GO Care PDF Template
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Participant Intake and Support plan
01/10/2025
Date this Participant Intake and Support Plan was started
Friday, January 10, 2025
Section 1: Personal details
Legal Name
Matthew Mclaren
Preferred name
Matthew
Date of Birth
Tuesday, April 25, 1978
Participant Address
5 Gleeson street Warrnambool
Gender
Male
Background
Do not identify as Aboriginal or Torres Strait Islander
Primary Disability/ Existing conditions
Any health, medication, environmental, safety risk, emotional/behavioural, cognitive/developmental, mobility, nutrition, or dietary conditions relevant to the participant’s care.
MS
Participant contact details
Mobile/ House number
0429458785
Preferred method of contact
Mobile phone
Guardian or Advocate Details
For participants under the age of 18 years, under guardianship or in the care of family or caregivers please complete below.
Emergency Contact Details
Must be contactable outside business hours
Section 2: NDIS Plan Details
Participant NDIS Number
430434211
Current NDIS Plan Start date
Tuesday, June 6, 2023
Current NDIS Plan Finish date
Thursday, June 5, 2025
Section 3: Participant needs and preferences
Participant needs and preferences regarding their supports. Consider physical, emotional, spiritual, cultural, social and health/medical needs.
Assistance with transport from wdea near big r shed to fletcher jones, attend art.
The participant’s living skills; and any daily routine they may have including eating, drinking, dressing, sleeping, bathing, toileting:
NIL
The participant’s education, training and/or
vocational needs, goals and preferences:
Support with transport and community access
Pick up Matthew from Wdea near big r shed he
will be waiting out front at 4pm.
Take to Art at fletcher jones. Drive up and
walk Matty inside. Come back in an hour or w
hen Matty tells you. Meet matt back inside a
nd walk back to car. Matty might like to get
a drink or have a chat before shift ends, d
rop home.
Increase my independent living skills
Gocare to support with transport and communi
ty access
Choice and control over my life
Maintain independence
I will work with therapists to develop strat
egies so that I can increase my independent
living skills.
Engage with ongoing therapists
Maintain health and well being
Maintain health and fitness
Home environment to be safe and promote my i
ndependence so I can stay living independent
ly as long as I can
Keep contact with Support coordinator
Active member in the community
Support to art, community access
Support from Gocare
Laundry modified
Modifications
Maintain my memory
Strategies for MS
The participant’s social and/or leisure preferences:
Increase my independent living skills Gocare to support with transport and community access Choice
and control over my life Maintain independence I will work with therapists to develop strategies so that I
can increase my independent living skills. Engage with ongoing therapists Maintain health and well
being Maintain health and fitness Home environment to be safe and promote my independence so I can
stay living independently as long as I can Keep contact with Support coordinator Active member in the
community Community participation Support to art, community access Support from Gocare Laundry
modified Modifications Maintain my memory Strategies for MS.
Section 4: Communication needs
Please list the participant communication needs, including details of any communication aids that are required. Please refer to the participants Communication Plan when possible.
Verbal
Section 5: Behaviours of concern
Behaviours of concern are determined by the Behaviour Support Specialist. If this is relevant for the participant, outline how behaviours of concern will be managed. Please refer to the Positive Behaviour Support Policy, Refer a Participant to a Behaviour Support Specialist Procedure and Behaviour Support Plan (provided by the Behaviour Support Specialist).
NIL
Section 6: Participant's Required Assistance with Activities of Daily Living (ADLs) and Mobility
Assistance with ADLs: Showering, toileting, dressing, grooming (Please include use of incontinence aids if applicable).
NIL
Mobilities needs and equipment: Hoists, walking aids, transfer aids, shower/toilet aids.
NIL
Section 7: Support provision information
Identify the types of support you would like
GO Care to provide
Service type | Service strateg ies | Review date |
|---|---|---|
Support worker to assist with transport | Pick up Wdea wo rks taxi rank, from big r shed . Tell Matthew wh o's coming if J osie cant suppo rt. Transport to Fl etcher jones ar t class. drive up, park and wa lk up encourage to use ramp. L eave Matthew with art teache r, he will tell you what time to return. Tran sport home. Mat thew loves to h ave a chat, sometimes enjoy s a hot chocola te. |
Shift specific questions
Who should we notify if there is a change to your scheduled shift?
Matthew Mclaren
How should we make contact about urgent shift changes?
Mobile phone
If your regular shift booking falls on a public holiday do you still require support as per your regular booking/ schedule B?
Please contact me prior to the shift occurring to confirm funding available and the shift is still required
Are you comfortable meeting a new support worker to assist you if your regular team is unavailable for your requested time/shift?
Yes
Please contact me or my guardian/advocate/next of kin (NOK) before assigning the shift to a new support worker to ensure it is appropriate
Is Agency Use Permitted? or do you use other providers we can contact to assist in providing coverage for your shift with GO Care?
No, I do not permit agency use
Section 8: Risk assessment
To be completed by GO Care Team Leader.
