Cumbria County Council

Transcription

1 Cumbria County Council Application for Housing Support via the Central Access Point, Cumbria Advice and Support Team short-term Accommodation or Floating Support Please return completed forms to: CAST- The Kraemer Building-The Courts- Carlisle- CA3 8NA or fax to Tel Consent to share information: MUST BE COMPLETED OR THE REFERRAL WILL NOT BE PROCESSED AND WILL BE RETURNED If I (customer) give permission for Cumbria County Council to share the information contained within this document and information supplied by other relevant agencies that are involved in my care and support. I also give permission for my current support and care agencies to be contacted for information relating to this application. I understand that if the information on this form is untrue, incorrect false or misleading it may lead to: My referral being cancelled If an offer of support has been made then it may be withdrawn In order for us to ensure that we provide you appropriate support that helps you to address your needs, it is essential that you are honest about your situation when the form is completed and do not withhold any information relevant to the application. Signature Date For Referral for Housing Support Section A-F1 must be completed. Do you require Floating Support: Yes No Do you require Short-term accommodation: Yes No Section A - Personal Details Name: Date of application: Date of Birth: Age: Female Male Current Address: Previous Address: How long have you lived at this address? Do you have Pets: Yes No If yes: what pets: Serving the people of Cumbria cumbria.gov.uk

2 Cumbria County Council Telephone Number- landline: Mobile: address: Do you consider yourself to have a disability? Yes If Yes, what is your disability No Do you have any dependants, (Children that live with you or any other person that you care for)? Yes If yes please give details below: No GP details (Name, address and contact number): Are you getting support from another service/person please give details: Are you in receipt of benefits (please select) Yes No If yes - What benefits: Weekly amount? 2

3 Application for Housing Support Are you in paid employment? Yes No How many hours do you work a week: Do you attend college? Yes No What days do you attend: Do you do voluntary work? Yes No What days do you attend: Section B - Monitoring information Ethnic origin as described by yourself, please tick one Any other Asian background Any other white background Any other black background White British Any other mixed background Asian British Bangladeshi Black African Black British Black Caribbean Chinese White and black Caribbean Indian White and black African Information not yet obtained Pakistani Traveller of Irish heritage White and Asian Gypsy/Roma Any other ethnic group Section C - Current accommodation information summary Do you own your own home? Yes No Do you have a tenancy with a registered landlord? Yes No Do you have a tenancy with a private landlord? Yes No Are you living in supported accommodation? Yes No Are you living in a bed and breakfast? Yes No Are you in foster care/children s home? Yes No Are you a care leaver? Yes No If you are a care leaver what is the expected end date of current accommodation and care: Do you live with family/friends on a permanent basis? Yes No Do you live with family/friends on a temporary basis? Yes No If this is temporary what is the address and when do you expect to leave? Are you in residential care? Yes No Are you in hospital? Yes No Hospital name: Reason for admission: Expected discharge date: Are you living in a caravan? Yes No 3

4 Cumbria County Council Are you in prison? Yes No Prison name and address: What is your expected release date: What will be your contact phone number: Are you in a probation bail hostel? Yes No Are you living in a hostel or other accommodation provided by the district homeless team? Yes Please give address and when you expect to leave No Are you homeless or at serious risk of becoming homeless? (This includes sofa surfing and staying with friends) Yes No Are you currently street homeless? (This does not mean sofa surfing or staying with a friend) Yes No Do you have concerns about your personal safety? Yes No If yes please give details: Section D - Risk and behaviours Please let us know any risk factors- support providers will complete their organisation risk assessment and management plan Harm to self Risk Yes No Please give details and dates: Have you ever been at risk from other people? Have you ever had a risk that relates to your physical condition, for example risk of stroke, seizure? Have you ever attempted suicide? Have you ever seriously neglected yourself? Have you ever been seriously affected by the use of alcohol, illegal or prescribed drugs? Has your mental health deteriorated causing you distress and placing you at risk? Have you ever been/are affected by domestic abuse? (please ensure that a CAADA risk assessment is completed) 4

5 Application for Housing Support Harm to others Risk Yes No Please give details and dates: Have you in any way caused harm to others /are you aware of any potential risks to others? Have you ever posed a risk to staff or volunteers/are you aware of any risks to staff, volunteers? Do you have a history of offending? (If so please complete section G) Are you subject to or have been subject to MARE or MAPPA? Are registered under the Sex Offenders Act 1997? Are there any requirements where you may/may not reside? Have you ever been in a position of responsibility and neglected your duty? Have you ever seriously affected others by the use of alcohol, illegal or prescribed drugs? Has deterioration in your mental health caused distress or risk to others? Have you ever been admitted to hospital as a result of your mental health? Fire Risk Risk Yes No Please give details and dates: Have you ever caused risk to self or others due to fire setting? Accidental? Deliberate? Negligent? As a result of tampering with services (gas, electrics, water, fire safety equipment)? Risk management plan: 1. If you currently have an agency supporting you please provide a copy of the plan with this application. 2. If you do not have a current plan, one will be agreed between you and your new support agency. Section E - Professionals completing the form Date of completion: Referring Agency name: Person making referral: Contact telephone number: Contact address: 5

6 ( ( Cumbria County Council Current involvement with individual: Will this involvement continue if Housing Related Support is offered? Yes No Document attached: Current support / care plan Yes No Risk management plan Yes No Other documents, please list: If you are completing this form on your own without support from an agency please complete, Sections F and G as this will provide us with additional information about your lifestyle and current situation For referring agencies: Section A-F1 must be completed. If you have any of the information relating to the individual that enables you to complete section G, or any part of it, you must do so. Section F - Housing Support Options The eligibility to access housing related support through either short term accommodation or floating support is that you agree to engage with the support offered. Do you agree to engage and work with the support agency Yes No We need to find out what is important to you, to help identify your goals and for us to find out more about you, please can you score yourself honestly against the following statements, we will ask you to complete this again when your housing support service ends 1 being not at all and 10 strongly agree Q1 I can manage my budget including all incoming and outgoings Q2 I understand the benefit system and how to ensure I claim full entitlement Q3 I know where to go for financial advice and support Q4 I find it easy to meet new people and make new friends Q5 I have hobbies and interests that keep me occupied Q6 I play an active part in my local community Q7 I know what my housing options are and how to access them Q8 I know how to manage and maintain a tenancy Q9 I know how to access advice and support Q10 I know what my strengths and talents are Q11 I have a healthy lifestyle (consider, exercise diet, smoking and drugs/ alcohol) Q12 I can cook healthy and nutritious meals on a budget Q13 I have issues/concerns with drugs or alcohol Q14 I know where to go if I have concerns about my health and wellbeing Q15 I do not pose a risk to others Q16 I keep myself safe Total score: _ : : : 6

7 Application for Housing Support Please use this provider and service overview to inform your choice of providers in F1 below. Floating Support Services Floating Support Provider Allerdale Croftlands Trust, Creative Support, Stonham Home Group, Oaklea Trust Barrow-in-Furness Oaklea Trust, Stonham Home Group, Creative Support Carlisle Stonham Home Group, Oaklea Trust, Croftlands Trust, Creative Support Copeland Creative Support, Stonham Home Group, Oaklea Trust Eden Creative Support, Stonham Home Group, Oaklea Trust South Lakeland Sanctuary Housing, Oaklea Trust, Creative Support, Stonham Home Group Below is a brief summary of each of the five floating supoprt providers covering the county. Stonham is a national organisation which aims to deliver person centred support to clients to enable them to have more choice and control in their lives. The service works in close partnership with other organisations to support clients to gain the skills and confidence required for independent living. Support Workers will visit clients in line with their individual support plans with achievable goals agreed and reviewed regularly to match peoples changing needs. Website address: Sanctuary Supported Living (SSL) offer a range of support services to over 6,000 people across England. Our floating support service within the South Lakes area helps people tackle all kinds of issues, from rent arrears and benefit issues, to activities that reduce social isolation. Our support is delivered by highly qualified staff who tailor the support provided to meet individual need. Website: 7

8 Cumbria County Council Provider of Short Term Accommodation for mental health in Barrow in Furness and South Lakeland Provider of Floating Support, housing budgeting and promoting social inclusion throughout the county Provider of Housing Related Support, information, advocacy and advice service for older adults in extra care. Creative Support is a not for profit provider of personalised services, supporting people to enjoy their lives and reach their full potential. We have extensive experience of supporting people with learning difficulties, mental health and other support needs. Croftlands Trust is an established local quality provider specialising in supporting people with multiple needs and complex lifestyles often, but not exclusively, revolving around issues of mental health, wellbeing and accommodation. Through our supported accommodation and floating support services and holistic approach we enable people to develop confidence and skills to find/keep settled accommodation and achieve their own goals. Website address: The Oaklea Trust s purpose is to support disabled and disadvantaged people towards independence, through choice and inclusion. Our vision is based on the principle that every citizen has a positive contribution to make to society and the right to control their own lives. Website: Short-Term Accommodation Provider Provider information- the below information has been provided by the current providers that deliver short-term accomodation for people that are homeless or at serious risk of homelessness. This information is to help you make a decsion reagrding the most appropriate provider you would like to be referred to. Provider of short-term accommodation substance misuse services are provided in Allerdale, Carlisle, Eden and South Lakes. Turning Point offers quality accommodation throughout Cumbria for people progressing through their journey of recovery from drug or alcohol addiction. We offer all types of housing from shared to single occupancy depending on the need and stage of recovery. We will work with individuals to create a personal support plan that will assist them to achieve and remain abstinent, to maintain independent accommodation and to enjoy an improved quality of life. Website: Provider of short-term accommodation offenders services are provided in Carlisle, Eden, Allerdale, Copeland. CASS has worked in Cumbria with people who have committed offences and who need temporary accommodation with support for over 20 years. We believe everyone should get the chance to turn their lives around so we offer good accommodation in Carlisle, Penrith, and West Cumbria and everyone has a keyworker who will help you as much as they can. Website: Provider of short term accommodation for single homeless, young people, teenage parents: Single homeless services are provided in Carlisle and Barrow in Furness Young People services are provided in Carlisle, Eden, Barrow In Furness, South Lakes Young people teenage parents service is provided in Barrow In Furness Our services provide a first class experience of flexible support that you control. We offer a safe and secure place to live with an Independent Living Worker who will help you design a personal plan to capture your goals and aspirations. We also support you to access services which will help you with the practical aspects of your tenancy, health and well-being including support with social activities, training and employment. You will be encouraged and supported to recognise your strengths and abilities and use those to plan for your future. Website: 8

9 Application for Housing Support Provider of short term accommodation for young people the service is provided in Whitehaven. Offer a safe and secure environment for young homeless people to work towards more suitable accommodation, Provide a relaxed and friendly environment, Assist the residents to maximize their benefit entitlement. Encourage the residents to seek training or employment. Help residents to build or rebuild their self-esteem and independence To actively promote independent living. Website: Provider of short term accommodation for mental health the service is provided in Workington. Croftlands Trust is an established local quality provider specialising in supporting people with multiple needs and complex lifestyles often, but not exclusively, revolving around issues of mental health, wellbeing and accommodation. Through our supported accommodation and floating support services and holistic approach we enable people to develop confidence and skills to find/keep settled accommodation and achieve their own goals. Website: Provider of short term accommodation for single homeless people in South Lakeland Stonham is a national organisation which aims to deliver person centred support to clients to enable them to have more choice and control in their lives. The service works in close partnership with other organisations to support clients to gain the skills and confidence required for independent living. Support Workers will visit clients in line with their individual support plans with achievable goals agreed and reviewed regularly to match peoples changing needs. Website: Provider of short term accommodation for Mental Health in Barrow in Furness and South Lakeland. Creative Support is a high quality provider of person centred social care services for people with learning disabilities, mental health and other needs. We provide a range of services throughout the county, which include, Floating Support, Supported Housing and Housing Related in Extra Care. Website: Section F1 - Housing Related Support Option by Support and Provider 1. Floating Support Floating to support is offered to people who have accommodation or living with others. An initial support package of 3 hours per week for 12 weeks will be offered and you have the opportunity to bank hours over an agreed time period that may exceed the 12 weeks, this allows for a flexible person centred approach to enable you to determine when and what support you need. It will be for you and your support provider to decide how you will be supported e.g., times and days. Please note you can access support during the hours of 8am-10pm seven days a week. If either you or your support provider believes you need an increase or decrease in support then you or your support worker can contact the CAP for a review. This support is funded by Supporting People and will be put in place with the provider of your chioce. Where you have no preference for provider, the Central Access Point (CAP) staff will allocate on your behalf. Where you are homeless, floating support can be available but please note this will not guarentee short or long term access to accomodation. You will be directed to the first housing options team for housing options advice, which could be a homlessness application. For people who require limited support to understand and apply for housing through Choice Based Lettings (CBL), basic money & debt advice and signposting to otherr agencies, an alternative to floating support will be access to a drop in service in your local area. 9

10 Cumbria County Council 2. Short Term Accommodation Short Term Accommodation is for people who are homeless or at serious risk of becoming homeless. Accommodation will be time limited with no guarantee of securing appropriate move on accommodation. There are a number of short term accommoation schemes across the county to support you, and have experienced staff to help address your primary issues, such as; drug & alcohol; mental health; offending behaviour; young people; teenage parents; single homeless. In Carlisle and South lakeland we supoprt the single homeless and family hostels attached to district homelessness team, access to these schemes is through the district housing options team. Do you have a preference of provider if offered Floating Support or Short Term Accommodation? Floating Support preferred provider: Short Term Accommodation preferred provider: Section G - Additional Information G1. Please use this section to tell us more about you What is important to you? What are your goals? What are your strengths and how can these be used to help you meet your goals? What has worked for you in the past/what hasn t worked for you? 10

11 Application for Housing Support What do people like and admire about you? Who are the important people in your life? What are you skills and gifts? What do you want to change in your life? What are you hobbies and interests? G2. Housing Issues Do you have any rent arrears? Yes No If so how much do you owe? Who do you owe them to? Do you have a re-payment plan in place? Yes No Have you been served with an eviction notice because of the arrears? Yes No Have you ever been evicted from a property? Yes No 11

12 Cumbria County Council Have you ever been evicted from Supported accommodation? Yes No If yes- please tell us why Are you registered on choice based lettings? Yes No If so what is your bidding number How often do you bid? G3. Anti- Social Behaviour Do you have a history of anti-social behaviour? Yes No When was your last episode of anti-social behaviour? Have you ever lost your home due to anti-social behaviour? Yes No Please tell us more about your anti-social behaviour 12

13 Application for Housing Support G4. Offending and offending history Have you ever been convicted of a criminal offence? (failure to disclose criminal convictions could lead to your support being withdrawn) Yes No If so please list the following: Type of conviction Date of Conviction Other relevant information that you think would help us. 13

14 Cumbria County Council G5. Substance Misuse/ Use of Drugs and alcohol Would you consider yourself to have an alcohol and or drug problem? Yes No Do you smoke cigarettes? Yes No How much alcohol do you drink each week? Do you take illegal drugs? Yes No Do you take legal highs? Yes No Are you currently receiving support for your alcohol/drug problem? Yes No G6. Health and Wellbeing- Health Chats opportunity Do you have a GP? Yes No Do You have any medical conditions that we need to be aware of? Yes No Are you prescribed any medication? Yes No Do you think you are in good health? Yes No Would you like any support advice about weight management? Yes No Do you exercise? (access to, weightwatchers, slimming world) Yes No Do you smoke? Yes No Do you want support to stop smoking? (Please call ) Yes No On average how may units of alcohol do you drink a week? Do you think you need help with reducing your alcohol intake? Yes No (Contact unity or ) Do you have any concerns about your mental health, or do you have any suicidal thoughts? (contact GP, first step ) Yes No Are you concerned about any aspect of your sexual health? Yes No You can contact the following offices for advice or to make an appointment West Cumbria North/East Cumbria South Cumbria Do you have a dentist? Yes No 14

15 Application for Housing Support G7. Additional comments Please add any other comments that may help the provider offer appropriate support 15

16 Cumbria County Council Section H - Planned and unplanned discharge Either you or your support worker will complete this section, please complete only 1 section. Section A Planned move on date: New address: Please list any unmet needs: Any other comments: Section B Unplanned move on date: New address: Please list reason for unplanned move on: Any other comments: 16

17 ( ( Application for Housing Support Section I - Updated support needs overview Please complete at the end of your support; we need to know what skills and knowledge you have gained during your time of support, 1 being not at all and 10 strongly agree, please circle the most relevant score Q1 I can manage my budget including all incoming and outgoings Q2 I understand the benefit system and how to ensure I claim full entitlement Q3 I know where to go for financial advice and support Q4 I find it easy to meet new people and make new friends Q5 I have hobbies and interests that keep me occupied Q6 I play an active part in my local community Q7 I know what my housing options are and how to access them Q8 I know how to manage and maintain a tenancy Q9 I know how to access advice and support Q10 I know what my strengths and talents are Q11 I have a healthy lifestyle (consider, exercise diet, smoking and drugs/ alcohol) Q12 I can cook healthy and nutritious meals on a budget Q13 I have issues/concerns with drugs or alcohol Q14 I know where to go if I have concerns about my health and wellbeing Q15 I do not pose a risk to others Q16 I keep myself safe Total score: _ : : : 17