Daily Record Form - MC - CM252 & 253 - Day Shift

Daily Record Form – MC – CM252 & 253 – Day Shift

Name of Support Worker 1*

First

Last
Name of Support Worker 2*

First

Last
Date of Support Session*

MM slash DD slash YYYY
Time Shift Started*

:
Hours

Minutes
Time Shift Ended*

:
Hours

Minutes
1. Did you ensure that M's room was ready for his return from school (if a school day)?
2. Have you checked all STOKES emails and communications?*
3. After school snack: Was it needed, who prepared it, what was it ?*
4. Did you collect MC from school in the van?*
5. WAV: Was van check carried out prior to journey?*
6. How was MC when taken to school, when collected from school, or when you arrived on shift?*
7. Splints: Did MC have his splints on at school? If not a school day, has M had splints on today?*
8. Lycra suit: Was suit worn at school? Was suit worn at home? What time was it taken off, if taken off early, please give details as to why.*
9. How was school handover? Home school communications noted?*
10. Please describe how your time was spent with M today, what support was required, any appointments attended etc*
11. Did you follow SALT communication guidelines today? How was this done, how did it go? Big Mack Switch used? E Tran Used? TACPAC? Songtime?*
12. SALT: What choices were given? What did M choose? How long did M take to choose? Did he look at the card or reach out for it? Was M happy when he got what he asked for? Do you think this choice was on purpose?
13. Physio: Did you follow physiotherapy guidelines today? How was this done, how did it go?*
14. Personal Care: Please detail MC personal care routine on shift today. Shower/strip wash, teeth etc Please detail what support was given and how it went. Were choices given when dressing?*
15. Family time: Did MC spend time with his family today? How long was he with them? Was he supported by staff during this time? If not what did you do?*
16. Dietary and fluid intake: What did MC eat and drink today. Please give details and rough times. Please details where M was when he ate. Please quantify liquids taken.*
17. How did MC interact with you and other team members today?*
18. Handover: Are there any appointments for tomorrow to be handed over?*
19. Incidents; Were there any incidents today? If so please complete an incident report form and contact CM or CMA.*
20. Daily cleaning: Cleaning rota checked? Please detail which cleaning activities have been carried out.*
21. Medication: Please detail medication and who gave this to him? Has staff member administering medication completed MAR chart? Were Mama Bear lotion, dental gel or Movicol required?*
22. Continence support: Please details times pad changed, wet, dry, full, bowel movement type etc If no bowel movement, has this information been handed over to Dad & next shift?
23. Home computer: Has Mahdi used this today? How long for? What programme did you try? What was Ms response? Did he enjoy/engage or not?
24. Debit card: Was this used, has the process been followed appropriately?
25. Body map: Any unexplained marks or bruising? If so has a body map been completed?
26. Emotional health & wellbeing: How would you describes M's emotional health and well being today?
27. Seizure Behaviour: Please note any unusual behaviours. eg twitching, muscle spasms, unusual sounds, sudden movements, absences etc*
28. Communication with Mum and Dad.
(Please record all calls from mum or dad here, time of calls and what was discussed)
29. Any other information
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