Date of assessment (day 1) Date of assessment (day 6 if needed) Date of assessment (day 2 if needed) Date of assessment (day 7 if needed) Date of assessment (day 3 if needed) Date of assessment (day 8 if needed) Date of assessment (day 4 if needed) Date of assessment (day 9 if needed) Date of assessment (day 5 if needed) Date of assessment (day 10 if needed) Did the assessment team include If yes, please provide the name and independent review (Y/N) organisation of the independent reviewer 1) Number of ward assessments 1) Number of food assessments undertaken undertaken 2) Where the number assessed is fewer than 2) Where the number assessed is fewer than the minimum please provide an explanation the minimum please provide an explanation Assessment team numbers staff Assessment team numbers patient – – assessors assessors Number of staff assessors day 1 Number of patient assessors day 1 – – Number of staff assessors day Number of patient assessors day – – 2 (if needed) 2 (if needed) Number of staff assessors day Number of patient assessors day – – 3 (if needed) 3 (if needed) Number of staff assessors day Number of patient assessors day – – 4 (if needed) 4 (if needed) Number of staff assessors day Number of patient assessors day – – 5 (if needed) 5 (if needed) Number of staff assessors day Number of patient assessors day – – 6 (if needed) 6 (if needed) Number of staff assessors day Number of patient assessors day – – 7 (if needed) 7 (if needed) Number of staff assessors day Number of patient assessors day – – 8 (if needed) 8 (if needed) Number of staff assessors day Number of patient assessors day – – 9 (if needed) 9 (if needed) Number of staff assessors day Number of patient assessors day – – 10 (if needed) 10 (if needed)
Date of assessment (day 1) Date of assessment (day 6 if needed) Date of assessment (day 2 if needed) Date of assessment (day 7 if needed) Date of assessment (day 3 if needed) Date of assessment (day 8 if needed) Date of assessment (day 4 if needed) Date of assessment (day 9 if needed) Date of assessment (day 5 if needed) Date of assessment (day 10 if needed) Did the assessment team include independent review (Y/N) If yes, please provide the name and organisation of the independent reviewer 1) Number of ward assessments undertaken 1) Number of food assessments undertaken 2) Where the number assessed is fewer than the minimum please provide an explanation 2) Where the number assessed is fewer than the minimum please provide an explanation Assessment team numbers – staff assessors Assessment team numbers – patient assessors Number of staff assessors – day 1 Number of patient assessors – day 1 Number of staff assessors – day 2 (if needed) Number of patient assessors – day 2 (if needed) Number of staff assessors – day 3 (if needed) Number of patient assessors – day 3 (if needed) Number of staff assessors – day 4 (if needed) Number of patient assessors – day 4 (if needed) Number of staff assessors – day 5 (if needed) Number of patient assessors – day 5 (if needed) Number of staff assessors – day 6 (if needed) Number of patient assessors – day 6 (if needed) Number of staff assessors – day 7 (if needed) Number of patient assessors – day 7 (if needed) Number of staff assessors – day 8 (if needed) Number of patient assessors – day 8 (if needed) Number of staff assessors – day 9 (if needed) Number of patient assessors – day 9 (if needed) Number of staff assessors – day 10 (if needed) Number of patient assessors – day 10 (if needed)
place-org-asses-details-jan15.docx