What time do you usually get up/go to bed? Do you have a regular nap or enjoy a snack or walk at a particular time of the day? Do you have a hot drink before bed, carry out personal care activities in a particular order, or like to watch the news at 6pm? What time do you prefer to have breakfast, lunch, and evening meal?
Include anything you may find troubling, eg family concerns, being apart from a loved one, or physical needs such as being in pain, constipated, thirsty or hungry. List environmental factors that may also make you feel anxious, e.g. open doors, loud voices or the dark.
Include things that may help if you become unhappy or distressed, eg comforting words, music or TV. Do you like company and someone sitting and talking with you or do you prefer quiet time alone?
Can you hear well or do you need a hearing aid? How is it best to approach you? Is the use of touch appropriate?
Do you wear glasses or need any other vision aids?
How do you usually communicate, eg verbally, using gestures, pointing or a mixture of both? Can you read and write and does writing things down help? How do you indicate pain, discomfort, thirst or hunger? Include anything that may help staff identify your needs.
Have I you had any falls, had a C.V.A(Stroke), and if so what if any disabilities because of it. Are you a diabetic and if so are you Type 1 or 2
How are you on a normal day, are you happy, moody, do you like to chat a lot. Can you be aggressive/agitated etc
List your usual practices, preferences and level of assistance required in the bath, shower or other. Do you prefer a male or female carer? Do you have preferences for brands of continence aids, soaps, cosmetics, toiletries, shaving, teeth cleaning or dentures? Do you have particular care or styling requirements for your hair? Do you need help to take medication? Do you prefer liquid medication?
Have I you had any falls, had a C.V.A(Stroke), and if so what if any disabilities because of it. Are you a diabetic and if so are you Type 1 or 2