Daily Record Form – Stella B – Night Shift

Client Name*
First
Name of Support Worker(s) on Shift*
Date of the shift*
Date Format: DD slash MM slash YYYY

Please remember to enter the correct date the shift started.
Shift Start Time*

: HH

MM
Shift End Time*

: HH

MM

Night Time Routine
Can you confirm that you have received detailed handover?*
- I can confirm
- I cannot confirm
What time did Stella choose to get ready for bed? This should always be Stella’s choice, as her care is designed to be person centred.*

: HH

MM
Please describe bedtime routine, and record when Stella eventually retired to bed.*
Was the Wendylette system used today to help Stella achieve the optimum sleeping position?*
- Yes
- No
If not - why not?
Were her cot sides put back up when left in bed?*
- Yes
- No
Was the TOTO turning system in use last night?*
- Yes
- No
If not , why not?
Confirm settings and also confirm that this system ensured Stella’s position was changed at least 3-4 hourly overnight?*
Was the camera trained on Stella overnight so that staff could observe for any issues?
Document any other assistance or care delivered to Stella overnight and include reasons and times.*
State the times that Stella woke during the night? What did she need support with? For how long Stella was up?*
e.g. toileting, needed reassurance etc.

Did Stella required any assistance with hygiene during the night, for instance as a result of incontinence?*
- Yes
- No
If so, please detail below
How would you rate Stella's overall quality of sleep during the shift from 1-5?*
1 being poor & 5 would be excellent.
Record any other issues or concerns you may have encountered?*

Can you confirm that you have received detailed handover?
- I can confirm
- I can not confirm
Is there anything you would like to raise to Libertatem Healthcare ?*
- Yes
- No
Please give further details*
Do you have any safeguarding concerns?*
- Yes
- No
Please give further details*
Signature*

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