Initial Application Form For

Solihull Supportive Lodgings Scheme

Home Assessment

1. DETAILS OF PROSPECTIVE CARERS

Applicant 1

Applicant 2

Surname: / /
Forenames: / /
Other “known by” names / /
Previous Name(s):
(if applicable) / /
Date of Birth: / /
Place of Birth / /
Address: / /
Length of time at this address. / /
Home Telephone Number: / /
Mobile Telephone Number: / /
E-mail address / /
Ethnic Origin: / /
Religion: / /
Occupation: / /
Availability: (e.g. hours of work, other commitments) / /

Partnership status

If the applicant is married, give date and place of marriage
If the applicant has a registered civil partnership, give date and place of registration
If the applicant is living with a partner, date on which they set up a household together
If the applicant is separated or divorced or has dissolved a civil partnership, give date and name of partner
If the applicant had set up a household with a partner, give date when this ended and name of partner

Identity

/ Applicant 1 / Applicant 2 /
Sex
Nationality
Ethnic origin
Primary language spoken in the home
Other language/s spoken in the home
Religion or faith group
Practising or non-practising
Is the applicant registered as disabled?

Who else lives in the household?

Children under 18

Family name / Forename/s / Sex
M/F / Date of birth / Ethnic descent / Relationship to applicant/s / Current school / Interviewed? /
Family name / Forename/s / Sex
M/F / Date of birth / Ethnic descent / Relationship to applicant/s / Agreement to CRB reference / Interviewed? /

Adults (including grown-up children) living in the household

Are there children (under 18) from a current or previous partnership living elsewhere? Where a child has died, their details should be recorded here

Family name / Forename/s / Sex
M/F / Date of birth/ death / Ethnic descent / Relationship to applicant / Inter-viewed? /

Does the applicant have adult children living elsewhere? Where this person has died, the details should be recorded here

Family name / Forename/s / Sex
M/F / Date of birth/ death / Ethnic descent / Relationship to applicant / Inter-viewed? /

Does the applicant/s hold a valid driving licence?

Are carers willing to use their vehicle for Staying Put purposes. Y/N.

If yes please complete the following.

Date Seen / Comments
Registration number
Valid Road Tax
Valid Insurance Cover
MOT
Driving Licence/s

REFERENCES INCLUDING STATUTORY CHECKS

STRICTLY CONFIDENTIAL – for limited circulation

Reference Type / Date Returned. / 1st Applicant / 2nd Applicant / Other adult member of Household / Other adult member of House hold
C.R.B enhanced check.
Home local authority
Previous local authorities for the last 10 years
Medical Reference.
Probation.
SSAFA (current or ex-services only)
Personal Reference 1.
Personal Reference 2.
Employer’s Reference (if appropriate).
Other relevant employment. (E.G voluntary work with Young people).
Past Partners. (if decision is made not to pursue by Fostering Manager clear reason why to be recorded).

APPLICATION PROGRESS

Date of Initial Home Visit.
Date of Application.
Attendance at preparation training.
(Sessions attended)
Name of Assessor.
Date Assessment Started.
Date Report Completed.
Number Of Assessment sessions.
Details of any delays or difficulties in the assessment process.

SUMMARY OF ATTACHED INFROMATION

Information attached / Tick if attached / Page number
Personal Reference 1
Personal Reference from 2
Past Partner references
C.R.B interview (if required) for …………….(persons name and position in household)
Discussion with household members.
Current Employee’s Reference.
Other Employment Reference (voluntary work)
Eco map of support.
Carer Profile.

HOME ASSESSMENT

PROFILE’S OF HOUSEHOLD

PERSONAL PROFILE ON EACH APPLICANT

· Health, Personality, Religion, Culture, Employment and Interests/ Hobbies;

· Disabilities of carer likely to affect the applicants ability to care for a Young Adult;

· Applicants own religion, level of observation, attitude and knowledge of their religions;

· Experiences of own childhood and transition to independence;

· Complete Carers Profile.

PERSONAL PROFILE OF ANY CHILDREN IN THE HOUSEHOLD

· Health, Personality, Religion, Culture, Employment, Interests / Hobbies;

· Understanding of and attitude regarding parents wishes to provide Staying Put Placements;

· Ability to cope with the impact of issues that a Young Adult may bring to the household;

· Understanding of confidentiality.

PERSONAL PROFILE OF ANY OTHER ADULTS IN THE HOUSEHOLD

· Health, Personality, Religion, Culture, Employment, Interests/ Hobbies;

· Understanding of and attitude regarding proposed Supported Lodgings Placements;

· Role adult will take regarding Staying Put Young Adult in the household;

· Confirm C.R.B checks are satisfactorily.

