Completed record
Admission Suitability and Placement Matching Assessment
Reference QA-ADM-0001 · Maple Lodge · Demo Young Person A
1. REFERRAL & PROPOSED PLACEMENT DETAILS
Accommodation category
2. MANDATORY REFERRAL INFORMATION CHECKLIST
All mandatory information complete?
If NO - referral status
2. MANDATORY REFERRAL INFORMATION CHECKLIST – Table
Entry 1
Ref
Required information
Status
Date received
Gap / action / owner
3. STATEMENT OF PURPOSE & SUPPORTED-ACCOMMODATION ELIGIBILITY
Overall Statement of Purpose fit
If NO or UNCLEAR
3. STATEMENT OF PURPOSE & SUPPORTED-ACCOMMODATION ELIGIBILITY – Table
Entry 1
Domain
Assessment question
Met?
Evidence / rationale
4. OUT-OF-SCOPE / RED-FLAG SCREEN
Any red flag present?
If YES - action
Independent review required?
4. OUT-OF-SCOPE / RED-FLAG SCREEN – Table
No entries recorded.
5. PRE-ADMISSION RISK & SUPPORT NEEDS SUMMARY
No entries recorded.
6. PREMISES, LOCATION & WORKFORCE SUITABILITY
No entries recorded.
7. COMPATIBILITY & PLACEMENT MATCHING - WHOLE-HOUSEHOLD OVERVIEW
Overall household compatibility rating
Any incompatibility requiring refusal?
Any condition required before admission?
7. COMPATIBILITY & PLACEMENT MATCHING - WHOLE-HOUSEHOLD OVERVIEW – Table
No entries recorded.
8.1. RESIDENT-BY-RESIDENT COMPATIBILITY ASSESSMENT
Pairing outcome
Management review required?
8.1. RESIDENT-BY-RESIDENT COMPATIBILITY ASSESSMENT – Table
No entries recorded.
8.2. RESIDENT-BY-RESIDENT COMPATIBILITY ASSESSMENT
Pairing outcome
Management review required?
8.2. RESIDENT-BY-RESIDENT COMPATIBILITY ASSESSMENT – Table
No entries recorded.
8.3. RESIDENT-BY-RESIDENT COMPATIBILITY ASSESSMENT
Pairing outcome
Management review required?
8.3. RESIDENT-BY-RESIDENT COMPATIBILITY ASSESSMENT – Table
No entries recorded.
8.4. RESIDENT-BY-RESIDENT COMPATIBILITY ASSESSMENT
Pairing outcome
Management review required?
8.4. RESIDENT-BY-RESIDENT COMPATIBILITY ASSESSMENT – Table
No entries recorded.
9. PLACEMENT MATCHING DECISION SUMMARY
No entries recorded.
10. PROPOSED INITIAL SUPPORT & TRANSITION PLAN
No entries recorded.
11. STAGE 1 - REGISTERED SERVICE MANAGER RECOMMENDATION
RSM recommendation
Conditions outstanding?
Restriction status checked?
If restriction applies
Record audit details
Submitted by Demo Registered Manager on 29/09/2026, 19:30:00. Production records will also capture authenticated user IDs, amendments, manager review and sign-off history.