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Sunbeam House Services Policy Document Title: Referrals, Transfers and Discharges Policy Effective Date: 01 September 2014 Policy No. 020 Revision: 1.0 Page 1 of 110 Department: 013 Full Policy ID Number : 013.020.1.0 Document Control Policy Title Referrals, Transfers and Discharges Policy Policy Number 020 Owner Senior Services Manager Contributors Referrals Committee Version 1.0 Date of Production 01 September 2014 Review date 01 September 2016 Post holder responsible for review Senior Services Manager Primary Circulation List Shared Drive Web address NA Restrictions none Version Control Version Number Owner Description Circulation 1.0 Senior Services Manager Review SMT

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Page 1: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 01 September 2014

Policy No. 020 Revision: 1.0 Page 1 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

Document Control

Policy Title Referrals, Transfers and Discharges Policy Policy Number 020 Owner Senior Services Manager Contributors Referrals Committee Version 1.0 Date of Production 01 September 2014 Review date 01 September 2016 Post holder responsible for review Senior Services Manager Primary Circulation List Shared Drive Web address NA Restrictions none

Version Control Version Number Owner Description Circulation 1.0 Senior Services

Manager Review SMT

Page 2: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 2 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

1.0 POLICY: This policy covers the following areas:

Referrals to Sunbeam House Services (SHS) Transfers to, from and within SHS Discharges from SHS.

2.0 SCOPE:

This policy applies to:

Referrals: Individuals making and application for support services within SHS. Transfers: Individuals making an internal transfer from one SHS location to another. Individuals transferring from SHS to an alternative service or organisation. Individuals transferring temporarily from SHS to a hospital, nursing home or

alternative service. Discharges: Individuals moving to an alternative service provider. Individuals being discharged home due to unsuitability of service. Individuals who no longer wish to receive the supports of SHS. Indviduals who have not attended SHS for a specific time period. Individuals who die in service.

3.0 ROLES & RESPONSIBILITIES:

• All staff working in SHS are responsible for complying with policy as outlined in the Referrals, Transfers and Discharges Procedures Document.

• The Referrals Committee are responsible for coordinating this policy. Specific guidelines are outlined in the Referrals Committee Structures and Procedures Document.

• The Referrals Committee and the Senior Management Team are responsible for reviewing and revising this policy.

Supporting Documentation:

Further information can be found in the following documents/booklets:

Appendix A: Referrals Committee Structures and Procedures Appendix B: Referrals, Transfers and Discharges Procedures Appendix C: Information for Applicants and their Support Persons

Page 3: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 3 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

APPENDIX A:

Sunbeam House Services www.sunbeam.ie

Referrals Committee

Structure and Procedures

Page 4: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 4 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

Table of Contents Page No.

Table of Contents 2-3

Referrals Committee Members and Function 4

Modus Operandi 5

Referrals Process 6

Referrals, Transfers and Discharges Procedures 9-15

GENERAL FORMS

SHS Application Form 16-18

Client Support Needs Form 19-32

Authority to Obtain and Disclose Information Form 33

Trial Period Form 34*38

Discontinuation of Service Form 39

HSE Entry Form 40

HSE Exit Form 41

ENTRY FORMS

Database Information Sheet and Consent Form 42-43

Personal Information Form 44

Entry Medical Form 45-49

Getting to Know Me Form 50-59

Page 5: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 5 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

TEMPLATE LETTERS

Acknowledgement of application 60

Referral to be pursued 61

Eligible for entry and vacancy 62

Letter to General Manager re funding 63

Not Eligible for entry 64

Not Eligible for entry - Outside catchment area 65

Letter to family to arrange a visit 66

Withdrawal of Application 67

Sampling period 68

Confirmation of Day/RT funding and start date 69

Confirmation of Residential funding and start date 70

Acceptance of Day/RT Placement 71

Acceptance of Residential Placement 72

Completion of Trial Period 73

Page 6: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 6 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

Sunbeam House Services

REFERRALS COMMITTEE

Members of the Referrals Committee

Referrals Officer

Senior Services Manager x 3

Board Representative x 1

Client Services Manager RT, Training and Education x 2

Client Services Manager High Support x 1

Client Services Manager Home Support x 1

Clients Services Manager Community Support x 1

Physiotherapist (shared) x 1

Page 7: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 7 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

Function of the Referrals Committee

• To review and assess referrals received for support services. – To determine whether Sunbeam House Services can deliver the appropriate service to the person referred.

• All decisions will be recorded through the minutes.

• In February of every year the function, process and outcomes of the Referrals Committee will be reviewed and audited. This audit report will be furnished to the CEO and the Board of Directors

Modus Operandi

• Data Protection Directive: All our dealings with an individual’s data shall meet with the requirements of the Data Protection Act 2003.

• The Referrals Officer is responsible for obtaining the up to date information required for the meeting.

• The Referrals Officer is responsible for circulating the correspondence, agenda and minutes, seven days prior the meeting.

• Correspondence received within seven working days of the forthcoming meeting cannot be discussed until the following meeting.

• Chairperson position will rotate on a six monthly basis. Chairperson will nominate other in his/her absence.

Frequency of Meetings Meeting are held on a monthly basis. Extra meetings are held as required.

Page 8: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 8 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

Referral Process

Referral in writing via the HSE Central Referrals Committee to the Referrals Officer

Referrals Officer to :send letter of acknowledgement to referrer and family

Pursue all relevant reports.

Send Brochure and Information Pack to family

Referral and all received documentation to be forwarded to the committee for discussion at

their meeting.

Following Referrals Meeting,

Decision made.

Eligibility

Page 9: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 9 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

a) Request additional reports if necessary. a) Letter of regret outlining the reason b) Home/school visit by Client Services Manager why SHS is not the appropriate

to complete the Client Support Needs Form service to meet the applicants’ needs

b) Shred/return reports.

a) Referrals Committee direct a request to the General Manager to submit a funding application in writing to the HSE. Copy of this letter to Referrals Committee.

b) Letter to individual, family and referral source informing them that a funding application has been made on their behalf.

c) Induction requirements to be determined and letter to be sent to individual and family with induction dates.

d) Following confirmation of funding, letter to be sent to individual and family informing them of type and duration of funding and proposed start date.

e) Await confirmation of written acceptance of placement. f) Individuals name to be removed from referrals waitlist on completion of a successful three-six

month trial period.

Possible Yes No

Definite Yes

Page 10: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 10 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

APPENDIX B:

Sunbeam House Services

Referrals, Transfers

and Discharges

Procedures

Page 11: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 11 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

Referrals Process

Referrals are requests made to Sunbeam House Services for the provision of support services. The following process applies:

1. Sunbeam House Services (SHS) are initially made aware of an individual’s need for a support service by the Health Service Executive (HSE).

2. A copy of the HSE Referral Form and relevant reports are forwarded to the SHS Referrals Committee for review.

3. Enquiries that are made directly to SHS are re-directed to the HSE’s Central Referral Committee, so that the appropriate channel of application and referral is followed.

4. Arrangements are made by phone and followed up in writing to meet the individual in order to complete the SHS Support Needs Form.

i. Parents are invited to be part of this process.

5. If it is determined that SHS can provide the appropriate service to meet the individual’s support needs, and an appropriate vacancy exists, a request is made to the Finance Manager to make an appropriate funding application to the HSE.

The above process is the responsibility of, and is undertaken by the SHS Referrals Committee.

