Selects appropriate clothing Puts on Removes socks for season / activity Puts on shoes on correct Removes Knows when clothing feet Removes shirt needs to be changed Uses Velcro closures Removes bra Grasps / holds clothing Ties laces articles Removes underwear Wears appropriate footwear Knows when clothes are Fastens buttons in the daytime right side out vs. inside out Zips zipper Wears appropriate footwear Recognizes modesty at night Applies / removes belt issues during dressing Puts on bra Resident Preferences Selects own clothing Uses adaptive / assistive device(s). If yes, specify: Expresses preferences: COMMENTS (EXAMPLES: 1) Resident would benefit from learning how to put shoes on correct feet; 2) Resident should not wear clothing with buttons or snaps; and 3) It is important that the resident wears baseball hats): Hygiene / Grooming Skills: On each line below, enter the number that best represents the resident’s present level of ability for each skill: 1. Physical 3. Verbal 5. Self-Reliant 2. Gestural 4. Independent N/A Not Applicable Knows when to brush teeth Washes face Applies aftershave / cologne / perfume Opens toothpaste tube Rinses hands Provides own fingernail Puts toothpaste on Dries hands care toothbrush Gathers / puts away Uses nail clippers Y N Tolerates toothbrush grooming items Blows nose with tissue Makes brushing motions Brushes / combs hair Understands need for good Brushes teeth / gums Styles hair hygiene / grooming Uses dental floss Y N Tolerates beautician / Uses mirror during care barber cutting hair Rinses mouth Applies make-up Requests hair appointment Turns on water Cleans dentures Applies deodorant Rinses toothbrush and puts Cleans glasses away Aware of when to be shaved Cares for hearing aid Applies soap to hands Shaves self with electric Provides own Menses care Makes rubbing motion with razor hands Mouth wash (fluoride rinse) Resident Preferences Expresses preferences: COMMENTS (EXAMPLES: 1) Resident has expressed fear that soap will burn eyes; AND 2) Resident just received glasses. Could learn to store properly): Toileting Skills:
Selects appropriate clothing for season / activity Knows when clothing needs to be changed Grasps / holds clothing articles Knows when clothes are right side out vs. inside out Recognizes modesty issues during dressing Puts on bra Puts on Puts on shoes on correct feet Uses Velcro closures Ties laces Wears appropriate footwear in the daytime Wears appropriate footwear at night Removes socks Removes Removes shirt Removes bra Removes underwear Fastens buttons Zips zipper Applies / removes belt Resident Preferences Selects own clothing Uses adaptive / assistive device(s). If yes, specify: Expresses preferences: COMMENTS (EXAMPLES: 1) Resident would benefit from learning how to put shoes on correct feet; 2) Resident should not wear clothing with buttons or snaps; and 3) It is important that the resident wears baseball hats): Hygiene / Grooming Skills: On each line below, enter the number that best represents the resident’s present level of ability for each skill: 1. Physical 3. Verbal 5. Self-Reliant 2. Gestural 4. Independent N/A Not Applicable Knows when to brush teeth Opens toothpaste tube Puts toothpaste on toothbrush Y N Tolerates toothbrush Makes brushing motions Brushes teeth / gums Uses dental floss Rinses mouth Turns on water Rinses toothbrush and puts away Applies soap to hands Makes rubbing motion with hands Washes face Rinses hands Dries hands Gathers / puts away grooming items Brushes / combs hair Styles hair Y N Tolerates beautician / barber cutting hair Requests hair appointment Applies deodorant Aware of when to be shaved Shaves self with electric razor Mouth wash (fluoride rinse) Applies aftershave / cologne / perfume Provides own fingernail care Uses nail clippers Blows nose with tissue Understands need for good hygiene / grooming Uses mirror during care Applies make-up Cleans dentures Cleans glasses Cares for hearing aid Provides own Menses care Resident Preferences Expresses preferences: COMMENTS (EXAMPLES: 1) Resident has expressed fear that soap will burn eyes; AND 2) Resident just received glasses. Could learn to store properly): Toileting Skills:
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