Daily Record Form – LW








  • MM slash DD slash YYYY

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    Please use 24hr clock
  • :

    Please use 24hr clock
  • Due to COVID-19, staff are to check Louisa’s temperature at 9am and 9pm and record here. A fever/high temperature is 37.8C or higher, which would result in the current COVID-Plan being followed. (located at the back of the Health and Safety Folder)






















  • Note steps taken to reduce pain and how staff supported with this, describe how LW was consulted, options offered before resulting in administering PRN – follow pain management programme. What was the outcome.
  • Showering/bathing/dressing etc. Completed as per Care Plan? Yes or no. If no detail why.
  • Lou is weighed every two weeks after her shower. Staff aim for 08.30, note actual time of weigh in and weight below







  • Briefly note what Louisa has done today, check with her in regard to talking about/ remembering her activities. (Include changes in her needs and/or usual behaviour or routine and action taken. Also include if any unusual or changed circumstances that affected Louisa – highlight any deviations)
  • Specify activities completed and document details on how Louisa engaged, support required and why, e.g. washing up, cleaning/tidying, checking her diary for the day’s activities, feeding Percy, choosing what she wants to do that day, choosing evening activity etc
  • Specify what activities have been done today and detail how Louisa engaged. If the session did not go ahead, note why.
  • Refer to NEURO Plan. Detail what Louisa has eaten and her engagement in preparation/cooking/ making drinks, and any risks identified.
  • Note when Lou has opened her bowels, the aim is to have healthy bowels as a result of her new nutritious eating plan and to discontinue lactulose.







  • Louisa has chosen and is supported to follow ‘The Alzheimer’s Solution’ to help her achieve her personal goal to be ‘Sexy at 60’ and thereafter. Her goals are broken down following the NEURO plan. Note below how Louisa engaged in her lifestyle choices and activities, support intervention and why.
  • Whole food, plant-based diet, low sugar, salt, and processed foods. Describe how Louisa engaged with her choices and the planning and preparation of her shopping.
  • Active lifestyle – ADL, movement every hour, for example, walking around the garden, etc. Monitor Louisa’s watch with her and note the steps here that she does daily
  • stress and fatigue management – meditation, yoga, mindful breathing exercises, pampering, nature, strong communities
  • Note how Louisa prepared for bed. Goal – 7-8 hours’ sleep per night. Note techniques used to improve sleep hygiene, e.g. promoting the same time to bed each night and same time to get up each morning. Monitor Fitbit for sleep data/restless, etc and record that here
  • Music, social interaction, Angel Cards, Church new activities, and learning
  • (Heightened frustrations/challenging behaviour – complete a separate ABC, note here if separate ABC completed)
  • SRecord observations of cognitive difficulties below and strategies used to assist, also observations that may be contributing , e.g. tiredness
  • Include Matters or Concerns Regarding Louisa’s Health and Well-Being or Requests Made for Assistance Over and Above That Agreed in The Care Plan.
  • Brief description – Fill in form and email to TM/CM