Assessment of Suitability & Vulnerability

for LOCATA nomination

This form is intended for the following purposes: An assessment of suitability and vulnerability for nomination to LOCATA, as eligible/entitled young person Leaving Care.

The assessment will support preparation, prioritisation and sustainability of a tenancy.

1. PERSONAL DETAILS

Surname

/ First Name(s)

Male/ (Please underline)

Address / Telephone No.

HOST ID:

Date of Birth:

2. VULNERABILITY & SUITABILITY

Please provide information regarding preparation for independence and readiness, suitability and any vulnerability issues

2.1 Background History (to include medical history)

This should include the time and length of the applicant's vulnerability including any factors that have brought about or heightened the vulnerability.

2.2 Agencies Involved (Example: Hospitals, GP, Health Visitor, Social Worker)

Please give name, profession, agency, address and contact telephone number. Could you please give brief details of their involvement and indicate who is the key worker

3.1 Housing History

Please state all addresses that the applicant has lived at over the past 5 years. This will include the addresses, dates of residence, and types of tenure i.e. whether the property was leased, rented, freehold, Council/Housing Association owned, living with friends or other.

Address / Date from / Date to / Type of tenure

Please state what problems the applicant has had with keeping themselves housed as well as what types of housing that they have coped well within.

3.2 Housing requirements and Accommodation Recommendations

Please state any recommendations which you consider relevant to the applicants accommodation requirements. Please detail why you have come to your conclusions.

3.3 Future Support

Please list the types of support currently being provided, or planned to be provided:

Agency / Named Contact / Telephone / Support offered (type and frequency)

What sort of signs should the housing officer be aware of that would indicate that your client is becoming unwell or requires extra support?

What would your client prefer to happen if they became unwell (i.e. people to contact)

3.4 Effect of behaviour upon others

Please state whether there is any indication violent, intimidatory or other behaviour that could present a danger to:

1.  Housing staff or

2.  To other adults and children whilst in temporary or permanent accommodation.

This information is vital to avoid risk to other people and to make sure that an accurate assessment of housing need is made.

4.0 ETHNIC (RACIAL) ORIGIN

To ensure full implementation of its Equal Opportunity Policies the Council has decided that it is essential to record the ethnic origin of all those applying for services. Clients should be asked to clarify their ethnic origin and the classification should be made by the nominating Caseworker where they fail to respond.

EXPLANATORY NOTE

(please cross ‘x’)
1.  Black Afro-Caribbean / X / Persons born in or whose recent forebears were born in Africa or the Caribbean
2.  Black Asian / Persons born in or whose recent forebears were born in the Indian Sub-Continent (to include Asians who wre born in Africa or the Caribbean or whose forebears were born there).
3.  Black British / Persons born in the United Kingdom to parent(s) of Afro-Caribbean or Black Asian families, even if this applies to only one parent.
4.  White U.K. / English, Scottish or Welsh.
5.  White Irish / Irish
6.  Other (please specify) / Persons born in or originating from countries not included in the above categories.

Does young person need an interpreter, if so for what language?

No

Name, address and phone number of agency submitting this report. (N.B. Vulnerability assessment forms are only accepted from Social Services or Probation).

UASC team

Harrow Children’s Services

Civic 1

Station Road

Middlesex

HA1 2LT

ALL INFORMATION CONTAINED IN THIS REPORT WILL REMAIN CONFIDENTIAL TO THE HOUSING DEPARTMENT AND WILL NOT BE DISCLOSED TO CLIENT OR ANY OTHER PARTIES.

Case workers signature: / Tel/Ext:
Office location
Date:

Lifeskills Programme completed:

Yes/No

Case has not been approved/case has been approved:

Yes/No

Team Managers name / signature:
Date:
Service Managers name / signature:
Date:

This form is to be sent back to:

Office location / Telephone number
Harrow Council Housing Department

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