Section 9: Care plan
Based upon the Participants NDIS goals
List NDIS Goals
Services/ intervent ions | Time Fram e | Review da te | Completed by | |
|---|---|---|---|---|
Goals Outcomes Increas e my inde pendent l iving ski lls Goc are to su pport wit h transpo rt and co mmunity a ccess C hoice and control over my l ife Mai ntain ind ependence I wil l work wi th therap ists to d evelop st rategies so that I can incr ease my i ndependen t living skills. Engage w ith ongoi ng therap ists M aintain h ealth and well bei ng Mai ntain hea lth and f itness Home env ironment to be saf e and pro mote my i ndependen ce so I c an stay l iving ind ependentl y as long as I can Keep c ontact wi th Suppor t coordin ator A ctive mem ber in th e communi ty Com munity pa rticipati on Sup port to a rt, commu nity acce ss Supp ort from Gocare Laundry modified Modifi cations Maintai n my memo ry Str ategies f or MS. |
Section 10: Participant Arrangements
Provide information on arrangements required for the participant, such as periodical appointments for vaccinations, dental care, doctor visits and allied health services.
Section 11: Allied Health Information
Information of medical practitioners involve
d in supporting the participant. This includ
es proactive support for preventative health
measures (e.g., dental, vaccinations etc)
Support Coordinator: Natasha Woodfall
Supports provided:
Contact name: Rhonda Jane
Phone number:
Email (If applicable): natasha@rhondajane.com.au
Section 12: Medical Complications
Provide information on participant complications, any signs and symptoms that may occur and action/s required in response.
List
Complicatio ns | Action/s re quired | Date | Completed b y |
|---|---|---|---|
MS | Memory Low MS strategi es from the rapists Uneven grou nd Medium Ensure grou nd is even and free fr om tripping hazards Lighting Medium Ensure suff icient ligh ting Health Medium Maintain ph ysical and mental heal th | ||
Complicatio ns | Action/s re quired | Date | Completed b y |
Memory L ow MS str ategies fro m therapist s Uneven ground M edium En sure ground is even an d free from tripping h azards L ighting Medium E nsure suffi cient light ing Heal th Mediu m Mainta in physical and mental health. | |||
Multiple s clerosis Gp, therap ists, ongoi ng treatmen t Hemoch romatosis South west hospital b lood venese ction Os teoporosis Medicati on. |
Section 13: Emergency management information
To be completed by GO Care Team Leader.
Section 14: Emergency and Disaster management information
To be Completed by the GO Care Team Leader.
GO Care Team Leader to attach any relevant emergency information such as the participant’s individual Redi plan and the participant’s individual Emergency and Disaster Management plan. For Medical Emergencies please refer to section 13.
Section 15: Communication plan
How relevant information in this plan will be communicated to the participant’s support network, other providers and government agencies. Refer to the Working with Participant Support Network Policy, Working with Participant Support Network Procedure and the Participants Individual Health Passport.
Section 16: Worker training arrangements
To be Completed by the GO Care Team Leader.
Relevant Documents
Section 17: Authorisation to use image
For Go Care support services community and promotional activities.
For good and valuable consideration, the rec
eipt of which is hereby acknowledged, I here
by consent to the photographing of myself /
above person and the recording of my/his/her
voice and the use of these photographs and/
or recordings singularly or in conjunction w
ith other photographs and/or recordings take
n by Go Care Support Services for community
and /or promotional activities, publicity, c
ommercial or other business purposes.
I understand that the term "photograph" as u
sed herein encompasses both still
photographs and motion picture footage.
I further consent to the reproduction and/or
authorization by GO Care Support Services,
71 Drummond Street, Warrnambool, VICTORIA, t
o reproduce and use said photographs and rec
ordings of voice, for use in all domestic an
d foreign markets.
I hereby release GO Care Support Services, a
nd any of its associated or affiliated compa
nies, their directors, officers, agents, emp
loyees and customers, and appointed advertis
ing agencies, their directors, officers, age
nts and employees from all claims of every k
ind on account of such use.
I have read and understand the above, and therefore consent:
Yes, please refer to my signature below.
Section 18: Signatures and Section 19: Details of plan developers
All parties involved in providing input to this document must list their details and signature.
When Should a Guardian or Advocate Sign this Form on behalf of a participant?
A guardian should sign if the participant is under 18 years of age or has a legal guardian appointed.
An advocate should sign if the participant has authorized someone to act on their behalf in decision-making or communication.
People involved in the creation of this document.
Name of Person/ Developer:
Amber Furlong
Date plan was created or edited:
Friday, January 10, 2025
Relationship to the participant
individual supports team leader
Email
individualsupports@gocss.com.au
Signature of developer
Nam e | Posi tion | Respons ibiliti es | Contact I nformatio n |
Gerard O’ Brien | Director | Culture, I nvoicing | 0430 003 174 |
Kaoru O’B rien | Chief Ex ecutive Officer | Vision, fu ture plann ing, Parti cipant/Wor ker Relati ons, Feedb ack, Compl aints | 0401 070 236 |
evilacqua | Operatio ns Manag er | Business a nd strateg ic plannin g/manageme nt, Feedba ck, Compla ints | 0472 782 808 |
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