Equipment and Minor Adaptations - Self Assessment Form

Leicestershire’s Adult Social Care Services department is currently running a pilot project for adults living in North West Leicestershire & Charnwood. It aims to offer the opportunity to adults to complete a self assessment for minor pieces of equipment or small adaptations to their home to assist them with their independence.

Completing the form - Explanatory Notes

We have tried to make the form as easy as possible to complete, but should you need assistance with completing the form, or any advice regarding the self assessment process, please contact your local social care office and ask to speak to an Adult Access duty worker. The relevant offices are: North West Leicestershire and Charnwood (see local offices).

The form covers areas at home that you may have difficulty with, for example, getting in and out of your chair or bath. Please complete the sections that affect you.

We will be confirm receipt of the information and, subject to your eligibility to community care, services will be arranged in consultation with you.

For each section you are asked whether you would want the service supplied and organised by Adult Social care Services or receive a Direct Payment. More information about Direct Payments is available from the department but basically it means that a cash payment can be made so that equipment or adaptations can be purchased independently of Adult Social care Services. Relevant receipts/proof of purchase should be retained see Direct Payment figures for some equipment and/or adaptations.