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Sample Housing Needs Assessment Form
Who by? United Response, June 2018
Why might it be of interest?
When a young person is moving out of home into supported living the housing provider needs to be sure they understand all the housing needs of the young person and this form is to gather that information. It is very detailed and you probably won’t have considered half these things while your young person lives with you.
But when they are in their own supported living home it is important that the house meets their needs. It may not be possible to meet all the needs exactly but by completing this form the housing provider can identify where adaptations will be needed and what things might not be safe and if these things cannot be achieved in specific properties.
I would expect all housing providers to have something similar. It may well also help you think about what your young person needs in the actual house.
PROPERTY SPECIFICATION
This form is used to help us determine the housing needs and requirements of someone we support or are likely to support in the future.
- About the tenant(s)
Name |
Age |
Overview of benefits inc DLA/PIP award |
Support in place and funding agreed? |
Other relevant info |
- Property Size
Number of bedrooms |
Number of Parking Spaces |
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Number of Bathrooms |
Utility Room |
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Number of Living Rooms |
Separate WC |
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Separate Dining Room |
- Property Requirements
Postcode/Area |
Please tick one box for each option
Must have |
Would like |
Don’t mind |
No |
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Flat |
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House |
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Bungalow |
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Ground floor (if a flat) |
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Upper floor flat accessed by stairs |
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Upper floor flat accessed by a lift |
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Small block of flats |
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Large block of flats |
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Able to have pets |
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Separate entrance (if a flat) |
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Detached house or bungalow |
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Semi detached house of bungalow |
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Terraced house of bungalow |
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Garden |
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Garden overlooked by other properties |
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Garden overlooked by other properties |
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Garden shared with other tenants |
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Secure garden |
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Direct access to outside space |
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Driveway (off street parking) |
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Internal stairs |
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Bath |
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Shower over bath |
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Walk in bath |
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Wet room |
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Allows smoking |
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Allows pets ( please specify type of pet) |
3. Accessibility
Please tick if required
Required |
Required |
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Ramp or level access to entrances |
Mid height power switches/sockets |
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Lift to access an upper floor flat |
Storage for a wheelchair/mobility scooter |
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Adapted bathroom suitable for a wheelchair user |
Reinforced ceilings to accommodate hoists |
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Adapted kitchen suitable for a wheelchair user |
Doorways and corridors wide enough for internal wheelchair use |
4. Location
Are there specific requirements in relation to location, for example proximity of neighbours, need to avoid living near children, animals and main roads |
5. Robustness
Please tick if required
Required |
Required |
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Boxed in wiring, cabling and piping |
Water proof flooring(for example linoleum or flotex) |
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Light switched flush to the wall |
Non-slip flooring |
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Robust light switches and electric sockets |
Floor fully sealed (waterproof) |
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Reinforced walls |
Robust and durable bathroom fittings |
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Walls with impact absorbent surfaces |
Anti vandal bathroom fittings |
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Walls with rounded corners |
Motion sensitive taps |
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Reinforced door frames which are securely fixed |
WC Cistern boxed in |
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Heavy duty door hinges |
Inspection chamber behind toilet to make unblocking easier |
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Protective door strips (finger protection) |
Anti-ligature fittings |
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Safety glass |
Under floor heating |
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Laminated glass |
Built in wardrobes |
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Integrated blinds (blinds within a double glazed unit) |
Wardrobes fixed to the wall |
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Lighting flush with the ceiling |
Solid internal doors |
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Robust and durable kitchen fittings |
Additional electric sockets so cables of appliances do not need to trail |
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Lockable cupboards in the kitchen |
Fully tiled walls in bathroom |
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Lockable fridge |
Solid internal doors |
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Microwave in lockable cupboard |
Outward opening bathroom door |
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Induction hob |
Boxed in TV unit |
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Lockable kitchen door |
Privacy window film |
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Built in microwave |
Non-poisonous outdoor planting |
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Built in storage in living area |
Hard landscaping risk assessment |
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Wall mounted TV unit |
Heating controls inaccessible to person supported |
6. Sensory Needs
Please tick one box for each option
Must have |
Would like |
Don’t mind |
No |
|
Soundproofing of walls |
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Sound insulating floor covering |
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Double glazing |
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Alternative to mechanical air ventilation in bathroom and kitchen or sound insulation |
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Separate dining room |
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Soft on-flickering lighting |
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Adjustable lighting |
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Sensory room |
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Non-reflective wall surfaces |
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Colour scheme to promote low arousal environment |
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Low surface temperature radiators |
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Temperature control on taps |
- Support issues/ assistive technology
Please tick if required
Required |
Required |
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Bathroom big enough to enable support with personal hygiene |
Door entry system with CCTV |
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Kitchen big enough to enable support with life skills |
Epilepsy sensor |
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Separate WC for staff |
Enuresis sensor |
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Parking |
Bed occupancy sensor |
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Sleep in room |
Bogus caller alarm |
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Integrated CO2 alarm |
Contact alarm to alert window opening |
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Integrated smoke alarm |
Door fobs |
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Heat detector |
Fingerprint locks |
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Flood detector |
Intercom to speak to support worker in another part of the building |
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Panic alarm |
Pressure mats underneath floor covering |
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Fall sensor |
Smoke alarm suitable for a person with visual impairment |
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Property exit sensor |
Motion sensors to monitor |
- Any requirements related to timescales?
Any other relevant information?
- Next steps
Once this form has been completed, please send it to the relevant Housing Business Manager who will review the information and get back to you to agree the next steps.
If this is new business (as opposed to new housing for someone we already support)
- Please ensure that you have discussed this with your development manager.
- If there is family or social worker/other professional input, please ensure that they agree with the information provided on this form.
When suitable property has been identified, please ensure the following has taken place.
- Best Interest completed
- Property viewed by person to be supported
- Property viewed by family /advocate
- Property viewed by Social worker or other professionals
Please note below any concerns/objections which may need to be addressed before proceeding with the rental or purchase.
HOUSING APPLICATION
This form is used prior to the applicant moving into the Service or New property.
- About the tenant.
Name |
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Current Address: |
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Date of Birth: |
Sex: |
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Marital Status: |
NI number: |
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Next of Kin: |
Ethnic origin: |
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Social worker /Referral contact details: |
UR Service Manager/Team leader: |
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Is there a history of rent arrears at any previous properties? Please provide details: |
Is there a history of anti-social behaviour at previous properties? Please provide details: |
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Property/Service Address: |
Move in date if known: |
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Landlord Details: |
Property owner details: |
Categories: Housing, Independent Living
Tags: housing, location, needs assessment, property, size, specification, Supported living