Page 12: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 12 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

Admissions Process Once funding has been confirmed, the following steps are undertaken by the Referrals Committee:

1. A Confirmation of Funding letter is sent to the individual along with a proposed start date. 2. The Entry Forms are sent to the individual for completion and must be returned to the Referrals Officer prior to the individual commencing with SHS.

On commencement:

1. The individual’s details are entered on the in-house database. 2. The individual is allocated a Keyworker.

3. The individual’s record on the National Intellectual Disability Database (NIDD) is transferred from the previous service provider to SHS.

4. The HSE Entry Form is completed and submitted to the HSE.

5. The individual commences in SHS for a 3-6 month period (as

outlined in the Client Support Contract). During this period, a monthly review is undertaken and the trial period form is submitted monthly the Referral Committee. This allows for additional supports (if any) to be identified at the earliest possible stage.

6. When the trial period has been completed, a letter is sent to the applicant and the HSE detailing the outcome of the trial period.

7. The individual’s Person Centred Plan is devised.

Emergency Admissions Decisions on emergency/crisis admissions are made by the Managing Director in

conjunction with the person requesting the service and the HSE. The rights of other service users in that location are respected at all times. The case is later referred to the Referrals Committee.

Page 13: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 13 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

Transfer Process Transfers may be required because the existing placement is deemed unsuitable/because of the change needs of the individual/or at the request of the individual.

Internal Transfer Internal transfers refer to the transfer from one location to another within SHS. A request for an internal transfer may come from the person, their family/advocate or Client Services Manager. The transfer should be identified as part of the individual’s Personal Plan.

The following should be completed prior to a transfer taking place:

1. Application should be made by individual to their Client Services Manager (CSM) and then to Senior Services Manager (SSM).

2. A meeting should take place and the individual, family/advocate and

relevant staff should be invited to attend. 3. The internal transfer request is sent to the Referrals Committee for

discussion. 4. An application for additional funding may need to be made to the

HSE.

External Transfer External transfers refer to transfers to alternative services and/or organisations.

The person in charge shall ensure that the individual receives support as they transition between residential services or leave residential services through:

(a) The provision of information on the services and supports available. (b) Where appropriate, the provision of training in the life skills required for the new living arrangement.

Page 14: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 14 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

The person in charge shall ensure that the discharge of an individual from the designated centre

(a) Is determined on the basis of transparent criteria in accordance with the statement of purpose;

(b) Takes place in a planned and safe manner; (c) Is in accordance with the individual’s needs as assessed in accordance

with Regulation 5(1) and the individuals personal plans; (d) Is discussed, planned for and agreed with the individual and, where

appropriate, with the individual’s representative;

Temporary Transfer

Temporary transfers refer to transfers to hospital, transfers to nursing home and temporary transfers to alternative services.

When an individual is temporary absent from the designated centre, relevant information about the individual should be provided to the person taking responsibility for the care, support and wellbeing of the individual at the receiving designated centre, hospital or nursing home. This information should be accurate, legible and timely.

When an individual returns from another designated centre, hospital or nursing home, the person in charge of the designated centre from which the resident was temporarily absent shall take all reasonable actions to ensure that all relevant information on the individual is obtained from the person responsible at the other designated centre, hospital or nursing home

Page 15: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 15 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

Discharge Process

Sunbeam House Services reserve the right to discharge any person from the service if, having taken into consideration all relevant circumstances, it is determined SHS cannot provide the necessary supports to adequately address the individual’s support needs.

Individuals are discharges in the following situations;

1. Individuals moving to an alternative service provider. 2. Individuals being discharged home due to unsuitability of service, following

a plan of action, and all efforts being made with the involvement of the individual, their family members/guardian, staff and multidisciplinary team members, and all possible courses of action exhausted.

3. Individuals who die in service. 4. Non attenders. 5. Individuals who no longer wish to receive the supports of SHS.

The person in charge will ensure that the discharge of the individual;

1. Is determined on the basis of transparent criteria in accordance of the statement of purpose. 2. Takes place in a planned and safe manner. 3. Is in accordance with the individual’s needs

The following documentation should be completed in preparation of the discharge:

1. The Personal Plan should be reviewed and updated. 2. The plan should include a profile of the individual transferring. 3. All relevant information, including resources available to the

individual transferring, should be discussed and agreed between service providers.

Page 16: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 16 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

The following documentation should be completed when a discharge taking place:

1. A signed Authority to Obtain/Disclose Information Form 2. A Transition Plan detailing the steps undertaken with the individual in

preparation of the transition 3. A summary of the individual’s Support Needs Form 4. A completed Discharge Form

SHS respect the right of any individual who wishes to discharge himself/herself from our services. Should this be the case, SHS will make every effort to establish the reason(s) for this decision.

If a person is no longer attending, SHS will write to the individual/family noting that their place can only be kept for an agreed period.

If a person no longer wishes to avail of a service SHS will: 1. acknowledge this by forwarding a Discontinuation of Service Form

for completion. 2. update the in-house database and national database to show the

individual is no longer attending. 3. send a copy of the completed Discontinuation of Service Form and the

HSE Exit Form to the Health Services Executive.

Page 17: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 17 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

Sunbeam House Services Application Form

Name of Applicant: DOB:

Address:

PPS No. PIN No.

Contact Numbers: Home: Mobile:

REFERRED BY:

Name : Title:

Address: Contact Number:

IN ORDER TO DETERMINE THE TYPE OF SUPPORTS THE APPLICANT MAY REQUIRE,

PLEASE PROVIDE THE FOLLOWING INFORMATION:

What level of Intellectual Disability has the applicant been assessed at?

Mild Moderate Severe Profound

Page 18: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 18 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

Does the applicant have a physical disability? Yes No

Is the applicant a Wheelchair User? Yes No

Does the applicant have medical needs? Yes No

EDUCATION / PREVIOUS SERVICE HISTORY

SCHOOLS /SERVICES ATTENDED:

Name and Address of School/Service:

Dates Attended:

From:

To:

SCHOOLS /SERVICES ATTENDED:

Name and Address of School/Service:

Dates Attended:

From:

To:

SERVICE(S) REQUESTED

Please tick the relevant boxes of the service(s) that you wish to apply for:

Page 19: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 19 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

Day Service: Day Training Rehabilitive Training Supported Employment

Residential Service: Community Housing High Support Housing Monitored Housing

Respite Service:

No. of nights per week

No. of nights per month

No. of nights per year

Please return completed form to:

The Referrals Officer,

Sunbeam House Services,

Cedar Estate,

Killarney Road,

Bray,

Co. Wicklow.

Other relevant information:

PLEASE NOTE:

This form is for admittance to our Waiting List. Places in our centres are subject to approval by the SHS Referrals Committee and are subject to funding by the HSE.

Page 20: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 20 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

If you would like further information on the various services that Sunbeam House provides,

please see our website: www.sunbeam.ie

Page 21: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 21 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

For official use only

Initials and DOB of applicant:

PIN:

Date referral received:

Date referred to Referrals Committee:

Status/Action Plan Date/Note

□ Return to referrer

□ Seek additional information

□ Acknowledge letter to referrer/family

□ Acknowledge letter to parent

□ Waitlist

□ Other

Page 22: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 22 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

Sunbeam House Services

Support Needs Form

Page 23: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 23 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

Name:

DOB: PIN:

Home Address: Location address:

Date of meeting:

Review Date:

Page 24: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 24 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

Purpose of the form

The Client Support Form is designed to capture an overview of a person’s support needs in their day to day life

When to use the form

The form should be used to:

(a) Identify the support needs of a person newly referred to SHS

(b) Review and identify current supports to determine if an increase/reduction of supports are required.

