Form VN233: Ventura Conservatorship Status Report

Fill in ATTORNEY OR PARTY WITHOUT ATTORNEY (Name and Address), Telephone Number, E-MAIL ADDRESS and ATTORNEY FOR (Name).

Fill in IN THE MATTER OF and CASE NUMBER.

Fill in the blank before "the conservator of the person/estate of" and the blank after it.

Under Conservatee's current residence, fill in the address, the type of placement (i.e. own home, group home, skilled nursing facility, etc.) and how long the conservatee has been in the present residence. The * after 1. Conservatee's current residence has this note: the Probate Investigator's Office, and Conservatee's Counsel, must be notified of any change of address.

Mark No or Yes (explain): do you anticipate making any changes in the conservatee's residence in the next year?

Fill in the plan to return the conservatee to his/her personal residence if not now living at home. If there are no plans to return the conservatee to his/her personal residence in the foreseeable future, explain the limitations or restrictions for not doing so.

Mark all that apply under Current level of care: requires total care, requires assistance with care, has feeding tube, able to do own care, uses a wheelchair/walker, has catheter, ambulatory, urinary/bowel incontinence. Then fill in Details.

If residing in a facility or group home, attach copy of the facility's care plan.

If the challenged adult is a Regional Center consumer, and it is reasonable to do so, attach a complete copy of the current Individual Program Plan (IPP).

List the health problems under Conservatee's physical and medical condition.

Mark No or Yes: are any other health providers involved? Then fill in visiting nurse, social worker, podiatrist, dentist, counselor, physical therapist, speech therapist or other (specify).

List the medications and the activities the conservatee is involved in.

Fill in how often you expect to visit the conservatee. Does the family visit?

Are there plans to give the conservator a rest? Fill in respite care, adult day care, other care takers or In Home Support Services (IHSS), with the names and relationships of relief caregivers.

Complete the Conservatee's Estimated Monthly Income and Estimated Monthly Expenses even if a conservatorship of the person only.

Under LIVING EXPENSES, fill in Rent/Mortgage, Utilities, Nursing/Care Home, In-Home Care, Food, Clothing, Medical/Dental, Medications, Transportation, Entertainment, Other (specify) and Total Estimated Monthly Expenses.

Under OTHER EXPENSES TAXES, fill in the Current and Estimated Amount for Income Tax, Property and Payroll.

Under INSURANCE, fill in the Current and Estimated Amount for Homeowner, Renters, Automobile, Worker's Comp, Health and Life.

Say what the contents are of any safe deposit boxes.

Mark No or Yes: does the conservatee receive Medi-Cal benefits? Fill in the share of cost.

Mark No or Yes: do you expect to sell any of the conservatee's real or personal property in the next year? If yes, say what will be sold and explain reason why.

Mark No or Yes: does the conservatee own a home in which (s)he does not live in? If yes, is it rented? Mark No or Yes and fill in the Amount of rent. If not rented, explain why.

If the Conservatee's monthly expenses are greater than his/her income, explain how the shortfall will be met.

Does the conservatee have a trust or is (s)he a beneficiary of a trust and entitled to receive income from the trust? If so, provide an attachment with the name of the trust, the name(s) of the trustee(s) and their contact information, and if applicable court case number for the trust.

Mark No or Yes (explain): do you anticipate any unusual activities related to the management of the conservatee's estate during the next year?

Are there any special problems or needs raised by the Court Investigation, the Court, or other interested? If yes, fill in how you have addressed them.

The undersigned conservator will: inventory all assets in which the conservatee has any interest; submit accurate, complete, and timely accountings; carry out all mandatory usual and general duties of a conservator. The conservator will maintain periodic contact with the conservatee's physician and other health care providers, if appointed conservator of the person. The conservator will maintain periodic contact with the conservatee's family and friends, if applicable. The conservator will be available to the conservatee on a 24 hour basis for emergencies, or arrange for such coverage by a qualified agent. The conservator will maintain accurate records related to the estate; maintain all estate assets in a separate identifiable manner; maintain estate cash assets in interest-bearing accounts, except as necessary for every day administration. The conservator will maintain an adequate surety bond as required by law; update care plan as needed; refer to the Conservator's Handbook.

File the original Conservatorship Status Report with the court and mail a copy to the Probate Investigations Office at: 800 S. Victoria Ave, Ventura, CA 93009 and Public Defender's Office at: 800 S. Victoria Ave. Suite 207, Ventura, CA 93009.