strengths and Needs Assessments</p><p>1. Carry out your assessment through user consultation, professional observation, objective interpretation. 2. 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. 3. Filter the information you gather and leave unnecessary information out. 4. This list is not exhaustive, additions are welcome…..</p><p>The areas of our assessments should include the following items. 1. MOBILITY -general mobility -use of stairs -use of special aids -uses of wheelchair -transferring -use of hoists, slides, etc (electric/manual) -getting in/out of -Road safety -use of public transport bed/chair -balance -driver/passenger of car 2. MOTOR SKILLS -dexterity -fine motor skills (fingers) -gross motor skills -co-ordination 3. ASPECTS OF PERSONAL CARE -shaving -bathing/showering -washing -dressing/undressing -cleaning teeth/dentures -toileting -putting on make-up -choice of clothes -cleaning of glasses -personal grooming -use of aids -use of shower chair 4. ASPECTS OF MEDICAL CARE -prescribed cream/other -medical conditions -prescribed medication -security measures -self administration -administration by staff -ordering of medication -where kept controlled drugs -escort needs for appointments 5. LIFE SKILLS -cooking oven/microwave -washing up -tidying up -dusting -mopping floors -hoovering -cleaning surfaces -cleaning fridges -defrosting freezer -use of washing machine -use of tumble drier -sorting clothes -dealing with electrical appliances -amount of support and -use of any aids supervision needed</p><p>6. EATING AND DRINKING -use of a straw -use of plate -use of other aids -cut up food -texture -special diets -food allergies -chewing/swallowing -speech therapy needs 7. SOCIAL SKILLS/ - relationships/sexuality -introverted INTERACTION -interaction in group -challenging behaviour -interaction with one person -dealing with isolation -art/drama school input -extrovert/introvert -aids needed for - ability to use transport</p><p>6 -aggressive behaviour interaction 8. COMMUNICATION -verbal communication -makaton - British sign language -use of light writer/aids -other - literacy skills -numerical skills signs/symbols/sounds - comprehension -‘key-word-communicator’ -understanding of - correspondence complex communications -assertiveness 9. EMOTIONAL STABILITY -emotional balance -anxieties -depressive episodes -dealing with stress -dealing with isolation -challenging behaviour -aggressive behaviours -is the person shy, withdrawn, etc 10. FINANCIAL SKILLS -understanding of value of -budgeting small amounts money (up to £30-) -budgeting bigger amounts (£30- -managing DSS, DLA etc +) -dealing with bills/rent/etc 11. LEISURE ACTIVITIES -spontaneity -pro-active -own initiative -participation on offered -routines -hobbies activities -encouragement needed -time management 12. NIGHT-TIME SUPPORT -support required through -medication required -sleeping difficulties the night. </p><p>13. ORIENTATION -finding your way around - managing time -knowledge of your surroundings 14. CULTURAL -knowledge of background -special events, -birthdays, anniversaries 15. RELIGIOUS BELIEFS -practising religion -religious events -attendance of churches. -special needs i.e. diet mosques, synagogue etc etc.</p><p>7 Strengths & Needs Assessment</p><p>Name Birth Date</p><p>MY STRENGTHS MY NEEDS THINGS WHERE I DO NOT REQUIRE THINGS WHERE I WOULD REQUIRE SUPPORT STAFF SUPPORT 1. MOBILITY 1. MOBILITY</p><p>*Please remember to attach a copy of your Moving and Handling Plan</p><p>8 MY STRENGTHS MY NEEDS 2. MOTOR SKILLS 2. MOTOR SKILLS </p><p>MY STRENGTHS MY NEEDS 3. ASPECTS OF PERSONAL CARE 3. ASPECTS OF PERSONAL CARE</p><p>9 MY STRENGTHS MY NEEDS 4. ASPECTS OF MEDICAL CARE 4. ASPECTS OF MEDICAL CARE</p><p>MY STRENGTHS MY NEEDS 5. LIFE SKILLS 5. LIFE SKILLS</p><p>10 MY STRENGTHS MY NEEDS 6. EATING & DRINKING 6. EATING & DRINKING</p><p>MY STRENGTHS MY NEEDS 7. SOCIAL SKILLS/INTERACTION 7. SOCIAL SKILLS/INTERACTION</p><p>11 MY STRENGTHS MY NEEDS 8. COMMUNICATION 8. COMMUNICATION</p><p>MY STRENGTHS MY NEEDS 9. EMOTIONAL STABILITY 9. EMOTIONAL STABILITY</p><p>12 MY STRENGTHS MY NEEDS 10. FINANCIAL SKILLS 10. FINANCIAL SKILLS</p><p>MY STRENGTHS MY NEEDS 11. LEISURE ACTIVITIES 11. LEISURE ACTIVITIES</p><p>13 MY STRENGTHS MY NEEDS 12. NIGHT-TIME SUPPORT 12. NIGHT-TIME SUPPORT</p><p>MY STRENGTHS MY NEEDS 13. ORIENTATION 13. ORIENTATION</p><p>14 MY STRENGTHS MY NEEDS 14. CULTURAL 14. CULTURAL</p><p>MY STRENGTHS MY NEEDS 15. RELIGIOUS BELIEFS 15. RELIGIOUS BELIEFS</p><p>15 MY STRENGTHS MY NEEDS ADDITIONAL INFORMATION</p><p>Signature Service User</p><p>Date</p><p>Signature Key Worker </p><p>Date</p><p>Date of review of this document</p><p>16 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.</p><p>Overhead hoist (please put in type) ………………………………………………..</p><p>…………………………………………………………………………………………..</p><p>Manual hoist (please put in type)……………………………………………………</p><p>…………………………………………………………………………………………..</p><p>Slings: (please put in type and number) …….……………………………………..</p><p>…………………………………………………………………………………………..</p><p>Bed: (please put in type of bed ie adjustable, profiling) ……… … ……………..</p><p>…………………………………………………………………………………………..</p><p>Bumpers/Wedges/Bed rails: ……………………………….………………………</p><p>…………………………………………………………………………………………..</p><p>Shower/toileting chair: …..…………………………………………………………..</p><p>…………………………………………………………………………………………..</p><p>Eating/Drinking equipment/Specialist cutlery: …………………………………..</p><p>…………………………………………………………………………………………..</p><p>Wheelchair/s/Chargers (please note type): ….…………………………………..</p><p>…………………………………………………………………………………………..</p><p>…………………………………………………………………………………………..</p><p>Access/Exit adaptations to building/flat:: .. ………………………………………..</p><p>…………………………………………………………………………………………..</p><p>…………………………………………………………………………………………..</p><p>17 …………………………………………………………………………………………..</p><p>18 Aidcall equipment/adaptations: (to summon assistance) ………………………..</p><p>…………………………………………………………………………………………..</p><p>…………………………………………………………………………………………..</p><p>Communication equipment/aids/adaptations: ……………………………………..</p><p>…………………………………………………………………………………………..</p><p>…………………………………………………………………………………………..</p><p>Sensory equipment/adaptations: …………………………………………………..</p><p>…………………………………………………………………………………………..</p><p>…………………………………………………………………………………………..</p><p>Any other equipment/adaptations not noted above: ……………………………</p><p>…………………………………………………………………………………………..</p><p>…………………………………………………………………………………………..</p><p>…………………………………………………………………………………………..</p><p>…………………………………………………………………………………………..</p><p>DEVELOPMENT ACTIVITIES:</p><p>Please note any specialist adaptations/software applications that you currently use and find helpful in your day to day learning and development/work activities:</p><p>…………………………………………………………………………………………..</p><p>…………………………………………………………………………………………..</p><p>…………………………………………………………………………………………..</p><p>…………………………………………………………………………………………..</p><p>…………………………………………………………………………………………..</p><p>…………………………………………………………………………………………..</p><p>…………………………………………………………………………………………..</p><p>…………………………………………………………………………………………..</p><p>19 Please note any special instructions regarding the use of any items of equipment below.</p><p>……………………………………………………………………………………</p><p>……………………………………………………………………………………</p><p>……………………………………………………………………………………</p><p>……………………………………………………………………………………</p><p>……………………………………………………………………………………</p><p>Please note who is responsible for replacement and/or maintenance of your equipment ie wheelchair</p><p>……………………………………………………………………………………</p><p>……………………………………………………………………………………</p><p>……………………………………………………………………………………</p><p>……………………………………………………………………………………</p><p>……………………………………………………………………………………</p><p>…………………………………………………………………………………..</p><p>……………………………………………………………………………………</p><p>……………………………………………………………………………………</p><p>……………………………………………………………………………………</p><p>……………………………………………………………………………………</p><p>20 HEALTH NEEDS</p><p>NAME:</p><p>Height & Weight</p><p>Medication</p><p>Eyesight</p><p>Hearing Impairments</p><p>Speech</p><p>Allergies</p><p>Dietary Requirements</p><p>Continence/Elimination</p><p>21 Sleep</p><p>Exercise</p><p>Mobility</p><p>Physiotherapy</p><p>Mental Health</p><p>Nature of Disability</p><p>Signed by:</p><p>KEYWORKER:</p><p>If you require detailed medical information, please contact the service user’s GP – see page 2 for contact details.</p><p>22</p>