Completing the form

• Please complete all sections on the form • Sections of the form not relevant should be marked as ‘N/A’ • Attach any relevant supporting documents/Identify where

supporting documents can be found.

Note to Assessor:

Please explain the need to ask sensitive and personal questions.

Introduce yourself and explain why you are interviewing: • To identify the support needs for a person applying for supports

from Sunbeam House Services. • To review the person’s current support needs in an effort to

determine if an increase/reduction of supports are required. • Explain Data Protection Policy. All information will be treated as

confidential and on a need to know basis only.

Page 25: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 25 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

Multi-Disciplinary Team Involvement:

Please list the people present at the meeting and their title:

(ie: parent, CSM, CSW, teacher)

1.

2.

3.

4.

5.

Do you use the service of an MDT: Yes No

If yes, please tick to indicate which services you use and whether you access them from home or within the service:

Page 26: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 26 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

Brief Medical History & Presenting Issues:

Page 27: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 27 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

Please see Client Reports for above data

Should you identify an area or activity that requires a detailed assessment, then a Risk Assessment must be carried out.

AREA OF NEED Stability How will each need be met By Whom MEDICAL SUPPORT NEEDS Respiratory Care 1. Inhalation or oxygen therapy Stable Unstable Nurse CSW Family Self

2. Postural drainage Stable Unstable Nurse CSW Family Self

3. Chest PT Stable Unstable Nurse CSW Family Self

4. Suctioning Stable Unstable Nurse CSW Family Self

Feeding Assistance 5. Oral stimulation or jaw positioning Stable Unstable Nurse CSW Family Self

6. Tube feeding (e.g. nasogastric) Stable Unstable Nurse CSW Family Self

7. Parenteral feeding (e.g. IV) Stable Unstable Nurse CSW Family Self

Skin care 8. Turning or positioning Stable Unstable Nurse CSW Family Self

9. Dressing of open wound(s) Stable Unstable Nurse CSW Family Self

Other exceptional medical care

Page 28: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 28 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

10. Protection from infectious diseases due to immune system impairment

Stable Unstable Nurse CSW Family Self

11. Seizure Management Stable Unstable Nurse CSW Family Self

12. Dialysis Stable Unstable Nurse CSW Family Self

13. Ostomy care Stable Unstable Nurse CSW Family Self

14. Lifting and/or transferring Stable Unstable Nurse CSW Family Self

15. Therapy services Stable Unstable Nurse CSW Family Self

16. Pain Control Stable Unstable Nurse CSW Family Self

17. Epilepsy Stable Unstable Nurse CSW Family Self

18. Diabetes Stable Unstable Nurse CSW Family Self

19. Swallow Stable Unstable Nurse CSW Family Self

20. Hearing Stable Unstable Nurse CSW Family Self

21. Eyesight Stable Unstable Nurse CSW Family Self

22. Mental Health Stable Unstable Nurse CSW Family Self

23. Other(s) – Specify: ______ Stable Unstable Nurse CSW Family Self

Page 29: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 29 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

AREA OF NEED Stability How will each need be met By Whom

HEALTH & SAFETY ACTIVITIES 1. Taking medications Stable Unstable Nurse CSW Family Self

2. Avoiding health and safety hazards Stable Unstable Nurse CSW Family Self

3. Obtaining health care services Stable Unstable Nurse CSW Family Self

4. Ambulating and moving about Stable Unstable Nurse CSW Family Self

5. Learning how to access emergency services

Stable Unstable

6. Physio service required Stable Unstable Nurse CSW Family Self

7. Maintaining a nutritious diet Stable Unstable Nurse CSW Family Self

8. Maintaining physical health and fitness Stable Unstable Nurse CSW Family Self

9. Maintaining emotional well-being Stable Unstable Nurse CSW Family Self

10. Medication management Stable Unstable Nurse CSW Family Self

HOME LIVING ACTIVITIES 1. Using the toilet Stable Unstable Nurse CSW Family Self

2. Taking care of clothes (includes laundering)

Stable Unstable Nurse CSW Family Self

3. Preparing food Stable Unstable Nurse CSW Family Self

Page 30: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 30 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

4. Eating food Stable Unstable Nurse CSW Family Self

5. Housekeeping and cleaning Stable Unstable Nurse CSW Family Self

6. Dressing Stable Unstable Nurse CSW Family Self

7. Bathing and taking care of personal hygiene and grooming needs

Stable Unstable Nurse CSW Family Self

8. Operating home appliances Stable Unstable Nurse CSW Family Self

9. Sleeping Stable Unstable Nurse CSW Family Self

10. Adaptive devices & assistive supports Stable Unstable Nurse CSW Family Self

Please indicate if the devices/supports (Q.10) belong to you or to the school?

11. Money Management Stable Unstable Nurse CSW Family Self

12. Access to Respite Stable Unstable Nurse CSW Family Self

13. Other(s) – Specify ________________ Stable Unstable Nurse CSW Family Self

AREA OF NEED Stability How will each need be met By Whom COMMUNITY LIVING ACTIVITIES 1. Getting from place to place throughout the community (transportation)

Stable Unstable Nurse CSW Family Self

2. Participating in recreation/leisure activities in the community settings

Stable Unstable Nurse CSW Family Self

3. Using public services in the community Stable Unstable Nurse CSW Family Self

Page 31: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 31 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

4. Going to visit friends and family Stable Unstable Nurse CSW Family Self

5. Participating in preferred community activities (church, volunteer etc.)

Stable Unstable Nurse CSW Family Self

6. Shopping and purchasing goods and services

Stable Unstable Nurse CSW Family Self

7. Interacting with community members Stable Unstable Nurse CSW Family Self

8. Accessing public buildings and settings Stable Unstable Nurse CSW Family Self

SOCIAL ACTIVITIES 1. Socializing within the household Stable Unstable Nurse CSW Family Self

2. Participating in recreation/leisure activities with others

Stable Unstable Nurse CSW Family Self

3. Socializing outside the household Stable Unstable Nurse CSW Family Self

4. Making and keeping friends Stable Unstable Nurse CSW Family Self

5. Communicating with others about personal needs

Stable Unstable Nurse CSW Family Self

6. Using appropriate social skills Stable Unstable Nurse CSW Family Self

7. Engaging in loving and intimate relationships

Stable Unstable Nurse CSW Family Self

8. Engaging in volunteer work Stable Unstable Nurse CSW Family Self

9. Self Identity Stable Unstable Nurse CSW Family Self

10. Social relationships Stable Unstable Nurse CSW Family Self

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Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 32 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

11. Isolation Stable Unstable Nurse CSW Family Self

AREA OF NEED Stability How will each need be met By Whom LIFELONG LEARNING ACTIVITIES 1. Interacting with others in learning activities

Stable Unstable Nurse CSW Family Self

2. Participating in training/educational decisions

Stable Unstable Nurse CSW Family Self

3. Learning and using problem-solving strategies

Stable Unstable Nurse CSW Family Self

4. Using technology for learning Stable Unstable Nurse CSW Family Self

5. Accessing training/educational settings Stable Unstable Nurse CSW Family Self

6. Learning functional academics (reading signs, counting change etc.)

Stable Unstable Nurse CSW Family Self

7. Learning health and physical education skills

Stable Unstable Nurse CSW Family Self

8. Learning self-determination skills Stable Unstable Nurse CSW Family Self

9. Learning self-management strategies Stable Unstable Nurse CSW Family Self

EMPLOYMENT ACTIVITIES 1. Accessing/receiving job/task accommodations

Stable Unstable Nurse CSW Family Self

2. Learning and using specific job skills Stable Unstable Nurse CSW Family Self

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Policy No. 020 Revision: 1.0 Page 33 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

