Home > Hub article > Sample Housing Needs Assessment Form

Sample Housing Needs Assessment Form

Created: 01/12/2022, Bright Futures @Ruils

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.

  1. About the tenant(s)

Name

Age

Overview of benefits inc

DLA/PIP award

Support in place and funding agreed?

Other relevant info
  1. Property Size

Number of bedrooms

Number of Parking Spaces

Number of Bathrooms

Utility Room

Number of Living Rooms

Separate WC

Separate Dining Room
  1. 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
  1. 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
  1. Any requirements related to timescales?
    Any other relevant information?
  1. 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.

  1. 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