Home for Life Design

Home Assessment Report

Kristin Caroza of Touro University, performed the following occupational therapy home assessment to determine the
safety and current functional status of Nash in the home. This report details Barbara Nashs feeling of safety and
measures the accessibility of important occupations that occur throughout areas of the home. Information was gathered
via professional interview with the client and/or family, activity analysis, objective measurements and photography. This
assessment was performed on: 9/25/2015

Patient Information:
Patient Name:
Address:

Date of Birth: 1/1/1

Nash, Barbara
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2339
Schaeffer Hill Dr
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Henderson, NV 89052
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Gender:

Female

Tennant Type:

Owner

Is Veteran:

No

Housing Type:

Single Family

Has HOA:

Yes

No. Floors:

Lives With:

Self

Special Considerations:
Inaccessible none
Areas:

Assistive
Devices:

If the client has fallen, did the most recent fall:

Where did the fall occur: N/A

Result in Injury: No

What Room:

Result in Hospitalization: No

Fall Cause Type: N/A

Result in Rehabilitation: No

Fall Cause Comments:

Other Considerations:
Consideration Type

Therapist Note

Home and Personal Findings:

The following rooms assessed each indicate the Personal Safety Rating given by the patient and the Therapist
Accessibility Rating determined by activity analysis during skill performance:

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Pre-Assessment
Personal Safety
Rating %

Therapist
Accessibility
Rating %

100.00 %

100.00 %

100.00 %

100.00 %

100.00 %

100.00 %

Bathroom, In master bedroom.

100.00 %

100.00 %

Bedroom, Has rugs

80.00 %

100.00 %

Bedroom, Guest bedroom in front of house.

100.00 %

100.00 %

Outdoor Space, Backyard

70.00 %

50.00 %

Outdoor Space, Front home access

100.00 %

75.00 %

Room Assessed
Kitchen, Next to the dining room, by the
garage.
Dining Space, By the the kitchen and has
access to backyard.
Living/Family Room, By the dining room,
access to backyard.

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Post-Assessment
Therapist
Personal Safety
Accessibility
Rating %
Rating %

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Home Recommendations Based on Findings:

Kitchen, Next to the dining room, by the garage.

Personal Safety Rating

Accessibility Rating

100.00 %

100.00 %

Recommended Modifications:
- Cook Top Auto Shut Off
Pre-Assessment Notes: Uses step stool to reach for higher shelves. Consider open shelving concept.
Post-Assessment Notes:

Dining Space, By the the kitchen and has access to

backyard.

Personal Safety Rating

Accessibility Rating

100.00 %

100.00 %

Recommended Modifications:
- Add Lighting
Pre-Assessment Notes: No lighting over the table.
Post-Assessment Notes:

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Living/Family Room, By the dining room, access to backyard.

Personal Safety Rating

Accessibility Rating

100.00 %

100.00 %

Recommended Modifications:
- Add Accessible Outlets
- Add Furniture Risers
Pre-Assessment Notes: Open concept, little clutter, only outlets on the wall.
Post-Assessment Notes:

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Bathroom, In master bedroom.

Personal Safety Rating

Accessibility Rating

100.00 %

100.00 %

Recommended Modifications:
- Corner Shelf Grab Bar
- Soap Dish Grab Bar
- Grab Bar Opposite Side of Bathing Entry
- Horizontal Grab Bar
- 18" - Textured
- Comfort Height Toilet
- Anti-Slip Floor Coating
- Night Lights
- Rug w/ Anti Slip Backing
Pre-Assessment Notes: Walk in shower with slight step to enter. Bathroom connected to closet.
Post-Assessment Notes:

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Bedroom, Has rugs

Personal Safety Rating

Accessibility Rating

80.00 %

100.00 %

Recommended Modifications:
- Add Lighting
Pre-Assessment Notes: Could remove rugs. Bed is slightly high but no client complaints about getting in or out.
Post-Assessment Notes:
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Bedroom, Guest bedroom in front of house.

Personal Safety Rating

Accessibility Rating

100.00 %

100.00 %

Recommended Modifications:
- Add Lighting
- Organize/Declutter Space
Pre-Assessment Notes: Cat towers located in this room. Takes up a lot of space.
Post-Assessment Notes:

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Outdoor Space, Backyard

Personal Safety Rating

Accessibility Rating

70.00 %

50.00 %

Recommended Modifications:

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- Add Lighting
- Create Smooth Pavement
- Add Visible Steps
Pre-Assessment Notes: Does not use backyard during summer. Consider non slip ground by hot tub.
Post-Assessment Notes:

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Outdoor Space, Front home access

Personal Safety Rating

Accessibility Rating

100.00 %

75.00 %

Recommended Modifications:
- Add Lighting
- Create Smooth Pavement
- Add Visible Steps
Pre-Assessment Notes: 2 ways to enter front door. Steps or graded driveway. Client also enters home through
garage.
Post-Assessment Notes:

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Additional Service Recommendations (e.g. home health, medication management):

Additional Notes:
Very active, swims everyday and walks. Has two cats.

Submitted By:

Kristin Caroza, , License #

9/25/2015

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