Home for Life Design

Home Assessment Report

Orah Kabaei of Touro University, performed the following occupational therapy home assessment to determine the safety
and current functional status of Pinocci in the home. This report details Jeannette Pinoccis 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: 10/12/2015

Patient Information:
Patient Name:

Pinocci, Jeannette

Date of Birth: 5/7/1931

Address:

2573 Edensville Avenue

Gender:

Female

Henderson, NV 89052
Tennant Type:

Family

Is Veteran:

No

Housing Type:

Single Family

Has HOA:

Yes

No. Floors:

Lives With:

Self

Special Considerations:
Inaccessible N/A
Areas:

Assistive DME:FWW, wheelchair, raised toilet seat with

Devices: grab bars, shower chair, and temporary grab
bars in the shower.

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

Where did the fall occur: Inside the Home

Result in Injury: No

What Room: Kitchen

Result in Hospitalization: No

Fall Cause Type: Physiological

Result in Rehabilitation: Yes

Fall Cause Comments: Temporary loss of consciousness. Client

reports that she could not get up after the fall until her son came
over and saw her helpless, on the floor.

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:
Pre-Assessment
Personal Safety
Rating %

Therapist
Accessibility
Rating %

Bathroom, Master Bathroom

80.00 %

94.44 %

Kitchen, Kitchen/dining

100.00 %

91.67 %

Bedroom, Master bedroom

100.00 %

100.00 %

Bedroom, Guest room

100.00 %

75.00 %

Room Assessed

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Post-Assessment
Therapist
Personal Safety
Accessibility
Rating %
Rating %

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Home Recommendations Based on Findings:

Bathroom, Master Bathroom

Personal Safety Rating

Accessibility Rating

80.00 %

94.44 %

Recommended Modifications:
- Angled Grab Bar
- Grab Bar Right Side of Bathing Entry
- Vertical Grab Bar
- 18" - Textured
Pre-Assessment Notes:
Post-Assessment Notes:

Kitchen, Kitchen/dining

Personal Safety Rating

Accessibility Rating

100.00 %

91.67 %

Recommended Modifications:

Pre-Assessment Notes:
Post-Assessment Notes:

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Bedroom, Master bedroom

Personal Safety Rating

Accessibility Rating

100.00 %

100.00 %

Recommended Modifications:

Pre-Assessment Notes:
Post-Assessment Notes:

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Bedroom, Guest room

Personal Safety Rating

Accessibility Rating

100.00 %

75.00 %

Recommended Modifications:

Pre-Assessment Notes: Client reports that guest bed is too high for her to transfer in and out of. She does not ever
use this bed and reports that it is not of concern.
Post-Assessment Notes:

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

Install permanent grab bar inside and outside of shower.
Additional Notes:
Has supportive sons. Dr. Recently gave her permission to drive which she is very excited about.

Submitted By:

Orah Kabaei, , License #

10/13/2015

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