3. Interacting with co-workers Stable Unstable Nurse CSW Family Self

4. Interacting with supervisors/job coaches

Stable Unstable Nurse CSW Family Self

5. Completing work-related tasks with acceptable speed

Stable Unstable Nurse CSW Family Self

6. Completing work-related tasks with acceptable quality

Stable Unstable Nurse CSW Family Self

7. Changing job assignments Stable Unstable Nurse CSW Family Self

8. Seeking information and assistance from an employer

Stable Unstable Nurse CSW Family Self

AREA OF NEED Stability How will each need be met By Whom PROTECTION & ADVOCACY ACTIVITIES

1. Advocating for self Stable Unstable Nurse CSW Family Self

2. Managing money and personal finances Stable Unstable Nurse CSW Family Self

3. Protecting self from exploitation Stable Unstable Nurse CSW Family Self

4. Exercising legal responsibilities Stable Unstable Nurse CSW Family Self

5. Belonging to and participating in self- advocacy/support organisations

Stable Unstable

6. Obtaining legal services Stable Unstable Nurse CSW Family Self

7. Making choices and decisions Stable Unstable Nurse CSW Family Self

8. Advocating for others Stable Unstable Nurse CSW Family Self

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Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 34 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

RESPONSIVE SUPPORT NEEDS Externally directed destructiveness

1. Prevention of assaults or injuries to others

Stable Unstable Nurse CSW Family Self

2. Prevention of property destruction (e.g. fire setting, breaking furniture)

Stable Unstable Nurse CSW Family Self

3. Prevention of stealing Stable Unstable Nurse CSW Family Self

Self-directed destructiveness 4. Prevention of self-injury Stable Unstable Nurse CSW Family Self

5. Prevention of pica (ingestion of inedible substances)

Stable Unstable Nurse CSW Family Self

6. Prevention of suicide attempts Stable Unstable Nurse CSW Family Self

Sexual Nurse CSW Family Self

7. Prevention of sexual aggression Stable Unstable Nurse CSW Family Self

8. Prevention of nonaggressive but inappropriate behaviour (e.g. exposes self in public, exhibitionism, inappropriate touching or gesturing)

Stable Unstable Nurse CSW Family Self

AREA OF NEED Stability How will each need be met By Whom

Page 35: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 35 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

Other 9. Prevention of tantrums or emotional outbursts

Stable Unstable Nurse CSW Family Self

10. Prevention of wandering Stable Unstable Nurse CSW Family Self

11. Prevention of substance abuse Stable Unstable Nurse CSW Family Self

12. Maintenance of mental health treatments

Stable Unstable Nurse CSW Family Self

13. Prevention of other serious responsive needs – Specify: _________________ __________________________________

Stable Unstable Nurse CSW Family Self

This Plan has been agreed on ( ) and will be reviewed again on ( ). Additional Risk Assessments attached: Yes No

Signed By:

(Client/Family Member/Advocate)

Signed By:

(Nurse/CSW)

Signed By:

(Client Service Manager)

Letter attached from Client’s GP: Yes No If No, please explain: ___________________________________________________________

Page 36: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 36 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

Summary of Potential Risks

Name: Pin No: Location: Date:

WHAT IS THE AREA OF NEED OR ACTIVITY THAT REQUIRES RISK ASSESSMENT?

Please note – This is a SUMMARY of Potential Risks. Please refer to the full version of the person’s Risk Assessment Form for further details.

Recognise and identify the hazards (how and where things can go wrong)? Has a Risk Assessment been carried out

Date of Risk Assessment

1.

2. S

3.

4.

5.

6.

Page 37: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 37 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

Physiotherapy/Occupational Therapy Assessment Multi-Disciplinary Team Involvement:

Do you use the service of an MDT: Yes No

If yes, please tick the services you use:

Social Worker Occupational Therapy Orthotist

Nursing Psychologist Physiotherapist

Page 38: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 38 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

Mobility:

Assessor: Please review handling chart if available

Please pick the level of ability that describes you best:

Independent Supervision Assistance x 1

Assistance x 2 Hoist

Do you have a history of falls? Yes No

Are falls related to other issues e.g side weakness, hand grip? Yes No

If yes, give details of the issue: _________________________________________________________

Have the falls resulted in injury or fractures? Yes No

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Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 39 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

Assessor: Please review osteoporosis and falls questionnaire

Equipment:

Do you use and support equipment? Yes No

Do you have issues with sight or hearing which may hinder your use of equipment? If yes, please give details.

_________________________________________________________________________________________________________

If yes, please advise if you use the following equipment and advise if it will transfer with you:

use transfer use transfer use transfer

Stander Trike Wheelchair

Walker Orthotics Positioning Aids

Rollator Wedge Sensory Room

Please list other equipment that you use:

________________________________________________________________________________________________________

________________________________________________________________________________________________________

Page 40: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 40 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

Swallow:

Have you had any problems with your swallow? Yes No

Do you cough when eating or drinking? Yes No

Do you get repeated chest infections? Yes No

Do you have pacing issues? Yes No

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Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 41 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

Summary Report of Supports Needs Form

NAME: DATE OF ASSESSMENT:

Medical Support Needs Health & Safety

`

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Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 42 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

Home Living Community Living

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Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 43 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

Social Activities Lifelong Learning

Employment Protection & Advocacy

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Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 44 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

Responsive Support Needs Other Relevant Information

Page 45: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 45 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

Other Relevant Information Do we have a current vacancy to meet the person’s needs?

Do we have the staffing to meet the placement?

Page 46: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 01 September 2014

Policy No. 020 Revision: 1.0 Page 46 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

Sunbeam House Services

Authority to Obtain and Disclose Relevant Information

I (individual’s name)

of (address)

Hereby authorise Sunbeam House Services

To obtain relevant information and/or Medical Reports, which are

required for the purpose of providing a disability service to me.

To disclose in strict confidence such information for this purpose

to other third parties including statutory and voluntary organisations

and disability service providers in the area.

To keep the information and reports obtained for the above purpose

only, on the basis that the information will be stored and disclosed

Page 47: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 47 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

in accordance with the Data Protection Act 1988 and 2003.

Signed:

Print Name:

Witnessed by (at time of signing)

Print Name:

Date:

Page 48: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 48 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

Sunbeam House Services

Trial Period Review Form

For Day and Residential Service(s)

This form is used when an individual commences in a Day or Residential Service(s) provided by Sunbeam House Services to ascertain if SHS is the appropriate service to meet the individual’s support needs and/or if further supports are required.

When an individual commences in a Day/Residential Service, this form should be completed on a month by month basis by the Keyworker and the Client Services Manager and signed off by the Senior Services Manager. It should then be returned to the Referrals Committee.

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Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 49 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

Sunbeam House Services

Trial Period Review Form for Day and Residential Service(s)

TRIAL PERIOD REVIEW FORM – MONTH ONE

Dates: to

Name: DOB:

The above individual is currently attending: (Day and/or Residential Service)

Progress Update:

Actions Taken: (if applicable)

Further Actions/Supports Required:

Who has been informed ?

Date of next review:

Signed: Signed: Senior Services Manager Client Services Manager

Page 50: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 50 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

Date: Date: Please return form to Senior Services Manager on completion

Sunbeam House Services

Trial Period Review Form for Day and Residential Service(s)

TRIAL PERIOD REVIEW FORM – MONTH TWO

Dates: to

Name: DOB:

The above individual is currently attending: (Day and/or Residential Service)

Progress Update:

Actions Taken: (if applicable)

Further Actions/Supports Required:

Who has been informed ?

Date of next review:

Page 51: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 51 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

Signed: Signed:

Senior Services Manager Client Services Manager Date: Date:

Please return form to Senior Services Manager on completion

Sunbeam House Services

Trial Period Review Form for Day and Residential Service(s)

TRIAL PERIOD REVIEW FORM – MONTH THREE

Dates: to

Name: DOB:

The above individual is currently attending: (Day and/or Residential Service)

Progress Update:

Actions Taken: (if applicable)

Further Actions/Supports Required:

Page 52: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 52 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

Who has been informed ?

Date of next review:

Signed: Signed: Senior Services Manager Client Services Manager

Date: Date:

Sunbeam House Services

Trial Period Review Form for Day and Residential Service(s)

SUMMARY OF COMPLETED TRIAL PERIOD

Name: DOB:

Summary of Actions/Supports Taken during the trial period:

Further Actions/Supports Required:

(for example: extra staffing/extra funding/external supports)

Page 53: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 53 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

Signed: Signed: Senior Services Manager Client Services Manager

Date: Date:

Please return form to Senior Services Manager on completion

Sunbeam House Services

Discontinuation of Service Form

Name:

Address:

DOB:

While attending SHS, I availed of a service in:

I no longer wish to attend Sunbeam House Services. I understand that should I

want to return, I will have to re-apply to the HSE for a placement.

My reason for leaving is:

Page 54: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 54 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

Signed:

Print Name:

Dated:

Witnessed by:

Print Name:

Dated:

Entry Form

Training Centre:______________________

Program Name:_________________________

Client Name: _____________________

Address: ____________________

____________________

Date of Birth: ____________ _____________________

Training Start Date;__________________

Course Type: Centre

Scheduled Training Completion Date:____________

Hours per Week: ___ (Max 30hrs)

Referral Source:_____________________

Contact Name:_________________________ Address:__________________________________

Referral Date:____________________

Signed:_____________ Date:____________________

Page 55: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 55 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

Training Centre

RT/Work Employment Client Exit Form

This form must be completed and returned within 1 week of Exit Date.

For Office Use:

Verified by: ___________________________ Date: __/__/____

Occupational Guidance Officer

Place is Funded by _________________________ Health Board

Page 56: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 56 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

Service Location:

Organisation:

Client Name: Date of Birth:

Start Date: Exit Date:

Reason for Leaving: √ only one selection Outcome: √ only one selection Benefit /Allowance Withdrawn

HSE1 Training – Rehabilitative

Ceased to attend

HSE Funded Day Service

Death Non HSE

Training – Specialist Vocational

Discharge to Further Training

Training – FAS/SOLAS

Discipline Breach in Centre

Training – Teagasc

Dispute with Agency

Training – Failte Ireland

Dissatisfaction with Programme

Education – 3rd level

Emigrated / Moved

Education – PLC

HSE Funding Stopped

Education – VEC/SOLAS

Illness

Education – Private

Offered a Job

Sheltered Employment

Offered Education Programme

Supported Employment

Personal Commitments

Open Employment

Training Completed

Self Employment

Transport Difficulty

FAS/DSP Employment Programme

Trial Period Unsuccessful

Voluntary Work/Community Activity

Unable to Cope

Department of Justice and Equality

Under Dept. of Justice Other

Home Life

Unwilling to Cont. in Specific Centre

Unoccupied

Ceased to Attend

Illness

Death

Page 57: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 57 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

TPS Modules

No. of Modules Planned:_____ No. Successfully Completed:_____

Name of Certifying Body

(FETAC, ECDL, etc)

Number of Certified Modules Achieved

(Attach detail of modules on separate sheet)

1If client is transferring to alternative HSE funded Service, please state name of Service Provider and Location:

I confirm that the above information is accurate and complete.

Signed: Name:

(on behalf of Organisation) (Block Capitals)

Position: Date: / /

For HSE Office Use:

HSE Officer Name

__________________ Date: / / LHO:_____________________

Client ID: ______________ Data Entry Date:

/ / Signed: __________________

Name

Address

Page 58: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 58 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

RE: DATEBASE INFORMATION

Dear

I enclose a copy of a leaflet, which has been issued by the National Intellectual Disability Database Committee, in association with the Department of Health and Children and Inclusion Ireland, describing the Intellectual Disability Database which is used for planning the provision of future services for people with intellectual disability or learning difficulties at national and local level. This data is held on a computer.

The leaflet gives detailed information about the Intellectual Disability Database and about its particular importance in predicting future service requirements and in planning to meet those needs. Our Database is of crucial importance in the complex tasks, which we face in planning future services. Furthermore, the Department of Health and Children uses the Database to estimate the financial resources required to meet the needs, which are identified on the Database. Accordingly, it is very important, for the sake of future service development, that you grant us your permission to record information about yourself on the Database in respect of current service provision, future service requirements, and for trend analysis.

I wish to inform you, furthermore, that Sunbeam House Services uses ordinary word-processing facilities for typing professional reports and correspondence. Sunbeam House Services also keeps a record of medications administered and carries an in house data base for recording service history and Personal Outcomes. For identification purposes we also include a photograph on our database.

Please do not hesitate to contact the undersigned if you have any questions.

Yours sincerely,

John Hannigan Managing Director

Encl 1

Page 59: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 59 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

SUNBEAM HOUSE SERVICES

DATABASE CONSENT FORM

• I give my permission to Sunbeam House Service to record data about myself on the CID (Client Information Database) and on the NIDD (National Intellectual Disability Database).

• I also give permission for my photograph to be included on the client information database for identification purposes.

I understand that information is passed to the HSE (Health Services Executive) and CQL (Council of Quality and Leadership) for service provision and planning purposes.

I acknowledge that I have received the leaflet, A Guide to the Intellectual Disability Database.

Signature:

Print name:

Advocate: Client / Parent / Guardian

Date:

Page 60: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 60 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

SUNBEAM HOUSE SERVICES Personal Information Form

Name of Applicant:

Telephone:

Home:

Mobile:

Address:

D.O.B:

Medical Card No:

PPS No:

PIN No:

GP Name:

GP Tel. No.

GP Address:

Current Medications:

Allergies:

Dietary Requirements:

Page 61: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 61 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

Wheelchair User:

Yes

No

Level of Mobility:

Epilepsy:

Yes

No

If yes, type of epilepsy and frequency of seizures:

Father’s Name and Address:

Tel No:

Home:

Mobile:

e-mail address:

Mother’s Name and Address:

Tel No:

Home:

Mobile:

e-mail address:

Name of Emergency Contact (1)

Contact No:

Relationship to client:

Page 62: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 62 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

Name of Emergency Contact (2)

Contact No:

Relationship to client:

Page 63: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 63 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

SUNBEAM HOUSE SERVICES ADMISSION MEDICAL FORM

(to be completed on entry to SHS)

Name:

Address:

Tel No.:

D.O.B: Medical Card No: PPS No.

Contact Person 1: Tel No.: Relationship to client:

Contact Person 2: Tel No.: Relationship to client:

Functioning Level of Disability:

Date of proposed entry: Blood Group Type:

Name & Address of G.P:

Medical History

Have you ever had………… Yes No Date- Give Details

Any serious illness or injury (hospital admission)?

Hernia (Rupture)?

Treatment for a skin condition? e.g. dermatitis, eczema

Backache, lumbago, sciatica, slipped disc or joint pain?

Pneumonia, bronchitis, asthma, shortness of breath?

