SCHEDULE 4 REQUEST FOR TEMPORARY APPROVAL ASSESSMENT FOR

Request for Temporary Approval Assessment Report

Introduction

Concerning (list the names of carer/s and DOB’s)

Regarding the placement of: (list names of child/ren and DOB)

Why assessment commenced and when report was completed

Legal status of child(ren)

What is the nature and quality of any existing relationship with the child/ren

Address of proposed placement:

Purpose of the Viability

Why are we considering this placement as appropriate for this particular child?  Record circumstances leading to application. 

Expected outcome

Sources of Information

Files, Reports, Consultation with i.e. SW, etc (list)

Family Composition

Members of the Household/Family (list both household members and wider family members who may have contact with the child/ren)

(INSERT Carer 1)

Family and Social History (include childhood and upbringing including the strengths and difficulties of their parents or other persons who cared for them, religion and cultural, racial and linguistic origins. Also include any incidents of domestic violence including past and present)

Medical history (including medical history, substance misuse and mental health)

Education & employment history (educational achievements and any specific learning disability or difficulty, past and present employment and any other sources of income)

Criminal convictions (include convictions and cautions)

Previous relationships (where relevant) include any step-children)

Chronology of significant life events

(INSERT Carer 2)

Family and Social History (include childhood and upbringing including the strengths and difficulties of their parents or other persons who cared for them, religion and cultural, racial and linguistic origins. Also include any incidents of domestic violence including past and present)

Medical history (including medical history, substance misuse and mental health)

Education & employment history (educational achievements and any specific learning disability or difficulty, past and present employment and any other sources of income)

Criminal convictions (include convictions and cautions)

Previous relationships (where relevant) include any step-children)

Chronology of significant life events

Environmental Factors

Who owns the house i.e. privately owned, landlord etc

Describe the accommodation and home environment provided (décor, equipment, furniture, atmosphere etc)

What are arrangements for sleeping? Are there any issues due to age, gender, choice and views about sleeping arrangements?

What are the child/ren’s views on living in the house and if applicable sharing their personal space?

Is there sufficient equipment and resources within the house to meet the child/ren’s learning and developmental needs?

Provide details of how the environment provides a suitable placement to the child/ren with particular regard to their age and developmental stage

Describe the area, community in which the house is situated and the resources available locally to support the child/ren and the connected person/s

Child/ren’s needs

Describe the nature and quality of any existing relationship between the child/ren and connected person

Describe the connected persons capacity to care for the child/ren

Provide details and arrangements of how the connected person is able to meet the child/ren’s physical needs and medical and dental needs

Provide details of the connected persons ability to safeguard and promote the welfare of the child/ren and to protect them from harm or danger, including from any person who is known to present a risk to them

Describe how the placement and connected person will promote secure attachments for the child/ren, including positive contacts with parents were appropriate

Checks Undertaken and Outcome

Children's Social Care

Note that checks must be undertaken with all Children's Social Care Directorate areas where applicants have lived. The checks to be undertaken in respect of all those living in the applicants’ household

Details of any current or previous involvement with

Knowsley Children's Social Care.

Checks with other agencies

Any significant outcomes form any checks undertaken

Any action taken as a result of any outcomes noted

Social Worker and Team

Signature

Date

Team manager

Signature

Date

Name of Nominated Officer

Designation

Signature

Date

Agree/disagree

Feedback

Action

Child/Children:

Date(s) of birth:

Carer(s):

Address:

Agreement Date:

Agreement between Knowsley Borough Council and;

Name of carer(s)

We agree to care for (insert name of child/children)

We agree to the following terms and conditions

a) to care for the said child(ren) as if he/she were a member of my family

b) to comply with the terms of the placement plan for the named child(ren)

c) to given written notice of any changes to my household, or any changes to my circumstance which might affect my ability to provide care, to Knowsley Borough Council

d) to permit anyone authorised by Knowsley Borough Council to visit the named child(ren) at any time

e) not to administer corporal punishment to the named child(ren)

f) (where applicable) to allow the child to be removed by Knowsley Borough Council

g) to ensure that any information acquired relating to the child, his family or other person which is given in confidence in connection with the placement is kept confidential and not disclosed except with the agreement of Knowsley Borough Council

h) to allow contact with the child in accordance with any Court Order or arrangements made or agreed by Knowsley Borough Council

i) To inform the fostering service of the child progress and to notify it as soon as reasonably practicable of any significant events affecting the named child(ren)

(Please detail any further requirements of placement/carer)

Signature of carer .1

Signature of carer. 2

Signature of authorised officer on behalf of Knowsley Council