SENSORY DISABILITY ASSESSMENT & ACTION PLAN
Royal Borough of Kensington & Chelsea Social Services Department
SENSORY DISABILITY ASSESSMENT & ACTION PLAN
Title: Forename: Surname:
User No:
Case Paper No./Episode No:
Case Status:
Care co-ordinator:
OT Allocated:
Worker Allocated to NA/FACE:
Other Worker 1
Team:
Worker:
Non-ASCC Workers:
Work Type:
Assessment Start Date:
Date of Birth:
Ethnicity:
Ethnic subcategory:
Have you had direct contact with the client (i.e. by phone/in person), or if the client is unable to speak for himself or herself, have you had such contact with their next of kin/carer?
Date of client contact:
Summary of Needs
- COMMUNICATIONS
- LIGHTING/LOW VISION (L&LV)
- MOBILITY
- INDEPENDENT LIVING SKILLS (ILS)
- BENEFITS AND SOCIAL
Has the service user been offered Self Directed Support?
Is there a carer?
Eligible for Services following Assessment/Review (according to FACS risk criteria)?
Assessment decision: Assessment Sub-decision:
Team of worker completing assessment:
Worker completing assessment:
Designation
Date Assessment Completed:
Action Plan
- COMMUNICATIONS
- LIGHTING/LOW VISION (L&LV)
- MOBILITY
- INDEPENDENT LIVING SKILLS (ILS)
- BENEFITS AND SOCIAL
Comments/Details
Do you plan to issue a copy of Action Plan to Client/Client Representative? Estimated date:
Comments on issue of Action Plan: