Housing and Support Solutions Supported Housing Referral

Name of person being referred

Date of birth

Please input date (dd/mm/yyyy)

Mosaic ID

RIO ID

Broadcare ID

NHS number

Details of the Service Request - (The Mosaic work-step is still required)

Type of Supported Accommodation

Supported Living (CQC)

Daily Living (Non-CQC)

Young People (Ofsted)

Type of care and support required

24/7

Day support only

Please provide details of their primary and other needs.

Detail why this provision is the most appropriate (as opposed to a less restrictive option/more restrictive one)

Detail any of the supported housing vacancies (advertised on the vacancy tracker) that would be suitable for the person in priority order with the most favourable one being first.

Priority

Please assess the priority level of need (0-3) based on the definitions below

Complete priority level of need score (0-3) using the tick box based on the priority matrix above.

Low (0)

Medium (1)

High (2)

Urgent (3)

Definitions

Low (0)
No Issue with current accommodation
(ie. Elderly carer likely to become unable to continue supporting (low needs? Next 12-18 months?)

Medium (1)
Housing/accommodation available but impeding holistic development escalating needs and prevent independence by requiring some additional support (ie. issues with neighbours/noise or disrespect of boundaries; previous trauma at the property risk of falls)

High (2)
Housing/accommodation available but is causing distress and risk of harm requiring a significant amount of care and support (ie. stairs, proximity to roads, MH interventions)

Urgent (3)
Cannot return to current housing/accommodation or doesn’t meet needs or doesn’t have accommodation. Housing leading to significant and repeated harm, safeguarding concerns, behaviours impacting the safety of others (ie. Resolution required to prevent homelessness/rough sleeping or doesn’t have accommodation. Delayed hospital discharge/admission; accommodation that cannot be adapted)

Housing and Support Solutions Supported Housing Referral

Referral Form for Housing and Support Solutions Supported Housing

Definitions