Exaireo Continuous Support Tool 1.0

• Document No.

• Resident:

• Project:

  Select Baxter Gate Bradgate Drive Clifford Road Toothill Road Swithland Road Wordsworth Road Meadow Lane Park Road Foothill Road Willow Road

  • Baxter Gate
  • Bradgate Drive
  • Clifford Road
  • Toothill Road
  • Swithland Road
  • Wordsworth Road
  • Meadow Lane
  • Park Road
  • Foothill Road
  • Willow Road

• Date and time of observation / information:

  Date

• Observed / Information provided by:

• At Location
  Address

• Date and time of form completion:

  Date

• Person completing form (if different to above):

Observations Made or Information Obtained

• Tap to enter each observation made, or information obtained, in turn:

Observation / Information

• Type of issue:

  Select Drug Taking Alcohol Consumption Mental Health Deterioration Money Matters Non-Engagement Offending Behaviour Antisocial Behaviour Rent Issues Relationships Domestic Skills Other

  • Drug Taking
  • Alcohol Consumption
  • Mental Health Deterioration
  • Money Matters
  • Non-Engagement
  • Offending Behaviour
  • Antisocial Behaviour
  • Rent Issues
  • Relationships
  • Domestic Skills
  • Other

• 'Other' Issue:

• Details of Observation made or Information obtained:

• Personal Insights / Discernment:

Risk Assessment

• Does this place the resident at risk?

  Safe

  At Risk

  N/A

• Enter EACH Risk, in turn:

Risk

• Type of Risk:

• Level of risk:

• Does this place others at risk?

  Safe

  At Risk

  N/A

• Enter Risk:

Risk

• Type of Risk:

• Level of risk:

Barriers to Overcome and Suggested Solutions

• Barriers to overcome:

Barrier

• Barrier:

• Suggested Solutions:

Suggestion

• Solution Type:

• Details:

• Person to Action:

• By when:

  Date

Sign Off

• Signed:

  Sign