Redbridge e-forms Adults contact form Step 1 of 14 7% If you or someone you know is struggling to stay independent, the first step is to look at your care and support needs. By answering some simple questions, you will find areas where you want to make a change and the support you may need to do this. Don’t worry - we don’t need your name or address at this point. This is just to generate information for you. Where is your local council? The eligibility criteria for adult social care is the same across all councils in England, however to make a referral, we need to check that you live in Redbridge. Please enter your postcode? Who is completing this form?I am completing this Myself Myself with the support of someone On behalf of someone else Please check the person you are completing the form for is aware. Also, as you are completing this form on behalf of someone else, please answer each question as if you were them.Are you already receiving services from us? Yes No This is designed for people who are contacting us about services for the first time. As you are already receiving services, we recommend getting in touch with us to look at your current needs. If you are already in receiving services from us, you should contact your existing social worker. Keeping safe The question will help us identify any concerns you might have about the way other people behave towards you. This might be things that they do or say to you that makes you feel hurt or upset, it might be to do with money, or it might be about the way they look after you or don't look after you.I have concerns about how others treat me? Yes No Based on your concerns about how others treat you, please call the Safeguarding Adults Team on 020 8708 7333 to speak to us immediately. Alternatively you can select the contact me button below and someone from the team will contact you as soon as possible. Paying for care and support The questions will help you get an idea of whether you are likely to have to pay for some or all of the care and support you need. If you are found to be assessed as needing care, we will complete a full financial assessment to check what your weekly charge will be.Do you own your own home (including shared ownership)? Yes No Do you live alone? Yes No Do you have savings, investments or other properties worth over £23,250 (combined)? Yes No You told us that you have more than £23,250 in savings and investments. Based on this information, you will have to pay for the full cost of your care and support. We recommend you visit the paying for your care page to get a better understanding of how this works.You told us that you don't have more than £23,250 in savings and investments. Based on this information, you will be asked to contribute towards the cost of your care and support. A weekly charge will be worked out by us based on your savings or capital, income and benefits. Your situation The next sections will help us understand how you're managing your everyday situation at home such as tasks like dressing, cleaning, cooking and getting out and about. When answering the questions: Base your answers on a typical week (if you have one). don't think about any support you have at the moment - imagine yourself alone in your home with nobody else there to help you Home and livingCan you clean and maintain your home on my own and without help? Yes No Can you manage your day to day paperwork on your own and without help? Yes No Eating and drinking Can you shop for food on my own and without help? Yes No Can you prepare and cook your own meals? Yes No Can you eat and drink on your own, without help from someone else? Yes No Personal careCan you use the toilet on your own? Yes No Can you wash or bath/shower yourself? Yes No Can you get dressed and undressed on your own? Yes No Social relationships and activitiesCan you develop and maintain relationships with family, friends and others? Yes No Can you go out into the community on your own? Yes No Can you socialise on your own? Yes No Work, training, education and volunteeringCan you access and take on work, training, education or volunteering on your own? Yes No Not applicable Caring for others Do you have children that are dependent on you? Yes No Can you carry out your parenting/caring responsibilities without help and support? Yes No Staying safe Are you safe to be at home on your own? Yes No Accessing the community I am able to get around in the community safely and able to use facilities such as public transport and leisure facilities on my own without help Yes No