New Client Visit Pack Step 1 of 9 11% Office Details:Date Visit Pack Completed:* Date Format: DD dash MM dash YYYY Manager Completing Visit Pack:*Carol SavageRachel DeeryLinda SpenceFiona KaneKerry O'RourkeDean FosterVisit Pack Completed by:*TelephoneIn personSenior CarerOtherReferral Details:H&C Number:SOS Care Number: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:*How will carers gain access to client's home?Keypad Number (if applicable)Next of Kin/ POA Details: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.Additional NOKNOK NameRelationshipContact NumberEmail If the client wishes to name more than one NOK please detail information below. Trust DetailsTrust Care Manager Name:* First Last Trust Care Manager Contact Number:*GP DetailsGP Surgery:GP's Name:* First Last GP Contact Number:* Package DetailsTotal Hours per week:*Hours per day:*Number of calls:*Care Commencement Date:* Date Format: DD slash MM slash YYYY If you have any additional information to add about the client not defined above please detail below: Service User Guide issued and explainedService User Guide issued and explained (Explain Lydian Care complaints procedure, If carers run over 15 mins to call office and problems to call office, all details are in the care book at the clients house)Detailed:*Lydian Care Plan and risk assessment discussedWhat Equipment do you have at Home? Do you have Tiled/Carpet/Wooden floors or any mats? Asking this just because it may be a fall risk/risk to staff and to have this noted Detailed:* Health & Safety responsibilities discussedDetailed:*Call times delays and cancellations discussed and agreedDetailed:* Client agreement to delivery of Care Services by Lydian CareDetailed:*Financial Transactions required?* Yes No Detailed:*Care Plan Review Date:* Date Format: DD slash MM slash YYYY Risk Assessment Review Date:* Date Format: DD slash MM slash YYYY Care PlanClients known allergies. I know I am allergic to: -*Client’s physical needs. The assistance I need with physical activities of living.*Client’s medical needs. My known medical conditions and the needs arising from this condition*Clients medication support. The support I require with my medication and by whom*Clients mental health assistance I require with orientation and self determination*Client’s personal care. The assistance I require with my personal care.*Nutrition and Hydration. The support I require with preparation and serving of meals and drinks* Risk Assessments1. Fire Safety/Risk AssessmentIs this person at greater risk from fire; • Aged 60 or older • Have a disability or impaired mobility - • Have a health condition that would impact upon their ability to acknowledge or respond to an emergency within the home - Referral criteria to NIFRS Evidence of; • No working smoke alarm - • History of fires - • Are not careful with smoking materials - • Scorch marks on bedding, clothing and/or carpets • Leaving cooking unattended • Large quantities of loose papers/stored/hoarded items in rooms • Use of candles unguarded/close to combustible materials. Detail:*Decision to refer to Northern Ireland Fire & Rescue Service?* Yes No 2. Internal risk assessmentArea Internal*Hallways /Passageways, RoomsPotential Hazards*Obstruction /Mats/TrippingRisk*Upstairs carpet,etc.. Potential risk to:*Care Staff/Client 3. Client Movement Assessment/Mobility AssessmentDoes 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 Movement - Walking*Movement - Washing*Movement - Chair to standing*Movement - Transfers Chair to bed, Bed to chair, Chair to toilet/commode*Movement - Bed to standing*Movement - Rolling bed* Movement - Positioning in bed*Movement - Wheelchair Transfers*As this visit pack has been completed remotely no signature is required.
