top of page
719-999-8779
Client:
Client
Submitted By:
Submit by
Submission Date:
Date
Quarterly Monitoring Report
ISSP Monitoring
Is the current ISSP plan still effective?
viewPlanEffective
Explain how the plan continues to be effective.
viewPlanEffectiveExplanation
Was it necessary to develop a new ISSP?
viewIncidentAddress
If yes, were IDT notified?
viewIdtNotified
Home Monitoring
Rate the overall appearance of the home.
viewHomeAppearance
Is there a fire extinguisher accessible/in date?
viewHowHandled
Where is the fire extinguisher located?
viewFireExtinguisherLocation
Is there a first aid kit accessible/in date?
viewFirstAidOk
Where is the first aid kit located?
viewFirstAidLocation
Are the CO detectors/smoke alarms working?
viewDetectorsWorking
Where is the CO detector located?
viewDetectorsNotes
Are all major appliances in good working order?
viewAppliancesFunctional
Does the home have adequate food supply, stored properly?
viewFoodSupplyAdequate
Are medication stored securely?
viewMedicationStorageSecured
Does the home have adequate bathing facilities?
viewBathingFacilitiesAdequate
Does the home have adequate heating and cooling?
viewHeatingCoolingAdequate
Are living areas/walkways free of obstructions?
viewWalkwaysClear
Are exits free from blockages?
viewExitsClear
Are cameras present in the home?
viewCamerasPresent
If yes, rights modification in place?
viewNotifiedOther
Does the client have a keyed bedroom lock w/ outside access?
viewBedroomLock
If no, is a rights modification in place?
viewBedroomLockRightsMod
Does the bathroom door have a lock?
viewBathroomLock
If no, is a rights modification in place?
viewBedroomLockRightsMod
Is the front door secured via key or door code?
viewFrontDoorAccess
If no, is a rights modification in place?
viewFrontDoorRightsMod
Does the client have access to food anytime?
viewFoodAccessAnytime
If no, is a rights modification in place?
viewFoodAccessRightsMod
Does the client have freedom to furnish and decorate their room?
viewFurnishFreedom
Does the client have freedom/support to control their schedule and/or activities?
viewScheduleFreedom
Does the client have freedom to accept visitors at any time?
viewVisitorFreedom
Is the home physically accessible?
viewHomeAccessible
If the client shares a room, do they have choice of roommate?
viewRoommateChoice
Are there any specific needs preventing client rights not otherwise mentioned?
viewRightsBarriers
Has the client had any medical visits in the last 3 months?
viewMedicalVisitsRecent
Do we have all visit summaries/orders?
viewVisitSummariesComplete
bottom of page