Indigestion, gastric or duodenal ulcer?

Recurrent diarrhoea or other bowel problems?

High Blood Pressure, chest pain or heart condition?

Kidney or bladder conditions, frequency, infections etc,?

Reactions to any drug-penicillin, tetanus etc.?

Buzzing or noises in head?

Migraine or headache?

Insomnia?

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Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 64 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

Night Sweats?

Tremors of Hands?

Current Medication(s)

Medication reviewed on:

Physical Examination

Lungs Heart

Skin Teeth Eyes

R

L

Ears

R

L

Other

ECG B/P

Hearing

R

L

Urine

Ketones

Albumen

Glucose

Blood

Tetanus: Date of last booster:

Heart Rate

Flu Vac: Date:

Page 65: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 65 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

Blood Test – Please tick boxes

Hepatitis Status:

Breast Examination:

Breast X-Ray (Mammogram):

Smear Test: Date of last smear test:

Prostate Check: Date of last prostate test:

Epilepsy Yes/No

If Yes, type of epilepsy

and frequency of seizures:

Diabetes: HbA1c Levels:

Any known Allergies:

Menstrual Cycle

Normal Heavy Painful Regular Irregular

Blood Tests FBC+DIFF Others

U+E TFT (T3,T4)

(Urea & Electrolytes)

Lipid Profile PSA (Prostate)

(HDL,LDC, Total cholesterol)

Blood Results

To be completed by staff following phone call to GP.

Normal Yes No

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Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 66 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

Family Medical History

Social History

Alcohol Units per Day/Week:

Cigarettes per day:

Other Details:

Social Interaction/Behaviour

Mental Health

Current Mental Health:

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Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 67 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

Additional Information

Doctors’ Signature: ________________________ Date: __________________

Name of Consultant Psychiatrist:

Are you or have you availed or Counselling services ? Yes/No

Page 68: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 68 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

DRUG SENSITIVITY

/ALLERGY:

NEW CHART START DATE: __________________________________

CLIENT NAME: ______________________________ PIN: _________________

D.O.B.: _______________ GP: _______________________________________

PHOTOGRAPH

TRANSCRIBED BY: ______________________ CHECKED BY: _______________________

“AS REQUIRED” AND “VARIABLE DOSE” PRESCRIPTIONS

Date Approved name of drug (Block Letters)

Dose Route Indication Max. Frequency/ Admin Times

Signature of Prescriber Cancelled

Date Initials

1

2

3

4

5

Page 69: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 69 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

6

7

8

9

10

ONCE ONLY PRESCRIPTIONS AND ANTIBIOTICS

Date Approved name of drug (Block Letters)

Dose Route Indication Frequency **Signature of Administrator

Signature of Prescriber

Cancelled

Date Initials

Client Name: DOB: PIN: Location:

TIMES OF ADMINISTRATION

CANCELLED

Page 70: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 70 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

Date

Approved Name of Drug (Block Letters)

Dose

Route

Special Instructions

Indicate Prescribed Times

by a Tick

Signature of

Prescriber

Date

Init.

6 8 10 12 14 18 20 22

A

B

C

D

E

F

G

H

I

J

K

L

M

N

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Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 71 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

O

P

Q

R

S

T

U

Page 72: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 72 of 110 Department: 13 Full Policy ID Number : 13.020.1.0

(Insert photo here)

Getting to Know Me

My Name is :

I like to be called:

I was born on: ______________

Sunbeam House Services

Page 73: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 73 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

Please read through the following pages so that you can get to know me better……

CONTENTS

1. Important people in my life

2. Special moments in my life

3. Things that I like

4. Things that I don't like

5. What I like to do

6. Areas where I might need some help

7. How I communicate and how you can help me

8. My hopes and dreams for the future

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Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 74 of 110 Department: 13 Full Policy ID Number : 13.020.1.0

Important people in my life

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Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 75 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

Special moments in my life

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Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 76 of 110 Department: 13 Full Policy ID Number : 13.020.1.0

Things that I like

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Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 77 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

Things that I don't like

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Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 78 of 110 Department: 13 Full Policy ID Number : 13.020.1.0

What I like to do

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Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 79 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

Areas where I may need some help

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Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

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How I communicate

and how you can help me

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Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 81 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

My hopes and dreams

For the future

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Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 82 of 110 Department: 13 Full Policy ID Number : 13.020.1.0

TEMPLATE LETTERS Acknowledgement of application

Date

Address

Re:

Dear

We wish to acknowledge your application for a place for (Name)

in Sunbeam House Services.

In order to pursue this referral, we request a copy of the following reports;

1. Psychological Report 2. Medical History Report

We may request other reports, as necessary, at a later stage.

If you have any queries relating to the above, please do not hesitate to contact me on (01) 2868451.

Yours Sincerely,

Catherine Elliott-Lewis

Referrals Officer

Please note: If this application is unsuccessful, all reports received will be shredded (in accordance with the Data Protection Act).

Please send copy of reports only.

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Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

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TEMPLATE LETTERS Referral to be pursued.

Date

Address

Re:

Dear

Thank you for your recent reports received on (date)

Unfortunately we are unable to process this referral further until

the following reports have been received:

1.

2.

If you have any queries regarding the above, please do not hesitate

to contact me at (01) 2868451.

Yours sincerely,

___________________

Catherine Elliott-Lewis

Referrals Officer

Page 84: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 84 of 110 Department: 13 Full Policy ID Number : 13.020.1.0

Page 85: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 85 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

TEMPLATE LETTERS Eligible for entry and vacancy

Date

Address

Re:

Dear

Thank you for referring the above named to this organisation for a service in (type of service and area)

As you are aware (name‘s) application was discussed at the Referrals Committee on (date).

Having considered all the reports and assessments we are pleased to be able to inform you that there is currently a vacancy in (area).

This placement cannot be confirmed until funding has been verified in writing by the HSE.

We have applied to the HSE (OTHER) on (date) for funding on behalf of (name)’s application.

You can contact us at (01) 2868451 to keep updated on this funding application.

When funding has been allocated, we will then be in contact with you to arrange a meeting to complete the entry forms, and to arrange a start date for the trial period.

Yours sincerely,

Catherine Elliott-Lewis

Referrals Officer

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Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

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TEMPLATE LETTERS Letter to General Manager re funding

Date

Finance Manager

Sunbeam House Services

Re: Funding application on behalf of (Name) (Address) (DOB) (PIN) (Type and Range of Service)

Dear

At the most recent Referrals Committee meeting held on the (date), the above applicant was successful in meeting the admission criteria of Sunbeam House Services.

Please submit a funding application to the HSE for (type and range of service(s) on behalf of the above applicant. He/She will require this service to be provided from (Date).

Yours sincerely,

Catherine Elliott-Lewis

Referrals Officer

Page 87: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

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TEMPLATE LETTERS Not Eligible for entry

Date

Address

Re:

Dear

Thank you for referring (name) to this organisation for a service.

(Name) application case was discussed at the Referrals Committee meeting on date(s)

Having considered all the reports and assessments, we regret that we are not in a position to offer a place to (Name) as we do not provide the type of service which would be appropriate to meet (his/her) needs.

Please refer back to your Local Health Office of the HSE for further availability of services.

All documents relating to your referral will now be shredded (in accordance with the Data Protection Act 2003).

Yours sincerely,

Catherine Elliott-Lewis

Referrals Officer

Copy to Applicant

Page 88: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

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TEMPLATE LETTERS Not Eligible for entry-Outside catchment area

Date

Address

Re:

Dear

Thank you for referring the above-named to this organisation for a service. (Name)’s referral has been reviewed by our Referrals Committee at their most recent meeting held on (date).

