ࡱ> 7 Z;bjbjUU e7|7| Ml    !!!t"@#I %&F-(n-n-n-./Lc/(GX$; [^Ο5/}..//Ο-5  n-n--5-5-5/, Rn-n-G-5/G-5 -5E>r"E>n-% `o;!4vE>E>d 0IE>-5E>-5<Tr     Community Care Review/Re-Assessment for People Living in Residential/Nursing Home Care BASIC DETAILSFamily Name:  FORMTEXT      First Name:  FORMTEXT      Swift #:  FORMTEXT      DOB:  FORMTEXT      Ethnicity: % FORMDROPDOWN Religion: %  FORMDROPDOWN Review Completed By:  FORMTEXT       Type of Review: %  FORMDROPDOWN Job Title: %  FORMDROPDOWN Community Team: %  FORMDROPDOWN Type of Establishment/Placement %:  FORMDROPDOWN  Name of Establishment:  FORMTEXT      Address:  FORMTEXT      Post Code:  FORMTEXT      Phone Number:  FORMTEXT      Date of Placement:  FORMTEXT      Date of Date of Last Review :  FORMTEXT      Date of this review meeting: FORMTEXT      Date of next review: FORMTEXT      Date SSD Care Plan Completed/Revised  FORMTEXT       It is important that the views of the user are heard and expressed in the review process. Users, carers and advocates should see the review as a positive chance to re-assess needs, review the performance of the home in meeting those needs and where necessary, renegotiate the details of the care plan. Following a review a different home might be looked for as a result of the changing needs of the user, or because of the inability of the current home to meet the needs of the user. People Involved & RoleNature of Contact %Contributory Reports FORMTEXT      Service UserAttendance at Meeting FORMTEXT       FORMTEXT      Key Worker FORMDROPDOWN  FORMTEXT       FORMTEXT       FORMDROPDOWN  FORMTEXT       FORMTEXT       FORMDROPDOWN  FORMTEXT       FORMTEXT       FORMDROPDOWN  FORMTEXT       FORMTEXT       FORMDROPDOWN  FORMTEXT       FORMTEXT       FORMDROPDOWN  FORMTEXT       Has a copy of latest Inspection and Registration report been obtained & read? FORMCHECKBOX  Yes  FORMCHECKBOX  NoDoes it contain any issues relevant for this review?  FORMCHECKBOX  Yes  FORMCHECKBOX  No If Yes, summarise the issues:  FORMTEXT       1. BACKGROUND Brief description of circumstances leading to the provision of residential/nursing home care FORMTEXT       2. RESIDENTIAL CARE PLAN OBJECTIVES Current objectives of the residential care plan. FORMTEXT       Is Residential Care Plan review outstanding? FORMCHECKBOX  Yes  FORMCHECKBOX  NoIs there a care plan/log for the service user available at the home? FORMCHECKBOX  Yes  FORMCHECKBOX  NoIs it properly and regularly completed? FORMCHECKBOX  Yes  FORMCHECKBOX  No 3. REVIEWED STATEMENT OF NEEDS List all current needs under each heading, highlighting new needs identified. Comment on the current effectiveness of the care plan in meeting objectives and the service users needs.  3a. Risks & Safety (Safe mobility, Falls prevention, Behavioural management) FORMCHECKBOX  Moving/ Handling  FORMCHECKBOX  Falling  FORMCHECKBOX  Sensory  FORMCHECKBOX  Immobility/Pressure Areas  FORMCHECKBOX  Health  FORMCHECKBOX  Confusion  FORMCHECKBOX  Wandering  FORMCHECKBOX  Care Refusal/ Self Neglect  FORMCHECKBOX  Social Isolation  FORMCHECKBOX  Self- Harm FORMCHECKBOX  Emotional Abuse  FORMCHECKBOX  Financial Abuse  FORMCHECKBOX  Physical Abuse  FORMCHECKBOX  Substance Misuse  FORMCHECKBOX  Risk to OthersHave Incident reports been seen?  FORMCHECKBOX  Yes  FORMCHECKBOX  NoHave any identified risks been reduced since admission or review?  