Short Term Accommodation

Short Term Accommodation in Fawkner

We’ve just opened a beautiful new Short Term Accommodation (STA) for adults aged 18 to 65.

It’s a safe, welcoming space where you can relax, recharge, and get the support you need. It has a bus stop right outside that connects to the North Coburg tram into the city.

Activities will be planned for the weekends and where appropriate during the week. We are also about increasing independent living skills and getting people ready to move into appropriate accommodation.

Fawkner address will be released once referral form has been approved

Name of Referrer *

First

Last

Referral Agency

Postal Address

Phone Number

Email *

Name of Participant *

First

Last

Address of Participant

Telephone of Participant

Date of Birth

Which of the following most accurately describe(s) you?

Male
Female
Non-binary
Transgender
Intersex
Other
Prefer not to say

If Other, please detail here

Marital Status

Single
Married
Other

If Other, please detail here

Does the participant identify as:

Aboriginal
Torres Strait Islander
Other

If Other, please detail here

Country of Birth

Language at Home

Primary Disability Description *

Medical Management Plans must be provided (Diabetes plan, Epilepsy plan, Asthma plan etc)

Are Behaviours of Concern / Restrictive Practices present? *

If Yes, we will forward you a Risk Assessment form to complete prior to sending a quote

NDIS Number *

Plan Dates *

Email for Invoicing *

Services required *

NOTE 1: Ratios are taken into consideration for group outings. We will quote for a provision of 1:1-day support rates for participants on 1:2 and 1:3 ratios if they decide not to join the group outing during their stay. NOTE 2: Full Description of ratios and assistance required to be discussed with Including You Office staff if you have ticked 1:1 or 1:2 Ratio. NOTE 3: If a participant requires more than the ticked ratio a phone call will be made to request a change to the original quote and must be signed off before the stay can continue.

Is 1:1 ratio required? Requires Full Assistance with Daily Tasks *

• Showering • Toileting • Dressing and undressing • Mobility assistance in the community • Behaviours that require full monitoring (eyes on, constant need for staff attention) • Requires full assistance and constant supervision in the community. • 1:1 Staff member present throughout a 24hr period (NOTE: Does not include Active Overnight. If you require Active Overnights, please call to discuss prior.)

Is 1:2 ratio required? Requires Some Assistance with Daily Tasks *

• Minimal showering assistance (assistance to get in and out of bath or shower) • Minimal personal care and dressing (assistance with, shoes, socks, hair brushing) • May require prompting to pick appropriate clothes and get ready for the day. • Supervision or occasional help eating or using cutlery. • May need staff to help with daily living choices. • Requires closer supervision in the community and on outings. • Can effectively join with a group on agreed upon outings for a period of up to 8 hours

Is 1:3 ratio required? Independent or Requires Prompting with Daily Tasks *

• A person who is independent in all areas of personal care including toileting, showering and brushing teeth • Can eat independently, make drinks for themselves and has good communication/social skills. • Understands road rules, social settings and can effectively join with a group on agreed upon outings for a period of up to 8 hours • Able to spend periods of time alone while staff attend to other duties

Preferred Days *

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Provide further details (if required)

Preferred Dates

Do you require Including You to provide transport to and from the SDA?

Provide further details (if required)

Reason for Referral

Participant Desired Outcome

Where did you hear about us?

Non-Discrimination Policy

Including You believes in an inclusive service. This means we are committed to being an inclusive and respectful service that welcomes all. Sex, gender ,identity, sexual orientation, age and religion.