Client Review Form

Office Details:
Date Review Completed:*
Date Format: DD dash MM dash YYYY
Manager Completing Review:*
Review Completed by:*
Persons attending and designation:
List*
Name Designation

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:*

DD
MM
YYYY
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:
Email
Permission to share information:
Client gives permission.
Client Gives permission for information to be shared with this person.

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If you have any additional information to add about the client not defined above please detail below:
Review Questions
1. How are you finding the team of carers that complete your calls at present?*
- Are they delivering the care they should be? - Do they arrive on time for your calls? - Are they professional? - Do they treat you well- with respect and dignity?
2. Are the staff wearing their gloves, aprons and uniform when they are here?*
- Do they wash their hands when they arrive - And afterwards - Any problems with that

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3. Are you satisfied with the care you are receiving?*
- Is the care the client receiving as per the timetable of service - Discuss understanding and their expectations of their care - Clarify and if client’s needs have changed- discuss with client that Lydian will liaise with Social worker/care manager
4. Have you any concerns or complaints about the care you are receiving?*
- Any concerns regarding the carers attending their calls - Any concerns or complaints about Lydian - Any worries or queries we can help with - Explain how to make a complaint. - Clarify and if client’s needs have changed- discuss with client that Lydian will liaise with Social worker/care manager

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5. Fire safety risk assessment*
- Do they smoke - Is there a lot of papers/clutter around the room - Do they have a smoke alarm/carbon monoxide alarm - Do they require a home fire safety risk assessment – liaise with care manager to sort
Actions If Required
Are there any actions Lydian must take following the responses from the client to the questions above? If so detail here.
Actions Required:*
Other Information
Has the client expressed concerns not detailed in the questions above? if so detail here
Other:*

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Equipment
Does the client have equipment in their home?*
- Yes
- No
Detail all equipment in client's home
Equipment Checked Date Due 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
- Have you reviewed Care plan & timetable is up to date and in place in client’s home and paperwork
- Sampling of recent carer’s notes viewed
Please select the Actions to confirm completed or leave blank if unable to complete.
If you have been unable to confirm items in checklist please detail here.

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Office Details:

Name	Designation

Equipment	Checked Date	Due Maintenance on