A summary of our ServicesEstablished since 1993 Maison Moti Limited provides the following range of community based step-down services for adults recovering from a mental health condition:

Residential care Shared Housing Supported Housing Floating Support Community Outreach

We currently have a combined total of 49 units of 24-hour supported accommodation across our residential, shared and supported housing services (One 15-bedded CSCI registered care home, two shared housing units providing 6 placements each and two supported housing units with 16 self contained flats in one and an additional 6 in the other). As a further step-down to these services we have 14 floating support placements provided over five properties. In addition we also provide an unlimited number of community outreach arrangements, either as the final step towards complete independence or as an early prevention service.

Service AimsAll our services strive to achieve the most independent life situation possible for our service users. We do this by ensuring a sustained focus on:

Stabilising and further promoting recovery from mental ill- health, &

Re-establishing the independent living skills required to enable an unsupported life in the community

Our Service Delivery Model We operate a 5-stage service delivery model across all our service areas, comprising:

Assessment (An Initial Assessment is conducted following the referral with a more comprehensive (Core) Assessment within 4 weeks of the service commencing)

Support Planning (An outline Support Plan is completed from the findings of the Initial Assessment following referral, with a more comprehensive (Core) Support Plan resulting from the Core Assessment, provided within 4 weeks of the service commencing)

Key Working (All service users are designated a named Key Worker with formal Key Working meetings held on at least an 8-weekly cycle)

Reporting (Reports setting out progress against each of the agreed Core Support Plan areas, together with other relevant information are provided to involved professionals and others as may be agreed on at least an 8-weekly cycle)

Review (A formal review of the service and the Core Assessment and Core Support Plan are carried out on at least an annual basis)

These are the key primary interventions via which all Maison Moti user services are determined, agreed, provided, monitored and reviewed.

1

Service Delivery Model Template

This template document is the tool via which the service delivery model is implemented and monitored.

It is set out in four distinct parts: 1. Service inquiry2. Referral3. Assessment4. Service delivery

The document provides a single point of reference for readily obtaining key customer and service user information, for purposes of tracking progress on service inquiries, referrals and more crucially on our interventions to monitor distance travelled, post service commencement.

Guidance notes Every Maison Moti service user is required to have an up to date Service Delivery Model Template (SDMT) in place at all times.

The document is to be maintained electronically on the company’s shared server and added to as changes occur or at required intervals, without deleting any previous information.

The SDMT should only be ceased when the service user moves on to a different service, or unless otherwise authorised by a member of Maison Moti’s senior management team.

If the service user moves to another service within Maison Moti a new SDMT is to be started.

Any new information added to the document must be dated in the ‘last updated’ box provided at the top of each Part and also next to the new text that is added. A paper copy of the SDMT is to be maintained on the individual service user’s files. At all times when information is added, the relevant page/s must be printed and inserted into the paper file, replacing the old page/s.

The SDMT can be made available to all involved professionals and others such as family and relatives, but only with the express consent of the service user.

Part 1 (Service inquiry) is to be completed only by staff based at Maison Moti’s head office.

Part 2 (Referral) is to be completed only by authorised operational staff. (Relevant sections can also be completed by the referrer if they choose to provide the requested information by way of completing the form rather than over the phone)

Part 3 (Assessment) – The initial assessment is to be completed only by Maison Moti’s Clinical Supervisor together with an authorised operational senior or middle manager. Part 3 is also to be used for all subsequent assessments as part of a formal review. These are to be completed by the designated Key Worker except for the risk assessment part in section 7 which is to be completed by the Clinical Supervisor.

Part 4 (Service delivery) is to be completed by project staff, usually the designated key worker and the project manager. (Changes to the risk assessment and risk management plan, including those further to a review, must only be completed by the Clinical Supervisor).

NB: Particular care should be taken to ensure that the referral agency, and in particular the service user, are not asked to repeat any information that has been provided previously.

2

About this document

Please take time to read the guidance notes that have been provided throughout this document to ensure that it is completed as intended.

3

This part is only to be completed in the case of an inquiry about Maison Moti services, including where an inquiry leads to a referral. In the event of a direct referral at first contact proceed straight to Part 2.Part 1 can be completed by any member of Maison Moti’s head office staff team. Any queries should be referred to a member of the senior management team.

