Quarterly-Monitoring Outcomes

VALE OF GLAMORGAN COUNCIL

Personal Support Plan/ Quarterly Monitoring/ Outcomes

(Pages 1 to 6 to be completed with the tenant/licensee)

Name:
Age:
Address:
Date of Review:
Date of next review:
Name of Organisation:
Key Worker:
Date support commenced:
Date of last quarterly review (if applicable):
Please give details of the types of support work that has been carried out in the last quarter:
Number of appointments missed since last quarterly review
Reasons
Have the goals from the last review or commencement of support (whichever the latter) been met?
What were the barriers in meeting those goals?
How does the tenant feel that the support is working and what has been the impact of the service on their lives?
What are the goals for the future / Goals achieved in the last quarter
Area / Previous Outcome / Short Term / Long Term / How to Achieve & Target Date / Goals Achieved / Current Outcome / Reason for not achieving outcome
Promoting Personal and Community Safety.
Feeling Safe
1
Contributing to the Safety and Well-being of Self and others
2
Promoting independence and control
Managing accom
3
Managing relationships
4
Feeling part of the community
5
Promoting economic progress and financial control
Managing money
6
Engaging in education and learning
7
Engaging in voluntary work or employment
8
Promoting health and well-being
Physical health
9
Mental health
10
Leading a healthy and active lifestyle
11
Reasons for outcomes not being achieved / STEP / Stages of outcome
Barriers / 1 / No Progress
Beyond the control of the provider / 2 / Initial stages of goal progression
Non Engagement / 3 / some progression of time-bound goals
Provider unable to meet needs/risk / 4 / substantial progression of time-bound goals
Still working towards support outcome / 5 / Goal Achieved
Area / Short Term / Long Term / How to achieve & target date
Advocacy Needs
Legal Issues
Are there any goals not covered above?
Additional relevant information, including details of any support received from another agency:
Are there any comments that you wish to make regarding the support services that you receive?
Is support to continue? / YES/NO* (please delete whichever is appropriate)
Level of support:
Date support is to end (if known):
Action to be taken following this review:
Support services to be provided following this review:

I understand the terms of the Individual Support Plan and I agree to co-operate fully in achieving my aims:

Signature of Tenant:
Date:
Key Workers Comments:
Signature:
Date: