Daily Record Form – Pav D | Libertatem Healthcare

Username:*
Clients Name:*
Name(s) of the Support Workers on shift*
Date of the shift
Shift Start time:*
Shift end time:*
What time did Pav get up today?*
Was a full handover taken from the previous shift prior to starting work with Pav?*
- Yes
- No
Please provide details of any concerns from handover given:*
Food and Drink
Did Pav eat well today?*
- Yes
- No
Please give a brief summary of Pavs dietary intake?*
Was Pav encouraged to have a good intake of fluids? Please provide a brief summary below.*

Save and Continue Later

Personal Hygiene
Describe the assistance given with his morning hygiene routine, such as whether a shower was given?*
Has Pav passed urine today? please summarise times and any issues below.*
Has Pav's pad been changed and his hygiene needs met accordingly?*
- Yes
- No
Has Pav's bowels been open today, and has this been recorded on the bowel chart?*
- Yes
- No
Please provide details below of any concerns or issues::*

Save and Continue Later

Visitors
Were any of Pav's family members present during the shift? Please record below who else was in the house:*
Was Pav visited by any healthcare professionals, or members of the wider multidisciplinary team? If so, please record names and times below:*

Save and Continue Later

Accessing the community
Did Pav access the community with 2 staff in accordance with the care plan?*
- Yes
- No
Please provide details below including times, and any activities undertaken or any issues encountered??*
Were there any episodes of challenging behaviour during shift?*
Were all episodes of challenging behaviours recorded on the bespoke ABC chart provided?*
Were there any injuries to staff or to Pav that were as a result of challenging behaviours? If so, detail below, and confirm incident form has been fully completed, as well as Body Map if injury relates to Pav.*
Was there any damage to property during your shift, and has this been recorded on an incident form and reported to Pav’s parents?*

Save and Continue Later

Medication
Were medications given in accordance with the care plan and MAR chart instructions, and has the MAR chart been fully updated with required documentation?*

Save and Continue Later

Seizures
Was there any seizure activity today, and has this been recorded in detail on the seizure charts provided?*
Approximately how many abscence seizure episodes were observed today?*
Approximately how many drop seizures were observed today?*
Please summarise any issues observed or interventions required that relate to abscence and or drop seizures?*
Have there been any tonic clonic episodes of seizure activity and has this been fully recorded on the appropriate seizure documentation?
Has there been any further issues to report relating to seizure activity?
Were the clinical team contacted and fully updated about any issues of concern, such as prolonged seizure activity or prolonged episodes of challenging behaviours? If so-detail any calls made*
Please give a summary of the shift below, and include details of behavioural concerns, property damage, seizure episodes and miscellaneous incidents-or confirm that details have been recorded on the appropriate document.*
Was a full handover given to incoming staff at the end of your shift, and has Pav’s parents been updated about any issues during the shift-such as behavioural concerns, property damage, seizure episodes and miscellaneous incidents?*

Save and Continue Later

General
Is there anything that you feel Libertatem Healthcare or need to be made aware of?
Do you have any safeguarding concerns?

Save and Continue Later

Submit a Daily Record