Date of first inquiry      Last updated      

1. Subject informationName       Date of Birth      Home address       Current address      Gender       Type of placement      Religion       Ethnicity      Nationality       NHS No      Marital status       NINO      

ChildrenYes No Details

     

Next of kinName       Relationship      Address       Tel      Mobile       Email       Immigration issuesYes No Details

     

Languages spoken      

Interpretation/ translation requiredYes No Details

     

Physical disabilities/ learning difficultiesYes No Details

     

Mobility issuesYes No Details

     

Mental health diagnosis:     

Part 1 – Service

Relevant section of Mental Health Act      Section upon discharge      

Subject to CPA: Yes No Details

     

Brief outline of relevant history:     

2. Inquirer information Full name       Designation      Address       Organisation      Telephone       Fax      Mobile       Email      

Responsible LA name and address (If different to above)Name of LA      Address      

3. Service details Indicate below the service that is required Service Group

Project X Vacancy details Comments

Residential care

Maison Moti            

Shared housing

Moti Lodge            Casa Moti            

Supported housing

Moti Villa            Chez Moti            

Floating support

Studio Moti            Other            

Community outreach            To be decided            Other            

Anticipated service start date

     

Anticipated service outcomes

     

4. Outcome      

5. Follow up actionDocument type Service group/

ProjectDate despatched

Sent to By post By e-mail

Referral procedure                  Maison Moti Brochure                  Relevant Service Specification

                 

Relevant Service User Guide

                 

Completed by      Name of operational staff inquiry sent to      Date sent      

Further actions required and actions subsequently taken (inc. date and name of person making the note)      

6. Additional infoRelevant additional information relating to Part 1     

7. No further actionWhere the inquiry is satisfactorily resolved, the contact does not lead to a referral and no further action is required note here any relevant comments and file away the document together with all related paperwork     

NFA authorised by       Date of closure      

This part is to be completed by Maison Moti operational staff authorised to deal with referrals. All information must be completed in full. If the required information has already been recorded in Part 1 then it is not necessary to repeat, however please note the additional information requirements in this part.

Date of first referral contact      Date/s follow – up referral info provided      Last updated      

1. Service detailsIndicate below the service that is requiredService Group

Project X Vacancy details Comments

Residential care

Maison Moti            

Shared housing

Moti Lodge            Casa Moti            

Supported housing

Moti Villa            Chez Moti            

Floating support

Studio Moti            Other            

Community outreach            To be decided            Other            

How did referrer learn about Maison Moti?     

Anticipated service start date

     

If service is not available by this date does the referrer want the service user to be placed on the waiting list?Yes No Details

     

Anticipated service outcomes

     

2. Referrer info Full name       Designation      Address       Organisation      Telephone       Fax      Mobile       Email      

Care Co-ordinator details (if different from above)Full name       Address      Telephone       Fax      Mobile       Email      

Part 2 – Referral

Funding authority detailsAuthority 1       Authority 2      Invoicing address       Finance contact      Telephone       Fax      Mobile       Email      

3. Supporting documents Establish which of the following documents have or will be provided. NB: Those underlined are compulsory, without which the referral may not be accepted. Document Dated To follow Date providedPsychiatric Report                  Psychological Report                  Risk Assessment                  OT Assessment Report                  Discharge Summary                  CPA Report                  Care Plan                  Social Circumstances Report                  Social Work Report                  Other (insert details)                  

4. Subject informationName       Date of Birth      Home address       Current address      Gender       Type of placement      Religion       Ethnicity      Nationality       NHS No      Marital status       NINO      

ChildrenYes No Details

     

Next of kinName       Relationship      Address       Telephone      Email       Mobile       Immigration issuesYes No Details

     

Languages spoken      

Interpretation/ translation requiredYes No Details

     

Physical disabilities/ learning difficultiesYes No Details

     

Mobility issuesYes No Details

     

Mental health diagnosis      

Relevant section of Mental Health Act      Section upon discharge       Subject to CPAYes No Details

     

Details of current medication and how it is administered     

Index offenceYes No Details

     

Forensic historyYes No Details

     

Known risk behaviours      

Placement history      

Relevant history      

5. Scheduling the assessment meetingScheduled date of assessment

      Venue      

To be conducted by       Also present will be      

6. Additional infoRelevant additional information relating to Part 2

     

The initial assessment is to be completed by Maison Moti’s Clinical Supervisor together with an authorised senior or middle manager. This section is also to be used for conducting all subsequent assessments, which are to be completed by the designated Key Worker, except for section 7 which will be completed by the Clinical Supervisor. NB: The plan resulting from any changes to the initial assessment (i.e. minor changes during the course of the service as well as from subsequent assessments as part of a formal review) are to be updated using the Core Support Plan in part 4 (The Outline Support Plan in this part is only to be used to document the plan prior to the service commencing).

