Daily Record Form – Slimaine B Day Shift

Over view of the shift*
AM Routine
What time did Slimaine get up?*

: HH

MM
Has Slimaine had a shower or bed bath this am?*
Please describe what care you gave.
Have you noticed any skin break down during personal care?*
- Yes
- No
If yes, please describe what you have noticed.*
Hydration and Nutrition
Please record total fluid intake for the day.*

Fatigue
Please rate Slimaine's fatigue level's during your shift*
1- Not tired 5 - Very tired Please record the times of fatigue.
Daily activities
What therapies did Slimaine do today? Please describe and provide the times.*
Memory and prompts
Were prompts required?*
- Yes
- No

Additional Information
Did Slimaine display anger, frustration or distress today? Please describe
Did Slimaine refuse any interventions or support today?*
Did Slimaine have any interactions with Fayrouz or the children today? Please describe:
Did Staff have any interactions with the children today? How was this handled?*
Has the appointment calender and team email been checked?*
- Yes
- No
Was the WAV driven today*
- Yes
- No
- Not driven
The WAV is to be driven weekly.
For what purpose was the WAV driven?
Was the remote control switched off*
- yes
- No
- Not driven
Is there anything that either Libertatem Healthcare or the Case Manager need to be made aware of?
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