The Essex Skipper Social Care referrals

Social Workers Name

Social workers Email address

Social worker contact number

Age of person to be referred

Which ratio would you consider the person to require? (The Essex Skipper will do their own assessment to identify the required ratio for the setting.)

Relevant information of person being referred which will help identify the way the person is supported by the service:

e.g: struggles with loud environments, recent bereavement, medical needs which require staff to administer medical care eg gastrostomy, sexualised behaviours etc...

Please give any information relating the member’s diagnosis relevant to their time at The Essex Skipper

Eg: Wheelchair accessibility, hoisting required, anaphylactic reactions, self harm....

Does the person display any challenging behaviours? If so please state what the behaviours are, the frequency of the behaviour, if there are any known triggers and how are the behaviours managed.

E.g : Flight risk, Hitting others, head butting, damage to property, removing seat belts in vehicles, sexualised behaviour, verbal assaults....

Please state if the person needs any assistance in regards to personal care

Eg wears pads requires changing/ wears pads but changes themself/ colostomy care requires support/ colostomy care independent/ needs prompting to use the toilet / none required

Please list any of the persons special interests

Eg emergency services, Pokemon, trains...

What activities are you most interested in for the person at The Essex Skipper?

What areas are interested in for the member at The Essex Skipper

Social Care Referral Form