All information in this section must be completed in full, unless already recorded in the earlier parts of this document. Before completing this section please complete any relevant incomplete sections from parts 1 and 2.

Date of assessment meeting

Conducted by Others present Last updated (state ‘review’ if as part of a formal review )

By

                             

Sources of information1      2      3      4      5      

1. Current situation      

2. Medication and treatment Is subject self medicating?Yes No

Will s/he be expected to self medicate upon commencing service with Maison Moti?Yes No Comments

     

Provide details of all medication for all physical and mental health conditionsMedication Dosage Frequency Administered

byComments (inc. side effects, when last reviewed and date finished)

1                              2                              3                              4                              5                              6                              

Part 3 – Assessment

Medication Dosage Frequency Administered by

Comments (inc. side effects, when last reviewed and date finished)

7                              8                              9                              10                              

Details of all current mental health treatment and how the subject is responding to the treatment. Also note any follow-up appointments and whether Maison Moti staff will need to facilitate these.     

Details of all current physical health treatment and how the subject is responding to the treatment. Also note any follow-up appointments and whether Maison Moti staff will need to facilitate these.      

The amount and details of all medication the subject will have available upon commencing service with Maison Moti and agreement to continue with supply until registered with a local GP and CMHT(NB: A minimum supply for 4 weeks is required)     

Plans for change of GP registration and CMHT

     

3. Background      

4. Professional support networkDetails of all professionals involved in providing for the subject’s current treatment, care and supportDesignation Name Address Tel Fax E-mailCare Co-ordinator                              Care Manager                              Psychiatrist                              CPN                              Social Worker                              GP                              CMHT                              Dentist                              Optician                              Dietician                              Emergency Out of Hours Service

                             

Other (Please specify)

                             

5. Personal relationships Contact details of all people of significance to the subject (i.e. family, relatives, friends, lovers etc …) and indentify any that the subject would like involved in his / her care whilst at Maison Moti. (Explain that this will mean that we would share all information, unless advised not to do so)

Name Relationship Contact details Frequency of contact

Consent given info sharing

                                                                                                                                                                              

State the level of support provided by family and friends and whether they would be prepared to increase the support if required?     

State whether the subject would benefit from support to promote contact, if so what this should be and whether the subject is agreeable to this?      

6.1 ConvictionsNumber Offence Convicted Sentence DetailsIndex offence                        1.                        2.                        3.                        4.                        5.                        6.                        7.                        

6.2 Other criminal actsAny relevant information about criminal involvement that did not lead to a conviction, any pending charges, details of bails, curfews etc…     

6.3 Conditions imposed by the Ministry of Justice      

7. Emotional and mental healthNB: This section must be completed by Maison Moti’s Clinical Supervisor

7.1 Current diagnosis Diagnosis      

Is the subject currently detained under the Mental Health Act?(If relevant state which section the subject will be under following discharge)Yes No Details

     

Has the subject ever been detained under the Mental Health Act previously?Yes No Details

     

7.2 Mental health historySummary of the subject’s mental health history, including his/ her circumstances and issues leading up to the mental health problems, the services received, current condition, etc…     

7.3 Significant life events Summary of all relevant events leading up to the mental health breakdown and how these continue to impact etc… (Include any incidents of bereavement, loss and separation).     

7.4 Self perception and confidenceProvide an outline of the subject’s perception of him/ her self, including self- esteem, his/ her level of confidence in self, how this impacts on him/ her, in his/her interaction with others, presentation etc…? Also, provide information on the subject’s ability to make decisions and to assert him/her self.      

7.5 Insight and awareness Provide an outline of the subject’s level of insight and awareness of his/ her mental health condition, how this affects him/ her, his/ her ability to manage the impact, etc…?      