FORMCHECKBOX  Yes  FORMCHECKBOX  NoSummary of any reported incidents involving user:  FORMTEXT       Needs: FORMTEXT       Care Plan Effectiveness and Changes Recommended: FORMTEXT       3b. Physical Health (Treatment of medical conditions, Rehabilitation. Pressure sore prevention. Nurse care managed treatment needs. Access to GP, Dentist, Optician, and Podiatry. Medical admissions to A&E or hospital)Needs: FORMTEXT       Care Plan Effectiveness and Changes Recommended: FORMTEXT       3c. Mental Health (Treatment & care, Mood/motivation, Cognitive function, Orientation, Memory and insight)Needs: FORMTEXT       Care Plan Effectiveness and Changes Recommended: FORMTEXT       3d. Medication (Management, review and administration needs. Sedation issues.)Needs: FORMTEXT       Date Medication Last Reviewed:  FORMTEXT       Care Plan Effectiveness and Changes Recommended: FORMTEXT       3e. Home Environment (Condition of room, access size, space and sharing. Furniture/personal items, presenting risks)Needs: FORMTEXT       Care Plan Effectiveness and Changes Recommended: FORMTEXT       3f. Personal Care and Daily Living (Mobility, Transfers Dressing/undressing Washing/Bathing. Eye, Nail/Hair Mouth & Foot care. Clothing. Eating/Drinking, Summoning Assistance. Sensory Communication. Continence. Assistance with Finances..Needs: FORMTEXT       Care Plan Effectiveness and Changes Recommended: FORMTEXT       3g. Social, Cultural & Activities (Cultural and spiritual needs. Regularity of family/friend contact. Access to community or social activities within the home. Relationships with other residents)Needs: FORMTEXT       Care Plan Effectiveness and Changes Recommended: FORMTEXT       Needs have (overall):  FORMCHECKBOX  Remained the Same  FORMCHECKBOX  Increased  FORMCHECKBOX  Decreased ! If Residential Care Plan is changed, include new plan with Review Document! 4. SERVICE USERS PERSPECTIVE (Priorities, Motivation, Views, Satisfaction)Has the service user been spoken to alone?  FORMCHECKBOX  Yes  FORMCHECKBOX  NoIf so, have any concerns been expressed?  FORMCHECKBOX  Yes  FORMCHECKBOX  NoDo they feel well supported by the care staff? Feel the residential care plan meets their needs? Feel satisfied with the overall standard of care? Feel they have new needs that need to be addressed? Summarise all the views that have been expressed by the Service User: FORMTEXT       5. FAMILY PERSPECTIVE (Priorities, Concerns, Satisfaction)Name of main family representative:  FORMTEXT       Phone:  FORMTEXT        Summarise views of the Service User s Family:  FORMTEXT       6. HOME STAFF PERSPECTIVE (Views & Concerns) Summarise Staff Views: FORMTEXT       7. COMPLAINTS (please ensure user has complaints guidance if required) FORMTEXT       8. FINANCIAL Who is Responsible for the collection of Benefits Agency Income? FORMCHECKBOX  Placement  FORMCHECKBOX  Relative FORMCHECKBOX  Service User  FORMCHECKBOX  LB Islington Summary of Financial Issues - Includes Personal Allowance Payment, Benefits Agency, Access, Appointeeship, Power of Attorney & named person responsible. FORMTEXT       9.REVIEW SUMMARY Outline the main issues, outcomes and recommendations from the review FORMTEXT       10. ACTION PLANActionPerson ResponsibleImplementation Date FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       Service