As you may be aware, Sunbeam House provides a range of services for adults 18 years and over at a number of our centres spread around Co. Wicklow. Unfortunately, we are not in a position to process the referral of (name) as the address of origin is outside the catchment area.

Please find enclosed all reports which had submitted to the Referrals Committee.

Yours sincerely,

Catherine Elliott-Lewis

Referrals Officer

Page 89: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

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TEMPLATE LETTERS Letter to family to arrange a visit (depending on service required – visit to SHS/School/Applicants home)

Date

Address

Re:

Dear

Following on from your referral of (name) to our Referrals Committee, we wish to acknowledge that we will be in contact with you shortly to arrange a visit (SHS/School/Applicants home - where appropriate) to discuss further, the referral of your son/daughter.

We look forward to meeting with you.

If you have any queries, please contact me at (01) 2868451.

Yours sincerely,

Catherine Elliott-Lewis

Referrals Officer

Copy to Client Services Manager and Senior Services Manager

Page 90: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 90 of 110 Department: 13 Full Policy ID Number : 13.020.1.0

TEMPLATE LETTERS Withdrawal of Application

Date

Address

Re:

Dear

We understand from (Title) that you do not wish to pursue the application for services with Sunbeam House Service.

We wish you every success in your future placement.

All reports relating to your application will now be shredded

(in accordance with the Data Protection Act 2003).

Yours sincerely,

_________________

Catherine Elliott-Lewis

Referrals Officer

Page 91: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

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TEMPLATE LETTERS Sampling period

Date

Name

Address

Dear

We wish to acknowledge that the Sunbeam House Services Referrals Committee recently carried out an assessment of support needs with (name) in his/her school environment. SHS are now in a position to provide a sampling week for (name) on the following dates (from-to) This will take place at (venue). It is very important to ensure that (name) is in a position to attend this sampling week.

The sampling week:

- Provides the student with an idea of what Sunbeam is like on a daily basis and gives them an idea of the variety of classes and activities on offer.

- Introduces students to the staff working in the respective Centre within Sunbeam House Services.

- Introduces students to the Service Users currently accessing supports within Sunbeam, encourage them to participate in activities and provide new and different experiences to students.

- Provides staff with an opportunity to liaise with the student and with the student’s SNA/Teacher and family and thereby get to know the student better.

- Assists Sunbeam as a Service Provider, to identify any additional needs or supports which the student may require and will also assist in ascertaining if the student is placed in an environment most suitable to meet their needs.

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Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 92 of 110 Department: 13 Full Policy ID Number : 13.020.1.0

Please be advised that this is a sampling week only and does not guarantee a service for (name) in (venue). The provision of a service will of course be dependent on whether Sunbeam can provide a suitable service to meet the student’s individual support needs and the provision of HSE funding.

Please note that Sunbeam is not in a position to provide transport to (name) while he/she is attending for his sampling week. Please do not hesitate to contact the Client Services Manager, (name and phone no.) should you have any queries or questions on the above.

We look forward to welcoming (name) to Sunbeam for his/her sampling week.

Kind regards,

Catherine Elliott-Lewis

Referrals Officer

Page 93: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

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TEMPLATE LETTERS Confirmation of Day/RT Funding and Start Date

Date

Name

Address

Re: Confirmation of (Day/RT) Funding and Start Date

Dear

We are delighted to inform you that we have received confirmation of funding from the HSE. This funding will enable us to provide a service for (name) on the (type of programme) for a (amount) year duration.

We would therefore like to propose a start date of (date) for (name) to commence his/her (type of programme).

Please complete the Acceptance of Placement Form enclosed and return it in the envelope provided.

If you or family have any questions, please give me a call. Alternatively, you/they can contact the Client Services Manager, (name and phone no.) who will be able to answer any questions you/they may have.

If you have any queries, please do not hesitate to contact me.

Yours sincerely,

Catherine Elliott-Lewis

Referrals Officer

Page 94: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 94 of 110 Department: 13 Full Policy ID Number : 13.020.1.0

TEMPLATE LETTERS

Confirmation of Residential Funding and Start Date

Date

Name

Address

Re: Confirmation of Residential Funding and Start Date

Dear (name)

We are delighted to inform you that funding has been made available by the HSE to facilitate (name)’s residential placement. This will be facilitated at (area)

It is proposed that (name)’s start date will be (date).

(name), Client Services Manager will be in touch with you prior to that date to confirm the arrangements. Should you need to contact (residential unit), the telephone number is (tel. no.)

It is a requirement of our admission process, that (name)’s Disability Allowance book/card accompany her when she commences in (residential unit).

I enclose the (list forms) entry forms for completion. Please return them to me in the stamped addressed envelope enclosed. You are welcome to contact me if you have any questions.

Kind regards,

Yours sincerely,

Catherine Elliott-Lewis

Referrals Officer

Page 95: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 95 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

TEMPLATE LETTERS

Acceptance of Place on RT/Day Programme

Date

NAME

ADDRESS

Re: Acceptance Letter

Sunbeam House Services – Rehabilitive Training Programme

I would like to accept the offer of a placement on the (programme type) with Sunbeam House Services, beginning (date)

I am aware that this placement is on a three month trial basis which will be reviewed on (date) and following the trial period, Sunbeam House Services reserve the right to discontinue the placement if the service does not meet my needs.

Signed: Date:

Client

Signed:

Parent/Guardian/family member Relationship to client

Page 96: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 96 of 110 Department: 13 Full Policy ID Number : 13.020.1.0

TEMPLATE LETTERS Acceptance of Residential Placement

DATE

NAME

ADDRESS

Re: Residential Placement with Sunbeam House Services

I wish to accept the residential placement offered to me by Sunbeam House Services. I am aware that this placement will be facilitated in (location)

Should it be deemed that the placement does not meet my needs; Sunbeam House Services has the right to discontinue the placement. Alternative arrangements will need to be considered and Sunbeam House Services will work with me to find appropriate alternatives. No decision will be made without prior consultation with me.

Signed: Date:

Client

Signed:

Parent/Guardian/Family member Relationship to client

Page 97: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 97 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

TEMPLATE LETTERS Completion of Trial Period

Date

Name

Address

Re: Completion of Trial Period at Sunbeam House Services

Dear

I write to inform you that your trial period on the (PROGRAMME) concludes on (DATE).

I am pleased to inform you that this trial period has been successful and your admission on this (DURATION) course is due to conclude on (DATE and YEAR).

Yours sincerely,

Catherine Elliott-Lewis

Referrals Officer

Page 98: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 98 of 110 Department: 13 Full Policy ID Number : 13.020.1.0

APPENDIX C:

Sunbeam House Services www.sunbeam.ie

Information

for applicants

and their support person(s)

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Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

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Sunbeam House Services

Information

Title Page No.

Mission Statement 3

How to apply to Sunbeam House for a service 4

Referrals Process 5

Entry Criteria 6

List of reports required 7

Support Services Information 8-9

Respite Information 10

Further Information 11

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Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

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SUNBEAM HOUSE SERVICES

Our Mission

Sunbeam House Services provides a range of supports to adults with intellectual disabilities. We aim to empower people with the necessary skills to live full and satisfying

lives as equal citizens of their local communities.

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Sunbeam House Services Policy Document

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Effective Date: 1st September 2014

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How to apply to Sunbeam House for a Service

Sunbeam House provides supports and services for people over 18 years of age with an intellectual disability.

