Client Review Form Office Details:Date Review Completed:* DD dash MM dash YYYY Manager Completing Review:*Carol SavageRachel DeeryFiona KaneReview Completed by:*TelephoneIn personSenior CarerOtherPersons attending and designation:List*NameDesignation Please list all attendees of the review in the boxes above - if there is more than one person attended - press the plus button at the side to add additional.Client Details:Title:* Client's Name:* First Last Client's DOB:* Day Month Year Address* Address Line 1: Address Line 2: Town/City: Postcode: Clients Contact Number:*Next of Kin/ POA Details:Has there been any changes to your listed NOK?* Yes No Name First Last Relationship to Client: Contact Number:Permission to share information: Client gives permission.Client Gives permission for information to be shared with this person.Have you any additional information to add about the client not defined above, please detail belowReview Questions1. How are you finding the team the of careers that complete your calls, are you satisfied with the care you are receiving, and do you have any concerns or complaints?*2. Are the staff wearing appropriate uniforms and PPE when required?*3. Has there been any changes to your home which may be considered as a fire safety risk or may impede the care staff completing your call?*EquipmentDoes the client have equipment in their home?* Yes No Detail all equipment in client's homeEquipmentChecked DateDue Maintenance on enter each equipment item in the text box above - then click the plus button to add more.Is the equipment maintained and checked?* Yes No Checklist* Have you reviewed & signed off current risk assessment is fit for purpose Have you reviewed & signed off current fire safety assessment is fit for purpose? Please select the Actions to confirm completed or leave blank if unable to complete.Other InformationHas the client expressed concerns not detailed in the questions above? if so detail hereDo you have anything further you would like us to follow up on?*Follow up if required:
