ilf assessors report sample - whatdotheyknow

SAM

PLEVisit Details

ILF Assessors Report

Assessor:

ILFA Ref:

Allocation Date:

Visit Date:

Visit Reason:

User Name:

ILF Ref:

Case Worker:

Date of birth:

Address:

Postcode:

Home Tel No:

Work Tel No:

Mobile Tel No:

Email:

Contact Preference:

Communication:

SAM

PLELocal Authority Contact Details


LA Contact:

Contact Team:

LA Department:

Address:

Postcode:

Work Tel No:

Extension:

Fax:

Mobile Tel No:

Email:

SAM

PLEFurther Information

Other People Resident in the HouseholdEnter the names, dates of birth and relationship to the applicant/ILF user, of everyone who resides in thehousehold. Also tick the relevant box if the person is in education or receives Disability Living Allowance.

Other People Sharing Care

Please list the ILF users sharing care who have separate tenancies.


Full Name DOB Relationship ILF Ref Education? DLA?

Total number of people (including ILF Users) who are sharing care:

Full Name DOB ILF Ref

Is the User subject to a s117 of the Mental Health Act1983? Yes No

If Yes, please give further information

Is the User subject to a Compulsory Treatment Order?(under the Mental Health (Care and Treatment)(Scotland) Act 2003)

Yes No

If Yes, please give further information

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Has the User been present in the UK for at least 26weeks in the last year? Yes No

If No, please give further information

If this section cannot be completed, please give reasons

SAM

PLEShared Care


Who has helped with providing the information below?:

What is their position:

Is the accommodation registered as a residential Home? Yes No

Was the accommodation formerly a residential Home? Yes No

If yes, did the applicant live in the same accommodationwhen it was registered? Yes No

If yes, has the Local Authority maintained its previousinput? (cash provision) Yes No

If No, please explain

Does the applicant/User have a tenancy/licenceagreement? Yes No


Has the IA seen the tenancy/licence agreement? Yes No

Does the tenancy/licence state who the care providershould be? Yes No

If Yes, please explain

Even if the care provider is not specified in the tenancy,is the landlord either the same person or organisationas the care provider or closely linked with the careprovider?

Yes No

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If Yes, who will be sending a written statement from the landlord stating that the tenant is notobliged to receive their assistance from the associated person or organisation?

Please could you ask for a copy of the tenancy agreement to be sent to the ILF. Please confirmwho will be sending in the tenancy agreement

Has an individual care package been agreed andindividually costed? Yes No


Does the applicant/User have a significant element of1:1 care? Yes No


Does the applicant/User’s situation constituteindependent living? If not, please record reasons in theIA report

Yes No


As far as can be established, does the applicant/Userchoose to live there? Yes No

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Does the care package provide a discernibleimprovement in the exercisable choice and control forthe applicant/User? If not, please record reasons in theIA report

Yes No



SAM

PLEImpairment

Areas giving need for personal assistance


Details of Impairment and health conditions

Mobility Related Issues

Motor Control (use of hands and arms)

Personal Hygiene (eg continence, bathing)

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Sensory Impairment and communication issues

Cognitive Function

Mental Health

Learning Disability

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Challenging Behaviour

General Health Issues (e.g. breathing, feeding, skin integrity, management of medication)

Risk Factors

Other impact of Impairment not mentioned above (e.g. need for double handling)

SAM

PLEManaging an ILF Award (New Applications)


Does the applicant have the capability to manage an ILFaward (with support if required)? Yes No

If the applicant will not be managing their own award,has a person been proposed to manage it for them? Yes No

Has the person who will be managing the awardreceived a copy of the User Guide Leaflets? Yes No

As far as you can determine, has the person who will bemanaging the award understood that they have theresponsibilities and obligations as set out in the ILF'sdocuments with regards to record keeping,accountability for employer responsibilities andnotification of changes to the ILF?

Yes No

Has the person who will be managing the award beengiven an explanation that the ILF fund user would beexpected to contribute the Available Income?

Yes No

Any comments about who should manage the ILF award. State below if no person identified.Give details, if known, of support to be used by the person managing the award

SAM

PLECurrent Award Manager (Revisits)


Title:

First Name:

Last Name:

Address:

Postcode:

Work Tel No:

Email:

Is the above the appropriate person? Yes No

If No, has another person been proposed to manage theaward? Yes No


SAM

PLEProposed Award Manager


Title:

First Name:

Last Name:

Address:

Postcode:

Work Tel No:

Email:

Relationship:

Has the person who is proposed to manage the awardreceived a copy of the User Guide Leaflets? Yes No

As far as you can determine, has the person who isproposed to manage the award understood that theyhave the responsibilities and obligations as set out inthe ILF's documents with regards to record keeping,accountability for employer responsibilities andnotification of changes to the ILF?

