Daily Visit Checklist
Lollipop's Companion Care
Client Name:
Date:
Visit Time: to
Duration:
Activities During Visit
Conversation and companionship
Cup of tea / refreshments
Reading together
Games / puzzles / activities
Watching TV / film together
Music / reminiscence
Short walk / fresh air
Social outing
Care home visit
Accompanied appointment
Light household tasks (agreed)
Other (see notes)
Wellbeing Observations
Client appeared well and in good spirits
Client seemed tired or low in mood
Client mentioned any health concerns
Client had eaten / appeared to have eaten
Client appeared comfortable in their environment
Any concerns noted (see notes below)
Client Mood
Happy
Content
Quiet
Anxious
Confused
Tired
Unwell
Visit Notes
Actions / Follow-up Required
Carer Signature (Laura)
Date
Client / Family Signature (optional)
Date
Lollipop's Companion Care · [email protected] · 07931 846267