State whether the subject is able to describe his/ her triggers or indicators to relapse and if so is s/he able to ask for support when this occurs?     

State whether the subject is able to identify risks (to self, others, from others etc) and if so what is his/ her method for managing the risks?      

7.6 Risk behaviours Refer to the ‘Methodology for determining risk levels’ document to establish whether the risk level is Low, Moderate, High or Extreme. Where there is no risk state ‘none’ and if a lack of information means that the risk is not known state ‘N/K’. Details must be provided below for all areas where there is either a historical or current risk. Risk Historical Current Risk

LevelDetails

Self –harmTalk/thoughts of self harm                  Act with suicidal intent                  Acts of self harm                  Other form of self harming behaviour

                 

Other (Please specify)                  

Risk Historical Current Risk Level

Details

Harm to othersTo children                  Sexual assault                  Violence to family                  Violence to other service users

                 

Violence to professionals                  Violence to public                  Exploitation of others                  Intimidating behaviour                  Other (Please specify)                  

Self-neglectPoor hygiene                  Malnutrition                  Poor physical health                  Non-compliance with medication

                 

Refusal of services                  Disengagement from key services

                 

Eviction                  From environment                  Other (please specify)                  

Harm from OthersNeglect                  Physical abuse                  Exploitation                  Financial abuse                  Bullying/ harassment                  Over medication                  Unlawful restriction                  (e.g. abduction)Racial abuse                  Other (please specify)                  

Other risksSubject to POVA                  Substance abuse                  Alcohol                  Use of weapon                  Incident involving the police                  (e.g. anti-social behaviour)

Risk Historical Current Risk Level

Details

Accidental harm at home                  Dangerous driving                  Absconding                  Arson                  Isolation                  Due to lack of exercise                  Exploitation                  Damage to property                  STD’s                  Others (Please specify)                  

7.7 Relapse indicators Identify any known behaviours that could indicate a risk of relapse and state the action to be taken in this event Number

Risk indicator/ behaviour Action to be taken in the event of occurrence

1.            2.            3.            4.            5.            6.            7.            8.            9.            10.            

7.8 Summary evaluation of emotional and mental health issues     

8. Physical health 8.1 General health infoHeight Weight Blood pressure(in centimetres) (in kilos) 120/80 = ideal

120/80 or 140/90 = normal but slightly higher than it should be140/90 over a few weeks – consult GP

                 

Does the subject have any physical disabilities or learning difficulties?Yes No Details

     

Does the subject smoke, drink alcohol or take illicit drugs?

Yes No Details     

8.2 Medical conditionsAll questions answered with a ‘yes’ in this part must be followed up with relevant details.Condition Y N NK DetailsAllergy      Anaemia      Angina      Anorexia Nervosa      Arthritis      Asthma      Autism      Back pain      Bulimia Nervosa      Cancer      Cataracts      Chicken Pox      Chronic Obstructive      Conjunctivitis      Constipation      Coronary Heart Disease

     

Diabetes      Diverticulitis      Eczema      Epilepsy      Erectile Dysfunction      Fibroids      Gallstones      Haemorrhoids      Hay Fever      Heart Attack      Hepatitis A/B/C      HIV and Aids      Hypotension      Hypertension      High Cholesterol      Incontinence      Irritable Bowel Syndrome

     

Kidney Failure      Kidney Stones      Laryngitis      Leukaemia      

Condition Y N NK DetailsMastitis      Meniere’s Disease      Meningitis      Migraine      MRSA      Multiple Sclerosis      Neuralgia      Obesity      Osteoarthritis      Osteoporosis      Ovarian Cyst      Pulmonary Disease      Parkinson’s disease      Pelvic Inflammatory Disease

     

Pneumonia      Prostate Disease      Psoriasis      Repetitive Strain Injury

     

Shingles      Stroke      Thyroid problems      Tinnitus      Tonsillitis      Tuberculosis      Ulcerative Colitis      Urinary Tract Infection

     

Varicose Veins      Vertigo      Other (Please specify)

     

Date of last medical examination      Is an annual medical examination due?      

Does the subject have any personal or religious beliefs that may prevent medical treatment?     

8.3 Healthy livingDescribe below the subject’s typical diet, stating what support/ services are necessary, if any? Diet Advice/ support/ services required?           

Does the subject have a weight issue?Yes No Details Advice/ support/ services required?

           

Does the subject take any form of physical exercise?Yes No Details Advice/ support/ services required?

           

Is the subject sexually active?Yes No Details

     

Does s/he have an awareness of the need to have safe sex?Yes No Details Advice/ support/ services required?

           

8.4 Summary evaluation of physical health issues      

9. Race, Culture & IdentityNote here information relating to the subject’s, race, religion, culture and identity. State whether there are any particular issues or considerations in this regard, whether s/he practices his/ her faith, if there is any issues of disassociation with race etc… and if support is required to promote race, culture or identity?      

Note here whether the subject has any discriminatory attitudes or beliefs, if s/he has acted on these in the past and/ or how these may have an impact on others and the service to be provided?      

Which of the following proof of identity documents does the subject have? Document Location where kept Checked by assessor CommentsPassport                  Home Office documents                  Driving License                  Medical Card                  Other (Please specify)                  Other (Please specify)                  

10. Education, training & employmentProvide a brief outline of the subject’s past and present education, training and employment (inc. voluntary work). Also establish his/ her future plans, identifying any obstacles to achieving these.      

11. Finance Is the subject currently in any form of employment?Yes No Details (inc. income)

     

Is the subject receiving any DWP benefits? (If not state whether they would be eligible?)Type of benefit Amount CommentsIncome Support            Job Seekers Allowance            Incapacity Benefit            Disability Living Allowance            Sever Disablement Allowance

           

Council Tax Benefit            Housing Benefit            Community Care Grant            Other (please specify)            

Does the subject have any outstanding financial claims or settlements (i.e. from the CICB, insurance providers etc…)?Yes No Details (inc the estimated amount)

     

Does the subject have any savings or assets?Yes No Details (including amount)

     

Does the subject have any other means of income?Yes No Details (including amount)

     

Does the subject have any debts?Yes No Details (including amount)

     

Is s/he able to manage his/ her money?     

Confirm that the subject will have sufficient monies available to them for their basic needs upon the Maison Moti service starting? (NB: Any applications for benefits / changes will usually take at least 4-6 weeks)     

12. Daily routine, recreation and leisure Provide an outline of the subject’s typical daily routine and details of his/ her hobbies and interests etc…?      

13. Presentation and social awareness Note here any issues relating to the subject’s appearance, personal hygiene, presentation, confidence level, intuitiveness, awareness of others, the environment etc…      

14. Interpersonal skills Note here your evaluation of the subject’s ability to listen, comprehend, and express him / herself through verbal communication, on his her diplomacy, sensitivity etc…     

15. Relationships and social support networks Record here details of the subject’s social and support networks, i.e. family, relatives, friends, involvement with community and social groups, professionals, lovers etc… State his/ her ability in general to engage in positive relationships.      

16. Independent living skills Establish the subject’s ability in the following areas. If fully competent check box Y, otherwise check box 1 to indicate little to no ability therefore high level of support required, box 2 to indicate some level of ability therefore medium level of support required and box 3 to indicate good level of ability therefore low level of support required. NB: All tasks identified as 1, 2 or 3 should be supported with information in the details box.Task Y 1 2 3 DetailsFill in forms      Write letters      Make official tel. calls

     

Budget      Pay bills      Manage debt      Bank account      Save      Plan menu      Food shopping      Cook      Clean      Laundry      Personal care needs

     

Self medicate      Use public transport

     

Access emergency services

     

Access health care services

     

Access professionals for current services

     

Social support network

     

16.1 Evaluation of subject’s independent living skills Note here your evaluation of the subject’s independent living skills and the level of support that will be required to help him/her to either achieve complete independent living or the next level of supported living      

17. Additional Information Note here the subject’s feelings about the referral for a service with Maison Moti, whether s/he is prepared to engage with services that would be provided and his/ her feelings about further move on to more independent services.      

Note here information on any relevant meetings/ hearings, such as discharge, CPA parole or other professional meetings that are scheduled and state whether it would be of benefit for a Maison Moti representative to attend.      

Other additional information relevant to Part 3. NB: Where applicable cross reference any information to the relevant section      

18. Summary of overall findings from the assessment Provide here a summary of the overall findings from the initial assessment, identify any gaps in information and state how these are to be addressed.      