Yes No

Has the person who is proposed to manage the awardbeen given an explanation that the ILF fund user wouldbe expected to contribute the Available Income?

Yes No

Any comments about who should manage the ILF award. State below if no person identified.State if ILF literature should be sent to the proposed person. Give details, if known, of supportto be used by the person managing the award

SAM

PLEAdditional Contact

If they are not the Award Manager,complete the following about the person who is the additionalthird party contact


Is there a third party contact the user wants to act as acontact for the LA? Yes No

If yes, is this third party contact the Award Manager? Yes No

Title:

First Name:

Last Name:

Address:

Postcode:

Work Tel No:

Email:

Relationship:

SAM

PLEUse Of Money

If yes, enter details of care providers and the types of records seen.


Is there any unspent money? Yes No

Not known

Please comment on any issues relating to unspent money

Are there any outstanding care bills or employers costs to be paid? (if possible give details)

If there has been a reduction in the amount spent on care, when did this happen? (if known)

Are there records showing how ILF money has beenspent? Yes No

Care Provider Record Type From To

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Please provide any additional information you think is relevant regarding records

Were records seen at the previous visit? Yes No

Please give any further information regarding records seen/not seen at the previous visit

As far as can be established, is all the ILF award beingspent appropriately on care? Yes No

Please advise if you consider the ILF should suspendpayments completely Yes No

Please advise if you consider the ILF payments shouldonly be paid on receipt of invoices Yes No

Please advise if you consider the ILF payments shouldonly be paid on receipt of Statement of Care Yes No

Please advise of any payment assurance concerns that should be followed up by Nottingham

SAM

PLE


SAM

PLEReport Summary


1. Provide a professional assessment of the support needs that are necessary for the user andalso provide supportive explanation (including severity and likelihood of the risk). Wherepossible this will be considered in conjunction with the local authority social worker. Provide apen picture of the User's circumstances. Identify all equality and diversity issues and how theyare to be addressed (Part 4 of the support plan)

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2. Other relevant information the user wants to convey. (Part 8 of the support plan)

3. Is there an application for Health Authority funding? Yes No

4. If yes, is this application for fully funded NHSContinuing Health Care? Yes No

Please give details

5. Is there an application for any other 3rd partyfunding? Yes No

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If yes, please give details

6. Do all parties agree with your recommendation? Yes No

If no, Please give details of how disagreements have been addressed, or how they might beaddressed by ILF Staff

7. Any points to be specifically followed up by Nottingham staff (eg checking details of carepackage with the LA contact). State who will be sending the care Schedule (formerly SSD1000)and the Financial Information Form to the ILF

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8. Please give any specific reasons for the ILF to review the package in less than 2 years

9. Any further notes and comments


SAM

PLEInterview Details

Please list those people present at the interview including yourself


Full Name Role

LA Rep Attended? Yes No

Date of Visit:

Date Report Completed:

SAM

PLEOutcomes - What is important to me?


1. Making sure that I have control over my life

What would happen if I did not have this support?

Outcome Importance:

2. Keeping me fit and well in body and mind


Outcome Importance:

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3. Making sure that I am safe and well


Outcome Importance:

4. Undertaking work, learning, training, hobbies and interests


Outcome Importance:

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5. Maintaing relationships with my friends, family and community


Outcome Importance:

6. Supporting my informal carers


Outcome Importance:

SAM

PLEIdentifying Alignment Issues

1. How would I like to receive my support?

2. Who can provide my support?


I would like to receive my support:

What I need to do

What assistance I need and who will provide it

I would like my support provided by:

What I need to do


SAM

PLE

3. Who will manage the funding of my support?

If funding will be managed by a third party, provide details below

I would like it to be managed by:

Full Name:

Address:

Postcode:

Work Tel No:

Email:

Relationship:

What I need to do


If you will manage funding with help from others, please provide details

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If yes, provide details below

Advocacy or support available?

Is a payroll agency employed? Yes No

Agency Name:

Address:

Postcode:

Work Tel No:

Email:

Other things I need to make my support happen

Full name:

Telephone:

Email:

SAM

PLEPackage Details (1)

Please list the ILF funded agencies associated with the user


Package Type:

Weeks/Year:

Is the package complete? Yes No

If no, please explain

Where there is shared care, please give details

Agency Name Address Telephone

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Package Details (1) Continued

Local Authority Input

ILF Input

Third Party Input

Element Wks/Yr Units Rate Amount Period Weekly



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LA Input Notes

ILF Input Notes

Third Party Input Notes

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Package Type:

Weeks/Year:





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ILF Input

Third Party Input




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LA Input Notes

ILF Input Notes


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Package Type:

Weeks/Year:





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ILF Input

Third Party Input




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LA Input Notes

ILF Input Notes


ilf assessors report sample - whatdotheyknow

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