STRICTLY CONFIDENTIAL Client Record Form - SUPPORTING...

a. White British Irish Other

b. Mixed White & Black Caribbean White & Black African

White & Asian Other

c. Asian or Asian British Indian Pakistani Bangladeshi

Other

d. Black or Black British Caribbean African Other

e. Chinese or other ethnic group Chinese Other

f. Refused

1 2 3

1 2 3

6. Ethnic origin of client as defined by client

Primary SecondaryOlder people with support needs 1 Older people with support needs 1

Older people mental health 2 Older people mental health 2

Frail elderly 3 Frail elderly 3

Mental health problems 4 Mental health problems 4

Learning disabilities 5 Learning disabilities 5

Physical or sensory disability 6 Physical or sensory disability 6

Single homeless with support 7 Single homeless with support 7

Alcohol problems 8 Alcohol problems 8

Drug problems 9 Drug problems 9

Offenders or at risk of offending 10 Offenders or at risk of offending 10

Mentally disordered offenders 11 Mentally disordered offenders 11

Young people at risk 12 Young people at risk 12

Young people leaving care 13 Young people leaving care 13

Women at risk of domestic violence 14 Women at risk of domestic violence 14

People with HIV/AIDS 15 People with HIV/AIDS 15

Homeless families with support 16 Homeless families with support 16

Refugees 17 Refugees 17

Teenage parents 18 Teenage parents 18

Rough sleeper 19 Rough sleeper 19

Traveller 20 Traveller 20

Generic 21 Complex needs 21

8a. Has the client been accepted as requiring services under thefollowing statutory frameworks (respond to each question)

Care Management (Social Services)

Care Programme Approach (CPA)

Probation service or Youth OffendingTeams

Statutorily homeless under the 2002 Homelessness Act

8b. Has the client been assessed as a higher risk under thefollowing (please respond to each question)

Care Programme Approach (enhanced)

Multi Agency Public Protection Arrangements

9. Source of referral

Nominated by local housing auth 1 Nominated under HOMES 8

LA housing department (referral) 2 Internal transfer 9

Social services 3 Moving from another RSL 10

Probation service/prison 4 Health service/GP 11

Community Mental Health Team 5 Youth Offending Team 12

Voluntary agency 6 Police 13

Self referral/Direct application 7 Other 14

10. Type of referral (see back of this form for definitions)

a. Host Host

b. Non-Host Multi-lateral Spot Purchase Structured Open Access

11a. Type of accommodation occupied by the client immediatelyprior to receiving the support service?

General needs local auth tenant 1 Prison 11

General needs RSL/HA tenant 2 Approved probation hostel 12

Private rented 3 Children’s home/foster care 13

Tied home or renting with job 4 Bed and breakfast 14

Owner occupier 5 Short life housing 15

Supported housing 6 Living with family 16

Direct access hostel 7 Staying with friends 17

Sheltered housing 8 Any other temp accom 18

Residential care home 9 Rough sleeping 19

Hospital 10 Other 20

Please if the client continues to live in this accommodation

11b. Location of this accommodation (ticked in Q11a)Name of local housing authority LA code Post code

STRICTLY CONFIDENTIAL

1. Who is the service provider?

Name

2. Type of providerLSVT 1 ALMO 6Housing association/RSL 2 NHS Trust 7Housing Authority 3 Voluntary Organisation 8Social Services Authority 4 Private Company 9Local Authority - Joint H&SS 5 Individual 10

SERVICE DETAILS Client / Tenant code

Floating support 13

Supported housing 1 Outreach service 14

Residential care home 6 Resettlement service 15

Adult placement 7Supported lodgings 8 Very sheltered housing 2Women’s refuge 9 Sheltered housing with warden 3Foyer 10 Almshouse 4Teenage parent accom 11 Peripatetic warden 5Direct access 12 Leasehold scheme 16

SP Administering Authority(eg Buckinghamshire)

SP Service ID

4. Start date of client support Day Month Year

service (e.g. 12/04/03)

CLIENT DETAILS

5. CLIENT CHARACTERISTICS. Enter age, sex, economicstatus of the client. Enter details of other members of the household whoreceive services under the same support plan.

Age Sex Relationship Economic

M/F to Client status

✓oneonly

if Interview Refused(Q5 – 6)

Version 1 01/04/03 JCSHR

Client Record Form - SUPPORTING PEOPLEFor RSL supported housing only - Management Group Code Scheme code

123456123456123456123456123456

Economic status

Full-time work (24 hours or more per week) 1

Part-time work (less than 24 hours per week) 2

Govt training/New Deal 3

Job seeker 4

Retired 5

Not seeking work 6

Full-time student 7

Long term sick/disabled 8

Child under 16 9

Other adult 0

○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○

○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○

○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○

○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○

6 7

8 9 10

11

12 13 14

15 16

17

PROVIDER DETAILS National Client Record Provider ID 7. Client group by which the client is defined not morethan three

Leave blank

○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○

1 2 3

1 2 3

1 2 3

1 2 3

Refer to Appendix 2 of the Guidance manual for LA codesOnly complete the post code where this accommodation is not temporary

1 2 3

4 5

2 3 4 5

1

✓

✓oneonly

✓

✓oneonly

✓oneonly

✓oneonly

✓oneonly ✓

do not complete for year 1

✓oneonly

3. Type of service

Client

Person 2

Person 3

Person 4

Person 5

Person 6

Relationship to Client P=Partner C=Child X=Other

Yes No Don’t Know

Yes No Don’t Know

UK Data Archive Study Number 7005 - Supporting People Client Records and Outcomes, 2003/04-2010/11

Quick reference for definitions of host and non-host referrals(Question 10)

HOST

All clients who, immediately prior to receiving a service, have been living inthe Administering Authority area where the service is located.

All referrals should be defined as host where clients receive a service that islocated in an Administering Authority area in which they have been living (im-mediately prior to receiving the service).

NON-HOST

All clients who, immediately prior to receiving the service, have been livingoutside of the Administering Authority area where the service is located.

Non-host referrals must be recorded as one of the following:

Multi-lateral - a referral made through a protocol between two or more Ad-ministering Authorities and where the referral comes from within this group ofauthorities.

Spot Purchase - a place purchased by an authority in a service located inanother Administering Authority area.

Structured - a referral made by a statutory agency to a service located inanother Administering Authority’s area.

Open Access - a self referral, or a referral by a voluntary agency, to a servicefor which there is no protocol.

Please send Client Record Forms to JCSHR each month and :

• always complete a BATCH HEADER for each month of record formsand provide full contact details.

• always complete a National Client Record Provider ID and ProviderName. The ID is supplied by the JCSHR – please phone the ClientRecord Helpdesk on 01334 461765 if you need to check this ID.

• always complete the Client Code/Tenant Code on every form. Thiswill ensure that you can identify the form from your in-house records if theJCSHR needs to contact you about missing information. These codes willnot be made available to statutory agencies. Reports to AdministeringAuthorities and the ODPM will be anonymous.

• always complete the SP Service ID – this ID appears on the contractschedules.

• Answer all questions fully. If the client was not interviewed or refusedto give details for Q5-Q6, please tick the ‘Interview Refused’ box. All otherquestions should be completed.



White & Asian Other


Other



f. Refused

8 9 10

11

12 13 14

15 16

17

1 2 3

4 5

1 2 3

1 2 3


Primary Secondary

Older people with support needs 1 Older people with support needs 1






Single homeless with support 7 Single homeless with support 7









Homeless families with support 16 Homeless families with support 16






8a. Has the client been accepted as requiring services under the

following statutory frameworks (respond to each question)




Statutorily homeless & owed a main homelessness duty

8b. Has the client been assessed as a higher risk under the

following (please respond to each question)

Care Programme Approach (enhanced)

Multi Agency Public Protection Arrangements










a. Host Host


11a. Type of accommodation occupied by the client immediately

prior to receiving the support service?








Sheltered housing or retirement housing 8 Any other temp accom 18



11c. Location of accommodation specified in Q11a



Name

2. Type of provider

LSVT 1 ALMO 6Housing association/RSL 2 NHS Trust 7Housing Authority 3 Voluntary Organisation 8Social Services Authority 4 Private Company 9Local Authority - Joint H&SS 5 Individual 10

SERVICE DETAILS Client / Tenant code

Floating support 13




SP Administering Authority

(eg Buckinghamshire)

SP Service ID


service (e.g. 12/04/04)

CLIENT DETAILS

5. CLIENT CHARACTERISTICS. Enter age, sex, economic

status of the client. Enter details of other members of the household who

receive services under the same support plan.



✓oneonly



Client Record Form 2004/05 - SUPPORTING PEOPLEFor HA supported housing only - Owning HA Name .......................................................................................

HA Association Code Management Group Code Scheme code

123456123456123456123456123456

Economic status

Full-time work (24 hours

or more per week) 1

Part-time work (less than

24 hours per week) 2


Job seeker 4

Retired 5

Not seeking work 6

Full-time student 7


Child under 16 9

Other adult 0

6 7

PROVIDER DETAILS National Client Record Provider ID 7. Client group by which the client is defined not morethan three

Leave blank

1 2 3

1 2 3

1 2 3

1 2 3

Refer to Appendix 3 of the Guidance manual for ONS LA codes

Only complete the post code where accommodation was not temporary

If postcode not known or accommodation was temporary, please tick.

2 3 4 5

1

✓

✓ oneonly

✓ oneonly

✓oneonly

✓oneonly

✓ oneonly

✓

do not complete for year 2004/05

✓ oneonly

3. Type of service

Client

Person 2

Person 3

Person 4

Person 5

Person 6


Yes No Don’t Know

Yes No Don’t Know

Post codeONS LA codeName of local housing authority

✓11b. Please if the client continues to live in this accommodation

• Please send Client Record Forms for new clients to the Client Record Office at the end ofthe month in which they begin the support service.

• Complete a Client Record Form Batch Header for each month of record forms submitted,and provide full contact details of the most appropriate person in your organisation torespond to queries about the forms.

• Always complete the National Client Record Provider ID and Provider Name . ThisID is supplied by the Client Record Office – please phone the Helpdesk on 01334 461765if you need to check this ID. Please note it is not the same as the Provider Referenceallocated by your Administering Authority nor is it the same as a new 14 character NationalProvider ID which is under development by the ODPM.

• Please complete the Client/Tenant code on every form. This will ensure that you canidentify the form from your own records if the Client Record Office needs to contact youwith queries. Reports to Administering Authorities and the ODPM will be anonymous.

• Always complete the SP Service ID – this appears on the contract schedule for eachservice, and is a numeric code.

• Answer all questions as fully as possible. If the client was not interviewed or refused togive details for any part of Q5-6, please tick the interview refused box and complete theremaining questions.

Q10 Type of Referral - HOST AND NON-HOST: A Quick Guide

Tick one box only

HOST

A referral to a Supporting People service is defined as host when the client was living in theAdministering Authority area where the service is located immediately prior to receiving theservice. For the purposes of the Client Record Form, “immediately prior” refers only to thenight before the client started to receive the service. Please note this question is not about“local connections”.

NON-HOST

A referral is defined as one of the non-host types when the client was living outside theAdministering Authority area where the service is located immediately prior to receiving theservice. You should choose the most appropriate non-host category as follows:

Multi-lateral – a referral made through a protocol between two or more AdministeringAuthorities and where the referral comes from within this group of authorities.

Spot purchase – the new client’s place in the service has been purchased by an AdministeringAuthority other than the one in which the service is located.

Structured – a referral made by a statutory agency where the client was living in a differentAdministering Authority to the one in which the service is located immediately prior to receivingthe service.

Open Access – a self-referral, or referral by a voluntary agency to a service located in adifferent Administering Authority to that in which the client was living immediately prior toreceiving that service.

Please consult the Guidance Manual for the SP Client Record Form manual for furtherexplanation and examples, or contact the Helpdesk on 01334 461765 if you are still unsure.

2. Type of providerLSVT 1 ALMO 6Housing association/RSL 2 NHS Trust 7Housing Authority 3 Voluntary Organisation 8Social Services Authority 4 Private Company 9Local Authority - Joint H&SS 5 Individual 10


oneonly


Client Record Form 2005/06 - SUPPORTING PEOPLEFor HA/LA supported housing only - Owning HA/LA Name .......................................................................................

HA/LA CORE Code Management Group Code Scheme code

PROVIDER AND SERVICE DETAILS not morethan three

Leave blank

Refer to Appendix 3 of the Guidance manual for ONS LA codesOnly complete the post code where accommodation was not temporary


oneonly

oneonly

oneonly

oneonly


11b. Please if the client continues to live in this accommodation


7. Client group by which the client is defined


Organisation Name .............................................................................

Service Name .....................................................................................

SP Service ID


National Client Record Provider ID(a 5 digit ID allocated by JCSHR)

National Provider ID(an 8 digit ID allocated by the ODPM)

Floating support 13





service (e.g. 12/04/05)

Client/Tenant code

oneonly3. Type of service

do not complete for year 2005/06

CLIENT DETAILS

5. CLIENT CHARACTERISTICS. Enter age, sex, economic status ofthe client. Enter details of other members of the household who receiveservices under the same support plan.




Client

Person 2

Person 3

Person 4

Person 5

Person 6


Economic status




Job seeker 4

Retired 5

Not seeking work 6

Full-time student 7


Child under 16 9

Other adult 0

6. Ethnic origin of client as defined by client oneonly



White & Asian Other


Other



f. Refused

1 2 3

4 5

6 7

8 9 10

11

12 13 14

15 16

17







Single homeless with support needs 7 Single homeless with support needs 7









Homeless families with support needs 16 Homeless families with support needs 16






Yes No Don’t Know

8a. Has the client been accepted as requiring services under thefollowing statutory frameworks (respond to each question)





8b. Has the client been assessed as a higher risk under thefollowing (please respond to each question)

Care Programme Approach (enhanced) 1 2 3

Multi Agency Public Protection Arrangements 1 2 3

1 2 3

1 2 3

1 2 3

1 2 3










a. Host Host


2 3 4 5

1









Sheltered housing or retirement housing 8 Any other temp accom 18



Yes No Don’t Know

National Client Record Provider ID and National Provider ID

• Always complete the National Client Record Provider ID (5 digits).

This ID is supplied by the Client Record Office at JCSHR – please phone the helpdesk on01334 461765 if you need to check this ID.

• Complete the National Provider ID (8 digits).

This ID is supplied by the ODPM. If you need to check this ID then check www.spkweb.org.ukand click on “National Provider IDs” or phone the helpdesk on 01334 461765.

• Always complete the organisation name and service name.

• Always complete the Client/Tenant code on every form. This will ensure that you can identifythe form from your own records if the Client Record Office needs to contact you with queries.Reports to Administering Authorities and the ODPM will be anonymous.

• Always complete the SP Service ID – this appears on the contract schedule for each service,and is a numeric code.

• Answer all questions as fully as possible. If the client was not interviewed or refused to givedetails for any part of Q5-6, please tick the interview refused box and complete the remainingquestions.

NOTE: CHANGE IN DEFINITION OF “YOUNG PEOPLE AT RISK” in client groups – NOWINCLUDES CLIENTS AGED 16-25.

Returning Client Record Forms to Client Record Office

• Please send Client Record Forms for new clients to the Client Record Office at the end of themonth in which they begin the support service.

• Complete a Client Record Form Batch Header (can be downloaded fromwww.spclientrecord.org.uk) for each month of record forms submitted, and provide full contactdetails of the most appropriate person in your organisation to respond to queries about theforms.


Tick one box only

HOST

A referral to a Supporting People service is defined as host when the client was living in theAdministering Authority area where the service is located immediately prior to receiving the service.For the purposes of the Client Record Form, “immediately prior” refers only to the night before theclient started to receive the service. Please note this question is not about “local connections”.

NON-HOST

A referral is defined as one of the non-host types when the client was living outside the AdministeringAuthority area where the service is located immediately prior to receiving the service. You shouldchoose the most appropriate non-host category as follows:

Multi-lateral – a referral made through a protocol between two or more Administering Authoritiesand where the referral comes from within this group of authorities.

Spot purchase – the new client’s place in the service has been purchased by an AdministeringAuthority other than the one in which the service is located.

Structured – a referral made by a statutory agency where the client was living in a differentAdministering Authority to the one in which the service is located immediately prior to receiving theservice.

Open Access – a self-referral, or referral by a voluntary agency or non-statutory agency to a servicelocated in a different Administering Authority to that in which the client was living immediately prior toreceiving that service.

Please consult the Client Record Guidance Manual for further explanation and examples, or contactthe Helpdesk on 01334 461765 if you are still unsure.

8a. Has the client been accepted as requiring services under the following statutory frameworks (respond to each question)




Drug Interventions Programme (DIP)


8b. Has the client been assessed as a higher risk under the following (please respond to each question)



8c. Is the client currently subject to requirements under an Anti-Social Behaviour Order (ASBO)?

1 2 3



CONTINUES OVERLEAF – PLEASE TURN OVER



PROVIDER AND SERVICE DETAILS

not more than three

Leave blank

�one only

�one only �


1. Who is the service provider?Organisation Name .............................................................................

Service Name .....................................................................................

SP Service ID


National Client Record Provider ID(a 5 digit ID allocated by JCSHR)

National Provider ID(an 8 digit ID allocated by the ODPM)

Floating support 13



Adult placement 7

Supported lodgings 8 Very sheltered housing 2Women’s refuge 9 Sheltered housing with warden 3

Foyer 10 Almshouse 4

Teenage parent accom 11 Peripatetic warden 5Direct access 12 Leasehold scheme 16


service (e.g. 12/04/06)

Client/Tenant code

�one only2. Type of service

do not complete for:

CLIENT DETAILS

4. CLIENT CHARACTERISTICS. Enter age, sex, economic status of the client. Enter details of other members of the household who receive services under the same support plan.



if Interview Refused(Q4 – 6)�

Client

Person 2

Person 3

Person 4

Person 5

Person 6


Economic status




Job seeker 4

Retired 5

Not seeking work 6

Full-time student 7

Unable to work because of long term sickness or disability 8

Child under 16 9

Other adult 0

6. Ethnic origin of client as defined by client �one only



White & Asian Other


Other


e. Chinese or other ethnic group Chinese Other ethnic group

f. Refused

1 2 3

4 5

6 7

8 9 10

11

12 13 14

15 16

17






















Yes No Don’t Know

1 2 3 1 2 3 1 2 3

1 2 3

1 2 3


Nominated by local housing auth 1 Nominated under MoveUK 8

LA housing department (referral) 2 Client applied for internal transfer 9






Yes No Don’t Know

5. National Insurance Number of Client

Client’s National Insurance number (e.g. AB 12 34 56 C)

Client does not know

Client refuses

Yes No Don’t Know



12a. How long has the client been living in the Administering Authority area where the service is provided?

years months days

12b. If the client has been living in that area for less than 6 months, where did they live before?


And how long did the client live there?

years months days

13. How long did the client live in the local housing authority area recorded at Q11c?

years months daysRefer to Appendix 3 of the Guidance manual for ONS LA codesOnly complete the post code where accommodation was not temporary


�one only

�one only


�

10. Type of referral (see below for definitions)

a. Host Host


2 3 4 5

1

11a. Type of accommodation occupied by the client immediately prior to receiving the support service?

Local authority general needs tenancy 1 Hospital 10

Housing association general needs Prison 11

tenancy 2 Approved probation hostel 12

Private sector tenancy 3 Children’s home/foster care 13

Tied housing or rented with job 4 Bed and breakfast 14

Owner occupation 5 Short life housing 15


Direct access hostel 7 Living with friends 17

Women’s refuge 21 Mobile Home/Caravan 23

Foyer 22 Any other temp accom 18

Housing for older people 8 Rough sleeping 19

Residential care home 9 Other 20

ONS LA codeName of local housing authority

Returning Client Record Forms to Client Record Offi ce

• Please send Client Record Forms for new clients to the Client Record Offi ce at the end of the month in which they begin the support service.

• Complete a Client Record Form Batch Header (can be downloaded from www.spclientrecord.org.uk) for each month of record forms submitted, and provide full contact details of the most appropriate person in your organisation to respond to queries about the forms.


Tick one box only

HOST

A referral to a Supporting People service is defi ned as host when the client was living in the Administering Authority area where the service is located immediately prior to receiving the service. For the purposes of the Client Record Form, “immediately prior” refers only to the night before the client started to receive the service. Please note this question is not about “local connections”.

NON-HOST

A referral is defi ned as one of the non-host types when the client was living outside the Administering Authority area where the service is located immediately prior to receiving the service. You should choose the most appropriate non-host category as follows:

Multi-lateral – a referral made through a protocol between two or more Administering Authorities and where the referral comes from within this group of authorities.

Spot purchase – the new client’s place in the service has been purchased by an Administering Authority other than the one in which the service is located.

Structured – a referral made by a statutory agency where the client was living in a different Administering Authority to the one in which the service is located immediately prior to receiving the service.

Open Access – a self-referral, or referral by a voluntary agency or non-statutory agency to a service located in a different Administering Authority to that in which the client was living immediately prior to receiving that service.

Please consult the Client Record Guidance Manual for further explanation and examples, or contact the Helpdesk on 01334 461765 if you are still unsure.

Host Referrals ONLY, Answer Q12

(Non-host referrals go to Q13)

Completed Forms

Answer all questions as fully as possible.

Always complete the client/tenant code on every form. This will ensure that you can identify the form from your own records if the Client Record Office needs to contact you with queries.

Non-host Referrals ONLY, Answer Q13

8a. Has the client been accepted as requiring services under the

following statutory frameworks (respond to each question)




Drug Interventions Programme (DIP)


8b. Has the client been assessed as a higher risk under the following (please respond to each question)



8c. Is the client currently subject to requirements under an Anti-

Social Behaviour Order (ASBO)?

1 2 3


Version 5 01/04/07 CHR, St Andrews




PROVIDER AND SERVICE DETAILS

not more than three

Leave blank

one only

one only



Organisation Name .............................................................................

Service Name .....................................................................................

SP Service ID


National Client Record Provider ID(a 5 digit ID allocated by CHR)

National Provider ID(an 8 digit ID allocated by CLG)

Floating support 13



Adult placement 7

Supported lodgings 8 Very sheltered housing 2Women’s refuge 9 Sheltered housing with warden 3

Foyer 10 Almshouse 4

Teenage parent accom 11 Peripatetic warden 5Direct access 12 Leasehold scheme 16


service (e.g. 12/04/07)

Client/Tenant code

one only2. Type of service


CLIENT DETAILS

4. CLIENT CHARACTERISTICS. Enter age, sex, economic status

of the client. Enter details of other members of the household who receive services under the same support plan.




Client

Person 2

Person 3

Person 4

Person 5

Person 6


Economic status

Full-time work (24 hours

or more per week) 1

Part-time work (less than

24 hours per week) 2


Job seeker 4

Retired 5

Not seeking work 6

Full-time student 7

Unable to work because

of long term sickness or

disability 8

Child under 16 9

Other adult 0

6. Ethnic origin of client as defined by client one only



White & Asian Other


Other



f. Refused

1 2 3

4 5

6 7

8 9 10

11

12 13 14

15 16

17






















Yes No Don’t Know

1 2 3 1 2 3 1 2 3

1 2 3

1 2 3


Nominated by local housing auth 1 Nominated under MoveUK 8







Yes No Don’t Know


Client’s National Insurance number (e.g. AB 12 34 56 C)

Client does not know

Client refuses

Yes No Don’t Know

PAPER FORMS FOR INTERNAL USE ONLY. ALL DATA MUST BE SUBMITTED ELECTRONICALLY



12a. How long has the client been living in the Administering

Authority area where the service is provided?

years months days

12b. If the client has been living in that area for less than 6

months, where did they live before?



years months days

13. How long did the client live in the local housing authority

area recorded at Q11c?

years months daysRefer to Appendix 3 of the Guidance manual for ONS LA codes

Only complete the post code where accommodation was not temporary


one only

one only


10. Type of referral (see below for definitions)

a. Host Host


2 3 4 5

1

11a. Type of accommodation occupied by the client immediately

prior to receiving the support service?

Local authority general needs tenancy 1 Hospital 10

Housing association general needs Prison 11

tenancy 2 Approved probation hostel 12

Private sector tenancy 3 Children’s home/foster care 13

Tied housing or rented with job 4 Bed and breakfast 14

Owner occupation 5 Short life housing 15


Direct access hostel 7 Living with friends 17

Women’s refuge 21 Mobile Home/Caravan 23

Foyer 22 Any other temp accom 18

Housing for older people 8 Rough sleeping 19

Residential care home 9 Other 20

ONS LA codeName of local housing authority

Returning Client Record Data to Client Record Office


Tick one box only

HOST

A referral to a Supporting People service is defi ned as host when the client was living in the Administering Authority area where the service is located immediately prior to receiving the service. For the purposes of the Client Record Form, “immediately prior” refers only to the night before the client started to receive the service. Please note this question is not about “local connections”.

NON-HOST

A referral is defi ned as one of the non-host types when the client was living outside the Administering Authority area where the service is located immediately prior to receiving the service. You should choose the most appropriate non-host category as follows:

Multi-lateral – a referral made through a protocol between two or more Administering Authorities and where the referral comes from within this group of authorities.

Spot purchase – the new client’s place in the service has been purchased by an Administering Authority other than the one in which the service is located.

Structured – a referral made by a statutory agency where the client was living in a different Administering Authority to the one in which the service is located immediately prior to receiving the service.

Open Access – a self-referral, or referral by a voluntary agency or non-statutory agency to a service located in a different Administering Authority to that in which the client was living immediately prior to receiving that service.

Please consult the Client Record Guidance Manual for further explanation and examples, (www.spclientrecord.



Completed Forms

Answer all questions as fully as possible. Always complete the client/tenant code on every form.

This will ensure that you can identify the form from your own records if the Client Record Office needs


If information unobtainable for Q12a or Q12b, please tick

If information unknown, please tick

to contact you with queries. Do not return paper forms. Data must be submitted electronically.

org.uk for copies and information) or contact the Helpdesk on 01334 461765 if you are still unsure.

• Please submit Client Record data for new clients to the Client Record Office at the end of the month in which they began the support service (information available from www.spclientrecord.org.uk).

• If you are using SP Digital please export your data and email the text file to [email protected]

• If you are using CROSS web entry, please enter and validate your data. Entries that have passed the first level of validation will be downloaded automatically by the Client Record Office.

6. Is the client a disabled person?

If YES, please record the nature of their disability (please tick all that apply)

Mobility Mental Health

Visual Impairment Learning Disability

Hearing Impairment Other

Progressive disability/Chronic Does not wish to disclose Illness (e.g. MS, Cancer)



Client Record Form 2008/09 - SUPPORTING PEOPLEFor HA/LA supported housing only - Owning HA/LA Name ...............................................................................................


PROVIDER AND SERVICE DETAILSNational Client Record Provider ID(a 5 digit ID allocated by CHR)

National Provider ID(an 8 digit ID allocated by CLG)


Organisation Name .................................................................................

Service Name .........................................................................................

SP Service ID


2. Type of Service Floating support 13



Adult placement 7

Supported lodgings 8

Women’s refuge 9

Foyer 10

Teenage parent accom 11

Direct access 12

3. Start date of client support Day Month Yearservice (e.g. 12/04/08)

Client/Tenant code

✓one only


Very sheltered housing 2

Sheltered housing with warden 3

Almshouse 4

Peripatetic warden 5

Leasehold scheme 16

CLIENT DETAILS


✓ if Interview Refused(Q4 - 7)

Economic status




Job seeker 4

Retired 5

Not seeking work 6

Full-time student 7


Child under 16 9

Other Adult 0

Client

Person 2

Person 3

Person 4

Person 5

Person 6

Age Sex Relationship Economic M/F to Client status



Client’s National Insurance number (e.g. AB123456C)

Client does not know Client refuses



White & Asian Other

c. Asian or Asian British Indian Pakistani Bangladeshi Other



f. Refused


12 3

4 5

6 7

89 1011

121314

15 16

✓one only

17

8. Client group by which the client is definedPrimary Secondary

Older people with support needs 1 Older people with support needs 1Older people mental health 2 Older people mental health 2Frail elderly 3 Frail elderly 3Mental health problems 4 Mental health problems 4Learning disabilities 5 Learning disabilities 5Physical or sensory disability 6 Physical or sensory disability 6Single homeless with support needs 7 Single homeless with support needs 7Alcohol problems 8 Alcohol problems 8Drug problems 9 Drug problems 9Offenders or at risk of offending 10 Offenders or at risk of offending 10Mentally disordered offenders 11 Mentally disordered offenders 11Young people at risk 12 Young people at risk 12Young people leaving care 13 Young people leaving care 13Women at risk of domestic violence 14 Women at risk of domestic violence 14People with HIV/AIDS 15 People with HIV/AIDS 15Homeless families with support needs 16 Homeless families with support needs 16Refugees 17 Refugees 17Teenage parents 18 Teenage parents 18Rough sleeper 19 Rough sleeper 19Traveller 20 Traveller 20Generic 21 Complex needs 21

✓one only ✓

not morethan three


Yes No Don’t Know

Care Management (Social Services) 1 2 3

Care Programme Approach (CPA) 1 2 3

Probation service or Youth Offending Teams 1 2 3

Drug Interventions Programme (DIP) 1 2 3

9b. Immediately prior to receiving the support service, was this client...?Not homeless 1

Found ‘statutorily homeless’ by a housing authority and owed a main 2homelessness duty

Found ‘statutorily homeless’ by a housing authority but not owed a main 6homelessness duty

Other homeless i.e. not found statutorily homeless by a housing authority 7but considered to be homeless by the service provider

Version 6 01/04/08 CHR, ST ANDREWS


9c. Has the client been assessed as a higher risk under thefollowing (please respond to each question)

Yes No Don’t Know



9d. Is the client currently subject to requirements under an Anti-Social Behaviour Order (ASBO)? Yes No Don’t Know

1 2 3

✓one only Yes No Don’t Know

1 2 3

10. Source of referralNominated by local housing auth 1

LA housing department (referral) 2

Social services 3

Probation service/prison 4

Community Mental Health Team 5

Voluntary agency 6

Self referral/Direct application 7

Relocated through a recognised National, 8Regional or Sub-Regional Housing Mobility SchemeInternal transfer 9Moving from another RSL 10Health service/GP 11Youth Offending Team 12Police 13Other 14

✓one only

11. Type of referrala. Host Host

1


2 3 4 5


✓one only

Local authority general needs tenancy 1Housing association general needs tenancy 2Private sector tenancy 3Tied housing or rented with job 4Owner occupation (private) 25Owner occupation (low cost home ownership) 26Supported housing 6Direct access hostel 7Women’s refuge 21Foyer 22Housing for older people 8Residential care home 9

Hospital 10Prison 11Approved probation hostel 12Children’s home/foster care 13Bed and breakfast 14Short life housing 15Living with family 16Living with friends 17Mobile Home/Caravan 23Any other temp accom 18Home Office Asylum Support 24Rough sleeping 19Other 20

✓one only



✓

Name of local housing authority ONS LA code Post code





13a. How long has the client been living in the AdministeringAuthority area where the service is provided?

years months days

13b. If the client has been living in that area for less than 6months, where did they live before?



years months days


Name of local housing authority ONS LA code


14. How long did the client live in the local housing authorityarea recorded at Q12c?

years months days


Completing Forms

Please consult the Client Record Manual, Quick Reference Card, and/or training slides for explanation and examples on how to complete this form. These can be found at www.spclientrecord.org.uk

Advice is also available through our helpdesk ([email protected] or Tel: 01334 461765).

Completed Forms

Answer all questions as fully as possible. Always complete the client/tenant code on every form.

This will ensure that you can identify the form from your own records if the Client Record Office needs to contact you with queries. Do not return paper forms. Data must be submitted electronically.

Returning Client Record Data to Client Record Office

• Please submit Client Record data for new clients to the Client Record Office at the end of the month in which they began the support service (information available from www.spclientrecord.org.uk).

• If you are using SP Digital please export your data and email the text file to spdata @st-andrews.ac.uk

• If you are using CROSS web entry, please enter and validate your data. Entries that have passed the first level of validation will be downloaded automatically by the Client Record Office.

www.spclientrecord.org.uk



Mobility Mental Health

Visual Impairment Learning Disability

Hearing Impairment Other

Progressive disability/Chronic Does not wish to disclose Illness (e.g. MS, Cancer)



Client Record Form 2009/10 - SUPPORTING PEOPLELeave these codes blank if you do not also complete a CORE new lettings supported log or if the type of service is floating support, outreach or resettlement. This section is for HA/LA supported housing only.


PROVIDER AND SERVICE DETAILSNational Client Record Provider ID(a 5 digit ID allocated by CHR)National Provider ID(an 8 digit ID allocated by CLG)


Organisation Name .................................................................................

Service Name .........................................................................................

SP Service ID


2. Type of Service Floating support 13



Adult placement 7

Supported lodgings 8

Women’s refuge 9

Foyer 10

Teenage parent accom 11

Direct access 12

✓one only


Very sheltered housing 2

Sheltered housing with warden 3

Almshouse 4

Peripatetic warden 5

Leasehold scheme 16

CLIENT DETAILS



Economic status




Job seeker 4

Retired 5

Not seeking work 6

Full-time student 7


Child under 16 9

Other Adult 0

Client

Person 2

Person 3

Person 4

Person 5

Person 6

Age Sex RelationshipEconomic M/FtoClient status


7. National Insurance Number of ClientClient’s National Insurance number (e.g. AB123456C)

Client does not know Client declined to provide Client does not have



White & Asian Other




f. Gypsy, Romany, Irish Traveller

g. Refused


12 3

4 5

6 7

89 1011

121314

15 16

✓one only

18


Primary Secondary

Older people with support needs 1 Older people with support needs 1Older people mental health 2 Older people mental health 2Frail elderly 3 Frail elderly 3Mental health problems 4 Mental health problems 4Learning disabilities 5 Learning disabilities 5Physical or sensory disability 6 Physical or sensory disability 6Single homeless with support needs 7 Single homeless with support needs 7Alcohol problems 8 Alcohol problems 8Drug problems 9 Drug problems 9Offenders or at risk of offending 10 Offenders or at risk of offending 10Mentally disordered offenders 11 Mentally disordered offenders 11Young people at risk 12 Young people at risk 12Young people leaving care 13 Young people leaving care 13People at risk of domestic violence 23 People at risk of domestic violence 23People with HIV/AIDS 15 People with HIV/AIDS 15Homeless families with support needs 16 Homeless families with support needs 16Refugees 17 Refugees 17Teenage parents 18 Teenage parents 18Rough sleeper 19 Rough sleeper 19Traveller 20 Traveller 20Generic/Complex needs 24 Generic/Complex needs 24

✓one only ✓

not morethan three



✓one only

Yes No Don’t Know

1 2 3


Client/Tenant code

3. Does your service work in partnership with other agencies to deliver this support?

If YES, please tick all that apply:

Health Education/Training

Social Services Benefits

Housing services Debt services

Drug/alcohol services Employment agencies/job centre

Police/probation Other

Youth Offending Teams 17

10. What is the client’s religion? (Please choose one)

None 8 Muslim 5

Christian (all denominations) 1 Sikh 6

Buddhist 2 Any other religion 7

Hindu 3 Not known 9

Jewish 4 Does not wish to disclose 10

Yes No Don’t Know

1 2 3

4a. Does the client have an Individual Budget? Yes No Don’t Know

1 2 3If YES, is the client using some or all of their Individual Budget to purchase this service?

Yes 1 No 2 Don’t know 3

FUNDING

4b. Was the client’s accommodation secured through a rent deposit scheme?Yes 1 No 2 Don’t know 3



Social services 3



Voluntary agency 6



✓one only


1


2 3 4 5

15. Type of accommodation occupied by the client when starting to receive the floating support, outreach or resettlement service.

✓one only



✓one only




years months days




years months days




18. How long did the client live in the local housing authorityarea recorded at Q16c?

years months days


www.spclientrecord.org.uk

12c. Has the client been assessed as a higher risk under thefollowing (please respond to each question)

Yes No Don’t Know




1 2 3

Answer for Floating Support, Outreach & Resettlement Services ONLY

16a. Type of accommodation occupied by the client immediately prior to receiving the support service.



✓one only

ALL CLIENTS

16b. Please if the client continues to live in this

accommodation


✓




Post code

12b. Immediately prior to receiving the support service, was this client...?Not homeless 1

Found ‘statutorily homeless’ by a housing authority and owed a main 2homelessness duty

Found ‘statutorily homeless’ by a housing authority but not owed a main 6homelessness duty

Other homeless i.e. not found statutorily homeless by a housing authority 7but considered to be homeless by the service provider

Don’t Know 8


Yes No Don’t Know

Care Management (Social Services) 1 2 3

Care Programme Approach (CPA) 1 2 3

Probation service or Youth Offending Teams 1 2 3

Drug Interventions Programme (DIP) 1 2 3

(All other service types, go to Q16)



Mobility Mental HealthVisual Impairment Learning DisabilityHearing Impairment Autistic Spectrum ConditionProgressive disability/Chronic Other Illness (e.g. MS, Cancer) Does not wish to disclose

PAPER FORMS FOR INTERNAL USE ONLY. ALL DATA MUST BE SUBMITTED ELECTRONICALLYSTRICTLY CONFIDENTIAL

Client Record Form 2010/11 - SUPPORTING PEOPLELeave these codes blank if you do not also complete a CORE new lettings supported log or if the type of service is floating support, outreach or resettlement. This section is for HA/LA supported housing only.


PROVIDER AND SERVICE DETAILSNational Client Record Provider ID(a 5 digit ID allocated by CHR)National Provider ID(an 8 digit ID allocated by CLG)

1. Who is the service provider?Organisation Name .................................................................................

Service Name .........................................................................................