An application can be made by you or for you: • Through your school • through the HSE (Brian Miller or Rossa O’Briain)

This application form lets us know what services and supports you are applying for:

• Day Training • Rehabilitive Training (RT) • Residential Supports • Respite • Supported Employment

We may ask for reports such as a School Report, Psychological Report or Medical Report. These reports help us to design a service for you and to put the supports in place that you may need.

You will be invited to visit the service, to have a look around and meet some of the other service users and staff.

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Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 102 of 110 Department: 13 Full Policy ID Number : 13.020.1.0

The application process from start to finish can take a few months. We need to make sure that the service will meet your needs, we need to have a vacancy and we need to get funding from the HSE. Once all of these things are in place, we may be able to offer you a place.

Entry Criteria The applicant must have an Intellectual Disability as their primary diagnosis.

The applicant must be over 18 years of age.

A suitable/appropriate vacancy must exist within the organisation.

Funding must be made available by the HSE.

Catchment Area

Priority will be given to those who live in the North Wicklow/South Wicklow area. Occasionally, referrals are considered from outside these areas. In circumstances where the Referrals Committee are unable to make a decision or where the decision would be unclear, the Managing Director’s decision will be final in all cases.

Applications

Applications, having been initially made to the HSE’s Central Referrals Committee, are then forwarded to Sunbeam House Services Referral’s Committee for consideration.

Reports

The Application should be accompanied by the following up to date reports:

(1) Psychological Report

(2) Medical Report

(3) End of year School Report

It is the responsibility of the referring body to ensure that all submitted reports are up to date.

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Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

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Other relevant reports may also be requested at a later stage (see list of reports) The Psychological Report must be no more than 2 years old. In certain circumstances, a slightly older Psychological Report may be considered. The absence of relevant requested reports may processing of the application.

Please note:

An application cannot be processed by the Referrals Committee until all relevant up to date reports have been received.

Page 104: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 104 of 110 Department: 13 Full Policy ID Number : 13.020.1.0

SUNBEAM HOUSE SERVICES List of reports required In order to process any referral the following reports must be supplied.

1. □ Psychological Report

Must include:

• Social and Developmental History • Assessment of Cognitive and Adaptive functioning. • Educational History – School / Class Reports for previous two years. • Record of school placements. • Record of work placements.

2. □ Medical Report

The following reports (3-11) may be required at a later stage:

3. □ End of Year School Report

4. □ Nursing Report

5. □ Physiotherapy Report

6. □ Occupational Therapy Report

7. □ Manual Handling Report

8. □ Speech & Language Report

9. □ Social Work Report

10. □ Respite Service Report

11. □ Other

Page 105: Document Control - Sunbeam

Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 105 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

SUNBEAM HOUSE SERVICES

Informal Visit

Applicant and parents/support person(s) are welcome to contact the Referrals Officer to arrange a visit to the relevant location.

Details of induction process

Families/Schools/Agencies are contacted and arrangements are made for the applicant to attend their potential service. The Senior Services Manager and/or Client Services Manager will advise the structure of the induction process.

Transport

SHS are no longer in a position to provide transport for new referrals. If you wish transport to be provided, please contact the HSE directly on this matter.

Details of trial period

Relevant forms are completed with the Referrals Secretary on acceptance or offer of a place.

There is a trial period of six months, which is reviewed after three months.

A key worker is allocated to the applicant.

The applicant is given the opportunity to sample various modules or aspects of the service(s) offered.

At the end of the trial period the applicant either:

a) Continues in the service. b) The trial period is extended. c) Is re-assessed for a more suitable service within the organisation.

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Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

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Should it be deemed that during this trial period, the service does not meet the needs of the applicant; SHS reserve the right to discontinue this placement.

The placement is discontinued and the Family, Referring Agency, and Director of Disabilities, HSE, Dublin, Mid-Leinster, are informed in writing.

(A copy of the SHS Referrals, Transfers and Discharges Policy and the Referrals, Transfers and Discharges Procedures Document are available upon request)

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Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

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SUNBEAM HOUSE SERVICES Sunbeam House Services provide a wide range of services in a variety of locations

Day Services

The activities and supports in each day service are tailored to the abilities, needs and interests of the people attending, with a focus on developing skills and community involvement.

Training/Rehabilitive Training

Trainees pursue a full time course of a specified duration, where they are prepared for independent living. Modules include computer skills, arts, leisure and culture, self-advocacy, literacy, work preparation, relationship skills and health and safety and others. FETAC and OCR certified courses are also available.

On completion of training programme, individuals are offered an on-going life-skills service that focuses on individual needs, where funding has been secured from the HSE. Some individuals may access this directly, depending on funding.

For those of a more mature age, a more flexible service is available.

Employment

Connect Employment – is a supported employment service which enables people to access main stream employment of their choice based on their individual skills, interests and experience. A trained job coach is available to support the person to find work of their choice, provide training in the work site and offer disability awareness training to co-workers and employers if required.

Community Support Services

This is a service provided to individuals living in their own home. Various supports including Money Management, Budgeting, Home Living and Personal Care supports are provided where necessary.

Flexi Service

The Flexi Service offers individuals opportunities and choices to participate in the life of the community in order to achieve their personal goals.

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Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

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SUNBEAM HOUSE SERVICES Residential Services

Sunbeam House Services is a Housing Association. A SHS provide a variety of accommodation within Co. Wicklow to cater for the various levels of Client requirements.

When a request for residential placement has been received and processed, a Local Authority Social Housing Supports Application Form is sent to the applicant and/or their family for completion. In order for Sunbeam House Services to apply for the funding, all individuals on our residential waitlist must also be on their local authority waitlist.

The following gives a brief outline of the type of residential services provided by Sunbeam House Services:

Community Housing:- These are staffed houses/apartments in the Community for people who have medium to low support needs but still require on-going supervision. Residential funding is required for the above and a request for same is made to the HSE.

High Support Housing:- This area provides staffed housing alongside a variety of services for people with different complex support needs.

Monitored Housing:- A core group of staff provide a range of supports to individual people living independently in SHS property.

Home Support:- This is a service provided to individuals living independently in their own home or in private rented accommodation and who may require various supports such as Money Management, Budgeting, Home Living and Personal Care. Home support funding is required for the above and a request for same is made to the HSE.

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Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

Policy No. 020 Revision: 1.0 Page 109 of 110 Department: 013 Full Policy ID Number : 013.020.1.0

SUNBEAM HOUSE SERVICES Respite Services

Respite is a short term admission to accommodate a person requiring short stay accommodation.

It is aimed to provide the individual to have a short break from home or a holiday break.

Respite admissions are planned and are non-emergency, with an agreed stay period.

• The individual may wish to join his/her friends for a holiday or social outings;

• Using Respite may be an introduction in the process of leaving home, e.g. to avail of living

more independently, or requiring more care;

• Respite can be facilitated in an SHS house or away with staff for a holiday or through

Homeshare;

• This service is available 24 hours, 365 days each year, but is limited in the amount of

available places.

How to apply for Respite:

An individual or relative can apply for respite by contacting the relevant Client Services Manager at the location that the individual attends. He/she will discuss the respite procedure with them and then liaise with the respite location manager.

Once the respite location manager makes contact with the individual and carer, then they will discuss the procedure with them.

Respite depends on availability so it is important to book it as far in advance as possible.

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Sunbeam House Services Policy Document

Title: Referrals, Transfers and Discharges Policy

Effective Date: 1st September 2014

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SUNBEAM HOUSE SERVICES

We hope that you found the information in this booklet useful.

If you require any further information, please contact the Referrals Officer at 01-2868451.

Please also see our website: www.sunbeam.ie for further information.