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Home
About Us
Our Official Charity Partner
Meet the Team
Clients
Testimonials
Acquired or Traumatic Brain Injury
Spinal Injury
Other Medical Conditions
Live Vacancies
Register CV
Candidates
Apply online
Supporting Our Official Charity Partner
Subject Access Requests
Refer a Friend Scheme
Care Packages for Brain and Spinal injury
Contact Us
Submit a Daily Record
Daily Record Form - Paul B - Day Shift
Step 1 of 8
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Username:
Client Name
*
Name (s) of Support Workers on shift today
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Today's Date
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Date Format: DD slash MM slash YYYY
Shift Start Time
*
:
HH
MM
AM
PM
Shift End Time
*
:
HH
MM
AM
PM
Brief Overview of today (what, when, how)
Morning Routine
Please give details of the handover? What time did Paul wake up?
*
Did Paul need any support washing and dressing?
*
Nutrition
What did Paul have for Breakfast?
*
What did Paul have for lunch?
*
What did Paul have for dinner?
*
Fatigue and Monitoring
Did Paul suffer from any levels of fatigue today, that you observed?
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Did this disrupt any planned activities?
How would you rate Paul's fatigue levels at 8am?
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0
1 -2
3-5
6-8
9-10
Energetic/No fatigue – Alert, oriented, keen to engage in daily activities Mild – some tiredness but fatigue passes after a short rest (15-20 minutes/length of a cup of coffee) Moderate – yawning, need an extended rest, sitting with eyes closed, resting for 30 – 45 minutes. Severe – slurred speech, reduced balance (feeling wobbly on feet), feeling an extreme lack of energy, falling asleep when resting, repetitive conversation, need to lie down and sleep for at least an hour. Worst possible – disoriented, poor concentration, repetitive (mentioning age and lack of memory), low in mood, tearfulness, sleeping for 1-2 hours.
How would you rate Paul's fatigue levels at 12? (midday)
*
0
1 -2
3-5
6-8
9-10
Energetic/No fatigue – Alert, oriented, keen to engage in daily activities Mild – some tiredness but fatigue passes after a short rest (15-20 minutes/length of a cup of coffee) Moderate – yawning, need an extended rest, sitting with eyes closed, resting for 30 – 45 minutes. Severe – slurred speech, reduced balance (feeling wobbly on feet), feeling an extreme lack of energy, falling asleep when resting, repetitive conversation, need to lie down and sleep for at least an hour. Worst possible – disoriented, poor concentration, repetitive (mentioning age and lack of memory), low in mood, tearfulness, sleeping for 1-2 hours.
How would you rate Paul's fatigue levels at 5pm?
*
0
1 -2
3-5
6-8
9-10
Energetic/No fatigue – Alert, oriented, keen to engage in daily activities Mild – some tiredness but fatigue passes after a short rest (15-20 minutes/length of a cup of coffee) Moderate – yawning, need an extended rest, sitting with eyes closed, resting for 30 – 45 minutes. Severe – slurred speech, reduced balance (feeling wobbly on feet), feeling an extreme lack of energy, falling asleep when resting, repetitive conversation, need to lie down and sleep for at least an hour. Worst possible – disoriented, poor concentration, repetitive (mentioning age and lack of memory), low in mood, tearfulness, sleeping for 1-2 hours.
How would you rate Paul's fatigue levels at 8pm?
*
0
1 -2
3-5
6-8
9-10
Energetic/No fatigue – Alert, oriented, keen to engage in daily activities Mild – some tiredness but fatigue passes after a short rest (15-20 minutes/length of a cup of coffee) Moderate – yawning, need an extended rest, sitting with eyes closed, resting for 30 – 45 minutes. Severe – slurred speech, reduced balance (feeling wobbly on feet), feeling an extreme lack of energy, falling asleep when resting, repetitive conversation, need to lie down and sleep for at least an hour. Worst possible – disoriented, poor concentration, repetitive (mentioning age and lack of memory), low in mood, tearfulness, sleeping for 1-2 hours.
Psychological and Emotional
Please rate Paul's mood this morning
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1
2
3
4
5
6
7
8
9
10
1 being low -10 being happy
Please rate Paul's mood around midday
*
1
2
3
4
5
6
7
8
9
10
1 being low -10 being happy
Please rate Paul's mood in the evening
*
1
2
3
4
5
6
7
8
9
10
1 being low -10 being happy
Please provide any other details of Paul's mood during the day?
*
Has Paul repeated, mentioned or discussed his mum passing, his age, heart attack or anything else?
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Yes
No
If so, how many times today has been repeated?
*
If so, what was said / discussed?
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Did you notice any fluctuations in Paul's mood after the discussion – e.g. withdrawal/quiet/disengaged, over active, etc.?
*
Did Paul show any signs of anxiety or stress today?
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Yes
No
If yes, then please describe this.
Activities & Visitors
What activities or planning did you do with Paul today?
*
Did Paul have any healthcare professionals call or visit the house today?
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Yes
No
If so, who were they? and were these planned?
*
How long has Paul been on his phone and ipad using social media facebook? (Provide information in hours and minutes)
*
General
Do you have any safeguarding concerns?
*
Is there anything else that Libertatem or the Case Manager need to be aware of?
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