User: (type names) FORMTEXT      Date: FORMTEXT      Signature: Reviewer: FORMTEXT      Date: FORMTEXT      Signature:Team Manager: FORMTEXT      Date: FORMTEXT      Signature:Date Review Completed (( Ended):  FORMTEXT       Date Review Sent to Service User (with amended residential care plan)  FORMTEXT        TIME \@ "dd/MM/yy" 28/09/06 Residential & Nursing Review FW  PAGE 1 J*,@BDNPdfz|~ععع【n#j5CJOJQJUmHnHujb5CJOJQJUj5CJOJQJUjCJOJQJUjvCJOJQJU jCJOJQJUmHnHujCJOJQJUjCJOJQJU5CJOJQJ B*CJ ph B*CJ(ph CJOJQJ%JR| (($Ifa$$Ifl45&Q'   04 laP$If@& :R;X;8Xwww (($If~$$Ifl4Fu5&0    4 laP246dfz|~>@\^`׻ל׎׀rj CJOJQJUj CJOJQJUjp CJOJQJUjCJOJQJU jCJOJQJUmHnHujNCJOJQJUjCJOJQJU CJOJQJ5CJOJQJjCJOJQJUjCJOJQJU,8:<oo z(($If]~$$Ifl4F 5&4*0    4 laPb (($Ifk$$Ifl40 5&'*04 laPbd(.($If[$$Ifl&,'04 laP (($Ifk$$Ifl40 5&]04 laP$&(*:<>RTV`bfz|~  & ( * 4 6 8 B D 𕎕xj5UmHnHuj^5U j5U5jCJOJQJUjnCJOJQJUjCJOJQJUOJQJ jCJOJQJUmHnHuj~CJOJQJUjCJOJQJU CJOJQJ5CJOJQJ/(*dfx (($If[$$Ifl&,'04 laP8 D rr(($If^ !(($Ifp$$Ifl40&E04 laPD       > @ B V X Z d f j U V Rvjgeg6CJj5UmHnHuj>5U5 j5UjCJOJQJU jCJOJQJUmHnHujNCJOJQJUjCJOJQJU CJOJQJ#j5CJOJQJUmHnHuj5CJOJQJUj5CJOJQJU5CJOJQJ'  @ h lwwww (($If~$$Ifl4F 5&a0    4 laPh j nd (($If$$Ifl4\ X 5& 04 laP U V m (R$If$If^ !X$$Ifl45&Q'04 laPRT|j0```` (($If$$Ifl4F+>&G  &&&0    4 laPRTVjlnxz|*,HJLNPdfhrtxzjCJOJQJUjRCJOJQJUjCJOJQJUjCJOJQJUj.CJOJQJU 5OJQJ jCJOJQJUmHnHujCJOJQJUjCJOJQJU CJOJQJ.*Nvxlbbbblbbb (($If$$Ifl4\ +>&/   04 laP 468:<PRT^`dfz|~߲ߤߖ߈zjCJOJQJUjCJOJQJUjCJOJQJUjfCJOJQJUjCJOJQJU jCJOJQJUmHnHujvCJOJQJU CJOJQJjCJOJQJUjBCJOJQJU,:bd&NPuuuuuuuuu (($If$$Ifl4F+>&G  0    4 laP  "$&(<>@JLPRfhjtvxzβΤΖΈzj!CJOJQJUjCJOJQJUjZCJOJQJUjCJOJQJUjCJOJQJUj6CJOJQJU CJOJQJ jCJOJQJUmHnHujCJOJQJUjCJOJQJU,Pxduoii$If !$$Ifl4F+>&G  0    4 laP (($Ifdf246RTVln&yni jUB*CJOJQJph56CJOJQJ jCJOJQJUmHnHujV#CJOJQJUCJj"CJOJQJUjj"CJOJQJU5CJOJQJj!CJOJQJUj~!CJOJQJU CJOJQJjCJOJQJU5CJOJQJ(4$Ift$$Ifl0.&J   04 laP$Ifv$$Ifl40.&J  &04 laP$$If(c$$Ifl47&'  &04 laP   Q$If$$If ! !(_$$Ifl5&Q'   04 laP  V !/01<=KLMRߛ߫ߋ{߫kj&5CJOJQJUj%5CJOJQJUj2%5CJOJQJUj$5CJOJQJUj5CJOJQJUCJjF$UB*CJOJQJph CJOJQJ56CJOJQJ5CJOJQJjUmHnHu jUj#U*QR"#$%&F|h|vvvmm $$Ifa$ !$$If$Ift$$Ifl'0Y5&u  &04 laP  #&FLMNO]^_qrۧ{xn{x{xd{x{xZ{xjl(CJUj'CJUj'CJUCJ jCJU5B*CJOJQJph56CJOJQJ56OJQJ 56CJCJ B*CJph B*CJph6B*CJph B*CJphCJj '5CJOJQJU5CJOJQJj5CJOJQJUj&5CJOJQJU#MN3a$$Ifl45&Q'   04 laP$$Ifa$$Ifl45&Q'   04 laPNq#Ps9 $($If($If (($If#$234PQ_`ast|rj,CJU CJOJQJj+5CJOJQJUj0+5CJOJQJUj*CJUjD*CJUj)CJUCJ jCJUjX)5CJOJQJUj(5CJOJQJU5CJOJQJj5CJOJQJU+'()8:[\]klmxy̼̬̥pi CJOJQJj.5CJOJQJUjj.5CJOJQJUj5CJOJQJU5CJOJQJ CJOJQJj-5CJOJQJUj~-5CJOJQJU5CJOJQJj5CJOJQJUj-CJUCJ jCJUj,CJU%9:\P{{$If~$$Ifl4F/ y5&K J  0    4 laP($Ift$$Ifl405&  &04 laP478BC   "68:DFJīwowlf 56CJCJj21UjUmHnHuj0U jU B*CJph6CJ jCJOJQJUmHnHujB0CJOJQJUjCJOJQJU CJOJQJj/5CJOJQJU5CJOJQJj5CJOJQJUjV/5CJOJQJU(67 c$$Ifl4[5&Q'  &04 laP$Ifv$$Ifl4.05&S  &04 laP7 HJ $ !((a$$Ifl45&Q'  &04 laP($Ifx$$If ! !(a$$Ifl45&Q'  &04 laP*,.BDFPRVxz|* , . < > @ T V X b d h !!!!!!!!!!ѾѾѾѾj2Uj~2U 56CJCJ5CJOJQJj2UjUmHnHuj1U jU B*CJph6CJ5B*CJOJQJph56CJOJQJ56OJQJ7 5) $ !((a$$Ifl45&Q'  &04 laP($Ifa$$Ifl45&Q'   04 laP*,TV, |t$$If ! !(a$$Ifl45&Q'  &04 laP($If $ !((, . < > f 5) $ !((a$$Ifl45&Q'  &04 laP($Ifa$$Ifl45&Q'   04 laPf h !|t$$If ! !(a$$Ifl45&Q'  &04 laP($If $ !((!!!!! 5) $ !((a$$Ifl45&Q'  &04 laP($Ifa$$Ifl45&Q'   04 laP!!!!!! 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