ACCOMMODATION

· Describe and give opinion on the adequacy of sleeping arrangements (own room), communal areas, living space etc for another young person;

· Is accommodation physically safe and hygienic?

· Comments on access to schools, colleges, employment, public transport etc;

· Can the applicant drive, are they willing to use their own vehicle, [do they have a current driving licence, insurance and MOT (if applicable)];

· Comment on front door keys, telephones, access to them by a Young Person?

· Cooking Meals - What are the applicants’ views on cooking for Young People/supervising any meal preparation/acquisition of food.

CARING SKILLS

· Parenting / caring skills and experience relevant to Young Adults;

· Ability to relate to Young Adults - their own and other peoples, how do they talk to, listen to, negotiate with, and build positive relationships with Young adults;

· Cooking Meals - What are the applicants views on cooking for Young People/supervising any meal preparation/acquisition of food;

· Understanding of the need for and ability to provide, a healthy safe place for a Young Adult to live;

· Understanding of and methods to manage issues that may arise regarding Young Adults in placement;

· Ability to balance the needs and lifestyles of all people within the household;

· Ability to provide support and care appropriate to the development and needs of the individual;

· Responding appropriately during periods of stress or crisis;

· Supports from family, friends and wider community.

INDEPENDENCE SKILLS

· How would they support a Young Adult to develop their personal safety in the home and community;

· Willingness to support Young Adults to make informed choices and work through mistakes;

· Willingness / understanding of supporting Young Adults to develop appropriate daily routines;

· Methods to support Young Adults to manage finances and budgets; Willingness to promote and support a Young Adult to access Education, employment, training and leisure opportunities;

· Understanding of and skills in preparing a Young Adult to move on in a planned way;

· Support a Young Adult to manage relationships with their own family members and friends.

CONFIDENTIALITY AND PRIVACY

· What use would the applicants make of Confidential Information about Young Adults past histories, would it be positive and enabling and not restrict their expectations? When and what to share with regard to information;

· Demonstrate an understanding of the implications of confidentiality and Privacy in caring for a Young Adult.

WIDER HOUSEHOLD ISSUES

· Comment on what household rules and routines do they have, how will a Young Adult be expected to fit into these?

· Comment on front door keys, Young adults coming and going, staying away from placement;

· Own holiday arrangements for household - what would they expect of a Young Adult?

· Attitude towards credit cards catalogues etc.;

· Support in an emergency.

ATTITUDES AND BEHAVIOUR REGARDING RACE, CULTURE, GENDER, SEXUALITY, DISABILITY AND HIV/AIDS

· Comment on applicants experience and understanding of the above issues;

· How would they help a Young Adult cope with prejudice, discrimination and oppression?

· How would they respond to oppressive attitudes or behaviour from a Young Adult in their household?

ABILITY TO WORK IN PARTNERSHIP

· Applicants’ willingness and ability to work with Social Workers and the Directorate as a whole.

· Ability to attend meetings and keep records as required.

· Understanding of roles and responsibilities as a Supported Lodgings Carer of a Young Adult.

· Understanding of the Policies, Procedures and Legal requirements of the Staying Put Project and Carers ability to work to these.

· Willingness to work with Young Adults to maintain meaningful contact with parents and relatives. Contact in the family home

· Attitude towards parents and relatives, especially when neglect, abuse and rejection are, or were, involved.

· Will be willing to work to a focussed or a changing Pathway Plan.

LEARNING

· Evidence of carers’ attitude to further learning/training, their willingness and ability to learn formally and informally through experience?

· What are their likely training needs?

YOUNG PERSON’S AND SUPERVISING SOCIAL WORKER’S VIEWS ABOUT THE CONVERSION (Complete this section only if former carers converting to supported lodgings/Staying Put)

ANALYSIS, EVALUATION AND SUMMARY

Analysis, evaluation and summary of key factors leading to the recommendation

This should identify the strengths, vulnerabilities and any areas for the applicant’s further development as Supported Lodgings carers. For staying Put, this should also include the young person’s and supervising social worker’s views about the conversion from fostering into supported lodgings.

Recommendation to the Supported Lodgings Panel

Applicant/s comments on assessment. We/I have read this assessment of me/us and agree with its contents and recommendations. If not please comment

Signature of Applicant 1 Date……………

Signature of Applicant 2 Date…………..

Signature of Social worker completing this report Date…………..

Signature of ATM responsible for the report Date…………..

Date presented to Supported Lodgings Panel Date…………..

SUPPORTED LODGINGS PANEL RECOMMENDATION

……………………………………………………………………………………………..

Signed…………………… Date…………..

Recommendation ratified by……… Date………………