19. Eligibility and suitability Is the subject deemed to be eligible for the service s/he has been referred for?Yes No Details

     

Is the subject deemed to be suitable for the service s/he has been referred for?Yes No Details

     

If a service is not to be offered set out here the reasons for this, giving consideration to whether an alternative Maison Moti service could be offered otherwise sign post to appropriate external services.      

Decision authorised by Managing Director?Yes No Comments Date

           

If decision not to provide a service has been authorised please state below the date decision notified to the referrer and to the subject and file this document away together with other relevant papers. Inform the referrer and subject of the appeals process (which is set out in the Referral Procedure).      

Info on appeals against decision not to offer a serviceDate of appeal Appellant name and contact

detailsGrounds for appeals

                 

Action taken following appeal

     

Outcome of appeal      

NB: If service is to be provided proceed with completing the rest of the SDMT.

20. Support Plan (Outline) Ensure that all areas identified in the initial assessment are set out under the relevant heading and a plan for how each area is to be addressed clearly stated, including a plan to manage all areas of risk.Identified area of need/ risk

Plan By whom By when Time estimate(per week)

Medication & treatment

                       

                                                          Professional support network

                       

                                                          Personal relationships

                       

                                                          Forensic                                                                                  Emotional & mental health

                       

                                                          Managing Risk

                       

                                                          Physical health

                       

                                                          Race, culture & identity

                       

Identified area of need/ risk

Plan By whom By when Time estimate(per week)

                                                          Education, training & employment

                       

                                                          Finance                                                                                  Daily routine, recreation & leisure

                       

                                                          Presentation & social awareness

                       

                                                          Interpersonal skills

                       

                                                          Relationships & social support networks

                       

                                                          Independent living skills

                       

                                                          Other                                                                                  

Total      

Note here the action to be taken in the event of an emergency or crisis.      

Identify here the overall approach and communication style that would best facilitate the subject’s engagement and progress, noting anything that should not be done as it may irritate or aggravate the subject.      

Date support plan completed      Date authorised by Maison Moti’s Managing Director      Date SDMT sent to the relevant Maison Moti project      Date sent to referrer      Date the Individual Service Agreement (ISA) sent to referrer and copy for prospective service user

     

Name & contact details of project

     

Service type       Proposed service start date      Trial period/Visits       Service charge      Period of time estimated at proposed service

      Proposed frequency of key working meetings

     

Reviews to be undertaken at       monthly intervals

Other instructions to project      

The completed information in Part 3 above represents the findings from our Initial Assessment, which together with any other information that may have been provided has been used to formulate the Outline Support Plan in section 20 above.

Please be advised that a more comprehensive assessment will be completed upon the service being commenced and this will form the basis of a Core Support Plan (Part 4). This will be sent to you for your approval within 4 weeks of the service start date. Once the Core Support Plan has been agreed you will then be sent regular reports (on at least an 8-weekly cycle) providing a summary of the progress against each of the support plan objectives.

Please use the comments box below to give us your feedback.

In particular what we would like to know from you is:

1. If relevant, the grounds for appealing our decision?2. Whether there any inaccuracies in the information provided?3. If there is any further information we should know of? 4. Whether you are agreeable to the proposed support plan?5. The date that you would like the service to commence from?

Please note that the service can only be agreed once you have signed and returned the Individual Service Agreement, which formally confirms your agreement to our terms and conditions and a service start date has been agreed.

We look forward to receiving your comments     

Once you have completed your comments please email the document (in its entirety) to the relevant member of staff at Maison Moti (first name followed by @maisonmoti.co.uk). If you have any queries please call our head office on 020 83666464.

Note to referrer

The remainder of this form is for internal use onlyDetails of all subsequent contact leading up to the funding and service start date being agreed.      

Date service agreed      Date of notification to finance team      NB: Info to finance to inc. copy of ISA which must include service user name, service start date, service charge and funding authority invoicing contact details

This part covers Core Assessment, Core Support Plan, Key Working, Reporting, Monitoring and Review.It is to be commenced immediately after the service has started and kept up to date by the allocated key worker, and overseen by the relevant project manager.

Available medicationList below all medicine that the service user has in his/ her possession and establish whether further supplies will be necessary within the first 4 weeks of service commencing.

