DR MILLEY’S HOSPITAL ANNUAL VISIT FORM
STRICTLY CONFIDENTIAL
NAME OF RESIDENT:
DATE RESIDENCY STARTED:
DATE OF VISIT:
TRUSTEES UNDERTAKING THE VISIT:
REASON FOR TAKING UP RESIDENCY AT DR MILLEYS:
(a brief outline e.g. domestic violence, loss of accommodation, financial problems, which would show the ‘need’ which satisfied the granting of accommodation and highlighting any changes in circumstances)
CURRENT SITUATION
A HEALTH:
E.g.no significant health issues raised or brief outline of issues that would affect employment /independent living/leaving Milley’s.
B EMPLOYMENT STATUS:
E.g. 'works for X company, five days a week for 30 hours. Hourly rate = minimum wage.'
C FINANCIAL POSITION:
e.g. ‘no debts' / paying off x debts at y per week
D PARTICIPATION IN THE MILLEY’S COMMUNITY:
(would include here participation in residents’ activities, friendships, gardening and Residents’ Meetings)
E SOCIAL TIES INCLUDING FAMILY:
(would include here activities/relationships with wider Lichfield community and family, if any and if relevant)
F RESIDENT’S FUTURE PLANS, IN PARTICULAR AS REGARDS RESIDENCY AT DR MILLEY’S HOSPITAL:
(whether Milley’s’ seen as a stepping stone or permanent residence and any factors which may hinder the resident from becoming fully independent)
G CONDITION/CLEANLINESS OF FLAT:
H. ARE THE EMERGENCY CONTACT DETAILS STILL CORRECT?
J DOES THE ADMINISTRATOR STILL HAVE THE CORRECT PHONE NUMBER FOR THE RESIDENT?
K ANY CONCERNS RAISED BY RESIDENT DURING VISIT RE LIVING AT MILLEY’S:
L SUGGESTIONS RAISED BY TRUSTEES:
(could be signposting to help/support from other agencies or organisations, or how to address issues raised by living at Milley’s)
M THE HANDBOOK AND RESIDENTS’ RULES.
(a gentle reminder about the handbook and how broken rules could lead to a setting aside of the occupancy)
*PLEASE NOTE THAT AS AGREED AT A TRUSTEES MEETING, THIS WILL ALSO BE SEEN AS AN OPPORTUNITY TO CHECK THE FLAT FOR ANY MAINTENANCE ISSUES, PLUS THE STATE OF THE FLAT, INCLUDING THE OTHER ROOMS IN THE FLAT/STUDIO*