Accommodation & Environment Current accommodation circumstances (please tick & give details as appropriate) House Bungalow Sheltered Ground Flat above Residential Nursing Housing Floor Flat ground floor Home Home Owner Occupier Council Tenant Housing Private Tenancy Lodgings Association Tenant Living Alone Living with Living with Living with Living with Living with spouse offspring siblings other relative friend Suitability of No Problems Some difficulty due to Confined to one area Accommodation disability e.g. sleeps downstairs Access Level Front Level Back Flight of Stairs Step or Steps Central Heating Electric Fires Gas Fires Calor Gas Fires Open Heating Fires Microwave Electric Cooker Gas Cooker Calor Gas Solid Fuel Cooking Oven Cooker Toilet Inside Inside Upstairs Outside Chemical Commode Downstairs Commode Bathroom Downstairs Downstairs Upstairs Upstairs Bath None Shower Bath Shower If a live in carer is requested, is there a habitable room available for the carer to sleep in? Yes / No Any other risk related to the home environment? Yes / No If yes, please describe:
Accommodation & Environment Current accommodation circumstances (please tick & give details as appropriate) House Bungalow Sheltered Housing Ground Floor Flat Flat above ground floor Residential Home Nursing Home Owner Occupier Council Tenant Housing Association Tenant Private Tenancy Lodgings Living Alone Living with spouse Living with offspring Living with siblings Living with other relative Living with friend Suitability of Accommodation No Problems Some difficulty due to disability Confined to one area e.g. sleeps downstairs Access Level Front Level Back Flight of Stairs Step or Steps Heating Central Heating Electric Fires Gas Fires Calor Gas Fires Open Fires Cooking Microwave Oven Electric Cooker Gas Cooker Calor Gas Cooker Solid Fuel Toilet Inside Downstairs Inside Upstairs Outside Chemical Commode Commode Bathroom Downstairs Shower Downstairs Bath Upstairs Shower Upstairs Bath None If a live in carer is requested, is there a habitable room available for the carer to sleep in? Yes / No Any other risk related to the home environment? Yes / No If yes, please describe:
Fast-Track-Care-Plan.docx