Home
About us
Case management
Testimonials
Our people
News
Events
Join us
Contact
X
Daily Record Form - KH - CM211
Daily Record Form – KH – CM211
Name of Support Worker
*
First
Last
Date of Support Session
*
MM slash DD slash YYYY
Time shift started
*
:
Hours
Minutes
Please use 24hr clock
Time shift ended
*
:
Hours
Minutes
Please use 24hr clock
1. Any Medication Required?
Medication | Dosage | Time | Reasons for change
2. Personal Care/Prompts required?
ie wash hands, adjust trousers, change into different clothes
3. Diary
Briefly note what KH has done today, activities etc (Include changes in needs and/or usual behaviour or routine and action taken. Also include if any unusual or changed circumstances that affected client – highlight any deviations)
4. Daily Living Skills
Specify activities completed and document details on how KH engaged, support required and why, e.g. washing up, cleaning/tidying, checking diary for the day’s activities, choosing what client wants to do that day, choosing evening activity etc
5. Were there any issues with the daily activities, any changes for the next time you support?
6. Activities
Specify what activities have been done today and detail how client engaged. If the session did not go ahead, note why.
7. Nutrition:
Detail what KH has eaten and their engagement in preparation/cooking/making drinks, what support required and any risks identified.
Water / Drinks
8. Behaviour/Mood including happiness and positivity. Also briefly note what KH feels contbuted to happiness or lowri mood/outburst and staff observations.
(Temper/behavioural outbursts complete a separate ABC, note here if separate ABC completed).
9. Cognitive Observations
Record observations of cognitive difficulties below and strategies used to assist, also observations that may be contributing , e.g. tiredness
Memory
Insight
Information processing
Perseveration / fixation
10. Note any contact with Case Manager Include Matters or Concerns Regarding clients Health and Well-Being or Requests Made for Assistance Over and Above That Agreed in The Care Plan.
11. Incidents/Accidents
Brief description – Fill in form and email to TM/CM
12. Risks and action taken to minimise them
13. Any Other Feedback- to include observations on what they felt went really well/felt positive about?