Medicine Quantity Further supplies required1                  2                  3                  4                  5                  6                  7                  8                  

Attach photo of Service User here

Description of service user (to inc. height, weight, hair, eyes, distinguishing features, birth marks etc…)      

Date this Part (4) commenced

      By      

Last updated       By      

Service overview informationDate of service start       Date finance team notified      Project name and address       Service group      Project Manager       Key Worker      Trial Period       Date of Key Worker

allocation     

Frequency of key work meetings

      Date of Review      

Service user chargesDate tenancy agreement issued

      Rent charge per week      

Date HB application submitted

      Date of decision on HB claim & amount agreed

     

Amount of shortfall (if any) to be paid by SU

      Date notification sent to finance team

     

Weekly contribution towards utilities

     

NB: All payments by service users must be set up on a direct debit arrangement using our direct debit mandate form.

Part 4 – Service delivery

1. Core Assessment This section, Core Assessment and the Core Support Plan in section 2 below must be completed and sent to the Care co-ordinator within 4 weeks of the service start date.

The Core assessment is a more detailed assessment of each of the areas forming the Initial Assessment (in Part 3). Its purpose is to establish that the identified needs and risks have been assessed comprehensively and at the right level. Refer to the guidance notes in the Initial Assessment section for each of the related areas and also to the further guidance provided under each area in this part. The assessment should be broken down into manageable chunks and conducted over a 4 week period. NB: Only new or additional information should be added under each of the areas below, unless otherwise stated, i.e. medication which must be recorded in full again. In all other areas where there is no additional information or needs to those already stated in the initial assessment then this should be stated.Take time to explain the purpose of the assessment to the service user and obtain his/ her views and wishes, as well as any personal outcomes they would like to achieve with regard to each area.

1.1 Medication & TreatmentThis section must provide a complete and up to date account of all medication and treatment (for all physical and mental health conditions) relating to the service user. Therefore, all relevant info in Part 3, section 2 must be repeated. Is service user self medicating?Yes No

Provide details of all medication for all physical and mental health conditionsMedication Dosage Frequency Administered by Comments (inc. side effects,

when last reviewed and date finished)

1                              2                              3                              4                              5                              6                              7                              8                              9                              10                              

Details of all current mental health treatment and how the service user is responding to the treatment. Also note any follow-up appointments and whether these will need to be facilitated by staff.     

Details of all current physical health treatment and how the service user is responding to the treatment. Also note any follow-up appointments and whether these will need to be facilitated by staff.      

Plans for change of GP registration and CMHT     

1.2 Background      

1.3 Personal relationships Record here any additional contacts to those in Part 3, section 5 and provide details of the relationship with each person named in Part 5, how significant each contact is for the service user and also if support is needed to promote contact? Additionally, state whether the service user would benefit from assistance to develop other relationships?      

1.4 Forensic      

1.5 Emotional and mental health1.5.1 Current diagnosis      

1.5.2 Mental health history      

1.5.3 Significant life events Record here in detail how any events referred to in Part 3, section 7.3 continue to have an impact on the service user and whether support / services are required in this regard? Also establish whether there is any additional relevant information?     

1.5.4 Self perception and confidenceIf the service user has a negative self image and/ or low self confidence explore the reasons behind this and record them here, stating also what s/he feels could be done to improve in these areas.      

1.5. 5 Insight and awareness After further exploration record here the service user’s own understanding of his/ her mental health condition, the cause, the triggers, the relapse indicators and how s/he feels the condition could be stabilised and further improved. Also, describe the coping mechanisms the service user has adapted and whether further strategies could be developed. (Advice and guidance should be sought from our Clinical Supervisor as appropriate)     

1.5.6 Risk behaviours Changes suspected in this area must be notified to Maison Moti’s Clinical Supervisor who will reassess and record findings here.      

1.5.7 Relapse indicators Changes suspected in this area be must be notified to Maison Moti’s Clinical Supervisor who will reassess. And record findings here.      

1.6 Physical health 1.6.1 General health info     

1.6.2 Medical conditionsCondition Details           

1.6.3 Healthy living     

1.7 Culture, Race & Identity Following further exploration record here relevant info about any racial, cultural, religious, spiritual and other beliefs and any customs and practices that the service user wants to observe, including any related dietary requirements, etc…      Record here details of where any of the proof of identification documents referred to in Part 3, section 9 are located. If any were not seen at time of Initial Assessment ask to see them and record your observations. If not available are they still located at the same place as stated and can the service user access them if required?     

1.8 Education, training & employmentRecord here any interests that the service user could realistically pursue that could enhance his/ her employment opportunities. For example would s/he be interested in volunteering or any educational or vocational courses, does s/he have an up to date CV, could s/he benefit from training on interview skills etc…?      

1.9 Finance Check that all information in Part 3, section 11 is correct and still relevant and note any changes or additional information here.      

1.10 Daily routine, recreation and leisure Explore further with the service user his/ her interests and how these could be incorporated into his/ her activities and routine at Maison Moti. Note any additional information here.      

1.11 Presentation and social awareness Referring to the guidance in Part 3, section 13 explore further any issues in this regard and note any additional information here.     

1.12 Interpersonal skills Referring to the guidance in Part 3, section 14 explore further any issues in this regard and note any additional information here.     

1.13 Relationships and social support networks Explore further the nature and significance of relationships with the stated contacts in part 3, section 15 and note relevant information below. Consider how any relationships with significant others could be formed or further improved.      

1.14 Independent living skills Refer to Maison Moti’s ‘Comprehensive Independent Living Skills Assessment’ document and ensure that each of the stated areas is covered as part of this core assessment. Record here all areas the service user is assessed as requiring support in.      

1.15 Additional Information Record here any additional relevant information, cross referencing where appropriate to earlier sections.

     

1.16 Summary of overall findings of this assessment Record here a summary of the additional needs identified as part of the Core Assessment     

1.17 Service user viewsRecord here the wishes and feelings of the service user, or other comments. Note any areas of disagreement.      

Service user signature      Date signed      

2. Core Support Plan Record under the relevant area below all needs/ risks identified from the Initial, Core and all Subsequent Assessments and how these are to be managed. Particular attention should be given to stabilising and improving mental health, activities to promote social needs such as daily routines, recreation & leisure, social presentation & awareness, relationships and social support networks, education, training & employment and independent living skills. Identified area of need/ risk

Plan By whom By when Time estimate(per week)

Medication & treatment

                       

                                                          Professional support network

                       

                                                          Personal relationships

                       

                                                          Forensic                                                                                  Emotional & mental health

                       

                                                          Managing Risk

                       

                                                          Physical health

                       

Identified area of need/ risk

Plan By whom By when Time estimate(per week)

                                                          Race, culture & identity

                       

                                                          Education, training & employment

                       

                                                          Finance                                                                                  Daily routine, recreation & leisure

                       

                                                          Presentation & social awareness

                       

                                                          Interpersonal skills

                       

                                                          Relationships & social support networks

                       

                                                          Independent living skills

                       

                                                          Other                                                                                  

Total      

Note here the action to be taken in the event of an emergency or crisis.

(Repeat the information contained under this section from the Outline Support Plan in Part 3 section 20 and add other relevant information).      

Note here the overall approach and communication style that would best facilitate the service user’s engagement and progress, noting anything that should not be done as it may irritate or aggravate the service user. (Repeat the information contained under this section from the Outline Support Plan in Part 3 section 20 and add other relevant information).      

Record here any comments by the service user (inc. any areas of disagreement)     

Service user signature

Date signed      

Date support plan completed

Date authorised by project manager

Date sent to Care Co-ordinator

Others sent to (state name and date sent)

Date copy given to service user

                             

Date authorised by Care Co-ordinator     

Record here any comments by the Care Co-ordinator     

3. Key working and ReportingDate of key work meeting Date report sent To whom Comments                                                                                                                                                                                                                                                                                                                                  

Date of key work meeting Date report sent To whom Comments                                                                                            

4. Monitoring and ReviewNB: The formal review of a service user’s case (see top of Part 4 for period within which a review is to take place) is to include a full review of the information contained in the Initial and Core Assessments sections of this document. The changes identified as part of a subsequent assessment are to be recorded in the assessment section in Part 3 whilst the plan is to be recorded in the Core Support Plan section in Part 4. Type of review Date By Comments Change of

support plan required?

Date changes to plan made

CPA                              Placement                              Case audit                              Supervision                              Other(Please specify)

                             

Other(Please specify)

                             

Date document ceased      

Reason (Inc. details of move-on placement/ accommodation and service outcomes)     

Authorised by