SUBENVIRONMENTS PRESENT IN THE HOME

Student: Student L
Date: 11 August 2015
Completed By: Natasha Khoo

Home Stories
Bathroom

There are two bathrooms in the home. One bathroom is in the common toilet near the kitchen, the other bathroom is
in the master bedroom. Student L uses both bathrooms but uses the bathroom in the master bedroom more often
than the other. Each bathroom has a toilet bowl, sink and shower. Lewis uses a stool to wash his hands in the
bathroom

Bedroom

There are two bedrooms in the home. One bedroom is the master bedroom where Student L and his parents sleep
in. The other is where his grandparents sleep in. In the master bedroom, there are mattresses on the floor and a
small television. Student L sleeps in the middle of his mother and father.

Kitchen/
Dining Room

Living Room

There is a sofa and a television in the living room. Behind the sofa, there is a table and chairs for the family to eat
their meals. Student L sits on the same sized chair as his family.

There is a sofa and a television in the living room. Behind the sofa, there is a table and chairs for the family to eat
their meals. Student L sits on the same sized chair as his family.

Family Room/
Den

Basement

Porch/Patio/
Deck

Other

Other

Other

Other

other bathroom is
oom more often
hands in the

his parents sleep

the floor and a

he family to eat

Subenvironment Codes

DOMESTIC SKILLS ASSESSMENT

Assessment Date: 11 August 2015

Completed by: Natasha Khoo

1
2

BA = Bathroom

L = Living Room

B = Bedroom

F = Family Room

K = Kitchen

S = Basement

Training Key

Participation Levels

D = Dining Room

Y = Yard

*= High Priority

I = Independent

O = Other

C = Classroom

= Simulated

Student: Student L

P = Partial Participation

3
Yes
No

CA = Cafeteria

Weight

Environment
Skill Type

Partial Participation and Comments

Adaptation

Particip.
Level

Current

Future

Toileting
Wash and Dry
Hands
Brush Teeth

Adult will put toothpaste on toothbrush

for Student L to brush his teeth. Adult
will fill cup with water for him to rinse.

Feed self with

spoon and fork

Year 1
Rank

Date

Training

Year 2
Rank

Date

Year 3
Rank

Date

2016

2017

2018

BA

BA

BA

Yes

2016

2017

2018

BA

BA

BA

BA

Yes

2016

2017

2018

BA

BA

BA

Yes

2016

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2018

BA

BA

BA

BA

2016

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No

Mealtime Behaviors
Eat different
varieties of food

Weight
Needed

School

Grooming & Hygiene Student L will wear diapers throughout

the day but when brought to the toilet,

he will take off his pants and diapers, sit
on the toilet bowl to relieve himself
before wearing his diapers and pants
back again. A child size toilet bowl or
potty should be present.

Student L will either eat part of the food

given to him or take out food from the
bowl that he does not want before
throwing into the bin

4
5+

Yes
No

Meal Preparation

Begun

Completed

Weight

Environment
Skill Type

Partial Participation and Comments

Adaptation

Particip.
Level

Current

Future

School

Weight
Needed

Year 1
Rank

Date

Training

Year 2
Rank

Date

Year 3
Rank

Date

2016

2017

2018

2016

2017

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2016

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2016

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Begun

Completed

Weight

Environment
Skill Type

Partial Participation and Comments

Adaptation

Particip.
Level

Current

Future

Weight
Needed

School

Year 1
Rank

Date

Training

Year 2
Rank

Date

Year 3
Rank

Date

Use Appliances
2016

2017

2018

2016

2017

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2018

Meal Clean-Up

Clothing Care and

Use
A. Dress Self
Dressing

B. Undress Self

Lewis needs assistance from adult when

putting on diapers, shirt and pants. He
needs assistance to fully pull up diapers
and pants. He only needs assistance to
put his head through the shirt before he
can put his hands through the sleeves
independently.

x
X

BA

BA

BA

Yes

Clothing Care

Begun

Completed

Weight

Environment
Skill Type

Partial Participation and Comments

Adaptation

Particip.
Level

Current

Future

School

Weight
Needed

Year 1
Rank

Date

Training

Year 2
Rank

Date

Year 3
Rank

Date

2016

2017

2018

2016

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Clothing
Selection

Begun

Completed

Weight

Environment
Skill Type

Partial Participation and Comments

Adaptation

Particip.
Level

Current

Future

School

Weight
Needed

Year 1
Rank

Date

Training

Year 2
Rank

Date

Year 3
Rank

Date

Housekeeping
2016

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2016

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2018

Yard Care

Health and Safety

Begun

Completed

Weight

Environment
Skill Type

Partial Participation and Comments

Adaptation

Particip.
Level

Current

Future

School

Weight
Needed

Year 1
Rank

Date

Training

Year 2
Rank

Date

Year 3
Rank

Date

2016

2017

2018

2016

2017

2018

2016

2017

2018

2016

2017

2018

2016

2017

2018

2016

2017

2018

2016

2017

2018

2016

2017

2018

2016

2017

2018

2016

2017

2018

2016

2017

2018

2016

2017

2018

Other Domestic
Skills

Begun

Completed

Rank List
Grooming
&
Hygiene
2 Toileting
1 Wash and Dry
4 Brush Teeth

Mealtime
Behaviors

Meal Preparation

Use Appliances

Meal Clean-Up

5 Eat different variet

House
Keeping
Clothing
Selection

Un-dress Self

Clothing Care

Health & Safety

Other Domestic
Skills

Dress Self
2 Dressing

Yard Care

Rank List
Grooming
&
Hygiene

Mealtime
Behaviors

Meal Preparation

Use Appliances

Meal Clean-Up

House
Keeping
Clothing

Un-dress Self

Clothing Care

Dress Self

Health & Safety

Yard Care

Other Domestic
Skills

Selection

Rank List
Grooming
&
Hygiene

Mealtime
Behaviors

Meal Preparation

Use Appliances

Meal Clean-Up

House
Keeping
Clothing Selection

Un-dress Self

Clothing Care

Dress Self

Health & Safety

Yard Care

Other Domestic Skills