Adult social care - Needs assessment

You can use this assessment to tell adult social care about your current situation and any support you may need. 

About the assessment

Once you have submitted your assessment, we will contact you within 5 working days to discuss your assessment and if necessary, arrange a face-to-face visit to help you plan your support.

If you are completing this assessment on behalf of someone else, please answer each question as if you were them. You will need to get their permission before completing this assessment. If the person does not agree to the assessment and you are concerned about them, please call us on 0121 704 8007.

At the end of the assessment, we will ask you to confirm that you are happy for us to share information about you, where appropriate, with relevant NHS agencies and providers of care and support services. This will help to reduce the number of times you might be asked for the same information. If you need more information, please see our privacy statement or email ccadults@solihull.gov.uk.

Financial assessment

If you are eligible for support from us, you will need to complete a financial assessment.

If you continue with the assessment, you are are agreeing that you may have to pay towards any services you receive. A financial assessment will tell you how much you are likely to have to pay towards your support.

Are we your local authority?

You need to live within Solihull to receive support from us.

Check if you live within Solihulll at GOV.UK

If you do not live within Solihull, please contact your local council

Completing this assessment

Do you have difficulty:

  • understanding information provided
  • remembering information
  • using or weighing up the information as part of the process of being involved
  • communicating views, wishes, or feelings

If you believe that you are likely to have substantial difficulty in completing the assessment and do not have anyone to help you, please contact us on 0121 704 8007.

We may be able to support you to access an Independent Advocate to support you, or we could help you to look for other ways to complete an assessment.

If you are completing this assessment on behalf of someone else

You need the person's permission before completing the assessment. If the person does not consent and you have concerns, please call us on 0121 704 8007.

Who is this assessment for

If your needs do not relate to physical or mental impairment or illness, it is likely that you will not be eligible for support.

Additional information

Your main reason for contacting us

Communication

About you

When answering this question, think about:

  • Your history (family, job/career/education, medical, significant events in your life and how these shaped you)
  • What a good day looks like for you
  • If you have good days and bad days that change the level of support you need
  • What is working well
  • What you like doing
  • What your interests and aspirations are
  • The things you can do, what your strengths, abilities and skills are

Eligibility

If you can carry out the following activities without support, please answer 'Not applicable'.

Personal care

Keeping clean and fresh

Getting dressed and undressed

Using the toilet

Your home

Being able to make use of the home safely

Maintaining a clean, tidy and safe home

Shopping for food, making meals, drinks, eating and drinking

Getting out and about and relationships

Getting out and about on your own

Keeping in contact with friends and family

Work, training or volunteering

Caring for others

Tell us here if you care for another adult (over 18 years) or young person (under 18 years). Explain if you can carry out your caring or parenting responsibilities. Clearly separating the care you provide to each person.

Contact person

Who do you want us to contact about this assessment and how should we get in touch?

Submit

To complete this form, you must read and agree to the following:

  • I confirm that the information I have provided in this assessment is true
  • I understand that any support from adult social care may change if the information in this assessment is incorrect or my situation changes
  • I understand that I may have to pay towards any support
  • I understand that a computer record will be made which will be treated confidentially by Solihull Council. This information is held by the council for the purpose of providing information, advice and support to meet my needs
  • I understand that the council will share information about me where appropriate with relevant NHS agencies and providers of care and support services which will help to reduce the number of times I am asked for the same information
  • I understand that the information on this form will only be shared as allowed by the Data Protection Act 2018 and the General Data Protection Regulations
  • I confirm that if I have completed this assessment on behalf of somebody else, I have gained consent from this person

For further information about how we use your information, please read our Privacy Statement or email us at ccadults@solhull.gov.uk.

Your agreement

Data Protection

Your information may be shared with other council services and partner organisations to ensure our records are kept accurate and to help us to identify services or benefits you may be entitled to or interested in. We may also need to share your information for the prevention and detection of fraud and/or other crimes or as the law requires. For further information about how we use your information please refer to the Council’s Privacy Statement on www.solihull.gov.uk.