SP Service ID


2. Type of Service Floating support 13Supported housing 1 Outreach service 14Residential care home 6 Resettlement service 15Adult placement 7Supported lodgings 8Women’s refuge 9Foyer 10Teenage parent accom 11Direct access 12

✓one only

do not complete for:Very sheltered housing 2Sheltered housing with warden 3Almshouse 4Peripatetic warden 5Leasehold scheme 16

CLIENT DETAILS



Economic statusFull-time work (24 hours or more per week) 1Part-time work (less than 24 hours per week) 2Govt training/New Deal 3Job seeker 4Retired 5Not seeking work 6Full-time student 7Unable to work because of long term sickness or disability 8Child under 16 9

Other Adult 0

Client

Person 2

Person 3

Person 4

Person 5

Person 6

Age Sex RelationshipEconomic M/FtoClient status


7. National Insurance Number of ClientClient’s National Insurance number (e.g. AB123456C)

Client does not know Client declined to provide Client does not have



White & Asian Other




f. Gypsy, Romany, Irish Traveller

g. Refused


12 3

4 5

6 7

89 1011

121314

15 16

✓one only

18


Primary SecondaryOlder people with support needs 1 Older people with support needs 1Older people mental health 2 Older people mental health 2Frail elderly 3 Frail elderly 3Mental health problems 4 Mental health problems 4Learning disabilities 5 Learning disabilities 5Physical or sensory disability 6 Physical or sensory disability 6Single homeless with support needs 7 Single homeless with support needs 7Alcohol problems 8 Alcohol problems 8Drug problems 9 Drug problems 9Offenders or at risk of offending 10 Offenders or at risk of offending 10Mentally disordered offenders 11 Mentally disordered offenders 11Young people at risk 12 Young people at risk 12Young people leaving care 13 Young people leaving care 13People at risk of domestic violence 23 People at risk of domestic violence 23People with HIV/AIDS 15 People with HIV/AIDS 15Homeless families with support needs 16 Homeless families with support needs 16Refugees 17 Refugees 17Teenage parents 18 Teenage parents 18Rough sleeper 19 Rough sleeper 19Traveller 20 Traveller 20Generic/Complex needs 24 Generic/Complex needs 24

✓one only ✓

not morethan three



✓one only

Yes No Don’t Know

1 2 3


Client/Tenant code

3. Does your service work in partnership with other agencies to deliver this support?

If YES, please tick all that apply:Health Education/TrainingSocial Services BenefitsHousing services Debt servicesDrug/alcohol services Employment agencies/job centrePolice/probation OtherYouth Offending Teams 17

10. What is the client’s religion? (Please choose one)

None 8 Muslim 5

Christian (all denominations) 1 Sikh 6

Buddhist 2 Any other religion 7

Hindu 3 Not known 9

Jewish 4 Does not wish to disclose 10

Yes No Don’t Know

1 2 3

4a. Does the client have an Individual Budget? Yes No Don’t Know

1 2 3If YES, is the client using some or all of their Individual Budget to purchase this service?Yes 1 No 2 Don’t know 3

FUNDING

4b. Was the client’s accommodation secured through a rent deposit scheme?Yes 1 No 2 Don’t know 3

12c. Has the client been assessed as a higher risk under thefollowing (please respond to each question) Yes No Don’t Know

Care Programme Approach 1 2 3


Multi Agency Risk Assessment Conference 1 2 3


1 2 3



Social services 3



Voluntary agency 6



✓one only


1


2 3 4 5

15. Type of accommodation occupied by the client when starting to receive the floating support, outreach or resettlement service.

✓one only

Local authority general needs tenancy 1Housing association general needs tenancy 2Private sector tenancy 3Private sector leasing 27Tied housing or rented with job 4Owner occupation (private) 25Owner occupation (low cost home ownership) 26Supported housing 6Direct access hostel 7Women’s refuge 21Foyer 22Housing for older people 8

Residential care home 9Hospital 10Prison 11Approved probation hostel 12Children’s home/foster care 13Bed and breakfast 14Short life housing 15Living with family 16Living with friends 17Mobile Home/Caravan 23Any other temp accom 18Home Office Asylum Support 24Rough sleeping 19Other 20

✓one only




years months days




years months days



Non-host Referrals ONLY, Answer Q1418. How long did the client live in the local housing authorityarea recorded at Q16c?

years months days


https://www.spclientrecord.org.uk

Answer for Floating Support, Outreach & Resettlement Services ONLY

16a. Type of accommodation occupied by the client immediately prior to receiving the support service.Local authority general needs tenancy 1Housing association general needs tenancy 2Private sector tenancy 3Private sector leasing 27Tied housing or rented with job 4Owner occupation (private) 25Owner occupation (low cost home ownership) 26Supported housing 6Direct access hostel 7Women’s refuge 21Foyer 22Housing for older people 8

Residential care home 9Hospital 10Prison 11Approved probation hostel 12Children’s home/foster care 13Bed and breakfast 14Short life housing 15Living with family 16Living with friends 17Mobile Home/Caravan 23Any other temp accom 18Home Office Asylum Support 24Rough sleeping 19Other 20

✓one only

ALL CLIENTS



✓

Name of local housing authority ONS LA



Post code

12b. Immediately prior to receiving the support service, was this client...?Not homeless 1Found ‘statutorily homeless’ by a housing authority and owed a main 2homelessness duty Found ‘statutorily homeless’ by a housing authority but not owed a main 6homelessness dutyOther homeless i.e. not found statutorily homeless by a housing authority 7but considered to be homeless by the service provider Don’t Know 8


Yes No Don’t Know

Care Management (Social Services) 1 2 3Secondary mental health service 1 2 3Probation service or Youth Offending Teams 1 2 3Drug Interventions Programme (DIP) 1 2 3

(All other service types, go to Q16)

STRICTLY CONFIDENTIAL Client Record Form - SUPPORTING...

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