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
Number of Bathrooms		Utility Room
Number of Living Rooms		Separate WC
Separate Dining Room

Property Requirements

Postcode/Area

Please tick one box for each option

	Must have	Would like	Don’t mind	No
Flat
House
Bungalow
Ground floor (if a flat)
Upper floor flat accessed by stairs
Upper floor flat accessed by a lift
Small block of flats
Large block of flats
Able to have pets
Separate entrance (if a flat)
Detached house or bungalow
Semi detached house of bungalow
Terraced house of bungalow
Garden
Garden overlooked by other properties
Garden overlooked by other properties
Garden shared with other tenants
Secure garden
Direct access to outside space
Driveway (off street parking)
Internal stairs
Bath
Shower over bath
Walk in bath
Wet room
Allows smoking
Allows pets ( please specify type of pet)

3. Accessibility

Please tick if required

	Required		Required
Ramp or level access to entrances		Mid height power switches/sockets
Lift to access an upper floor flat		Storage for a wheelchair/mobility scooter
Adapted bathroom suitable for a wheelchair user		Reinforced ceilings to accommodate hoists
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
Boxed in wiring, cabling and piping		Water proof flooring(for example linoleum or flotex)
Light switched flush to the wall		Non-slip flooring
Robust light switches and electric sockets		Floor fully sealed (waterproof)
Reinforced walls		Robust and durable bathroom fittings
Walls with impact absorbent surfaces		Anti vandal bathroom fittings
Walls with rounded corners		Motion sensitive taps
Reinforced door frames which are securely fixed		WC Cistern boxed in
Heavy duty door hinges		Inspection chamber behind toilet to make unblocking easier
Protective door strips (finger protection)		Anti-ligature fittings
Safety glass		Under floor heating
Laminated glass		Built in wardrobes
Integrated blinds (blinds within a double glazed unit)		Wardrobes fixed to the wall
Lighting flush with the ceiling		Solid internal doors
Robust and durable kitchen fittings		Additional electric sockets so cables of appliances do not need to trail
Lockable cupboards in the kitchen		Fully tiled walls in bathroom
Lockable fridge		Solid internal doors
Microwave in lockable cupboard		Outward opening bathroom door
Induction hob		Boxed in TV unit
Lockable kitchen door		Privacy window film
Built in microwave		Non-poisonous outdoor planting
Built in storage in living area		Hard landscaping risk assessment
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
Sound insulating floor covering
Double glazing
Alternative to mechanical air ventilation in bathroom and kitchen or sound insulation
Separate dining room
Soft on-flickering lighting
Adjustable lighting
Sensory room
Non-reflective wall surfaces
Colour scheme to promote low arousal environment
Low surface temperature radiators
Temperature control on taps

Support issues/ assistive technology

Please tick if required

	Required		Required
Bathroom big enough to enable support with personal hygiene		Door entry system with CCTV
Kitchen big enough to enable support with life skills		Epilepsy sensor
Separate WC for staff		Enuresis sensor
Parking		Bed occupancy sensor
Sleep in room		Bogus caller alarm
Integrated CO2 alarm		Contact alarm to alert window opening
Integrated smoke alarm		Door fobs
Heat detector		Fingerprint locks
Flood detector		Intercom to speak to support worker in another part of the building
Panic alarm		Pressure mats underneath floor covering
Fall sensor		Smoke alarm suitable for a person with visual impairment
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
Current Address:
Date of Birth:		Sex:
Marital Status:		NI number:
Next of Kin:		Ethnic origin:
Social worker /Referral contact details:		UR Service Manager/Team leader:
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:
Property/Service Address:		Move in date if known:
Landlord Details:		Property owner details:

Categories: Independent Living

Tags: housing, location, needs assessment, property, size, specification, Supported living

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