Applicant's first name:
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Home Address:
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Applicant's surname:
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Buddies preferred name: This may be your full name or a version / identification you have.
Age:
Gender identification: When we use pronouns like “she” or “he” to identify a person without asking them what pronouns they use, we may be making an assumption about that person’s gender that differs from their gender identity. Some people express their gender in a non-binary way and use pronouns such as they/them or ze/hir/hirs. People who look to be one gender to you may identify as another gender.
Service users Gender preference for personal care: To protect the dignity of our Buddies and respect their needs and wishes, they may, or may not, prefer same sex staff to support them with personal care
Responsible adult care worker / social worker: Name, telephone, team
What is important for me and my health - how to keep me safe: Please list all important information you need Buddies to know about you and your health conditions, if any, so we can keep you safe and respond appropriately i.e. insulin, rescue meds, response to bites and insect stings.
What is most important to me: This could be your values, spirituality/religion, ethnicity, culture, pets, people, goals and aspirations. What things do you do to entertain yourself, music, leisure activities, gaming, puzzles etc.
People who are important to me: Think about how you want the people important to you to be involved in your care and support.
Please do and please don't: This should include as many things as you wish to include. What to help and encourage me with, reminding me about things I need to do or want to achieve. How to talk to me and how I process information.
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What support services are presently being accessed or provided: Please let us know of any services currently attended and any previous services. You may wish to add why these are not giving the full range of support and outcomes you would want or expect
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Local authority assessment: Copy of the details recorded by carers in assessment of needs
Lead professionals views: Copy of lead professionals statement
Initial assessment of care needs:
Communication, sensory needs: How I communicate and how to communicate with me
Physical health and well-being: I am supported to stay well, and all my health needs are regularly looked at.
Personal Care: I am supported with toileting, washing, drying and keeping myself clean and tidy
Adults at risk: I am supported to stay safe from all forms of abuse
Hot Surfaces: I am supported around the kitchen and other areas where there are hot surfaces, to understand the risks and avoid harm
Eating & drinking: I am supported by staff who will help me manage size, consistency, chewing and swallowing. They will also assist me to drink at an appropriate time to reduce any risk of choking or aspiration.
Fire safety: I am supported by staff who will help me in the event of an emergency. I have a PEEP
Mental health: People understand my mental health condition and needs and help me to understand some of the noise in my head
Medication: I take my medication at the correct time
Mobility, dexterity, slips, trips and falls: I am safe and secure when moving around in the centre and when out in the community. Staff are aware of my needs and ensure that I can move around without undue risk of hazards.
Manual Handling: Staff understand my needs around manual handling and are trained to assist me with dignity and respect and ensuring I am safe at all times.