FORMAT OF HOMESTUDY REPORT (HSR) FOR PROSPAECTIVE ADOPTIVE PARENTS (PAP’s)

IN INDIA

CARINGS RESIGTRATION NO. – ABKPD9595N (PrMa42420187) DATE OF REGISTRATION - 07.12.2015

AADHAR CARD - 675309054604 NAME OF THE SOCIAL WORKER – Sr. Fatima Lopes

DATE OF HOME VISIT - 10.02.2016

PART – I SELF ASSESMENT

A. Identifying information about the PAP’s and their family background :

Particulars of information Male Applicant Female Applicant

Full Name Anil Barthol D’mello Neelima Anil D’mello

Date of Birth & age 09-12-1970 (45 Years) 09-04-1972 (43 Years)

Place of Birth Vasai Vasai Complete Address with E-mail ID

( Present & Permanent Address)

Anil D’mello

PokharniWadiTamtalao Near Liberty Hotel, Vasai

(W) – 401201, Dist. Palghar Maharashtra

advasai@gmail.com

Neelima Anil D’mello

PokharniWadiTamtalao Near Liberty Hotel, Vasai

(W) – 401201, Dist. Palghar Maharashtra

ndvasai@gmail.com Country of Origin India India

Country of Citizenship India India

Passport Number G0405207 Not Applicable Religion Roman Catholic Roman Catholic

Language(s) Marathi, English, Hindi Marathi, Hindi Date of Marriage 10-01-1999 10-01-1999

Date of Earlier Marriage ( if any) Not Applicable Not Applicable

Date of Divorce ( if any ) Not Applicable Not Applicable

Present Educational Qualification Bachelor of Commerce Bachelor of Arts

Employment/ Occupation Business House Wife Name & Address of Present

Employer / Business concern

Glomed Healthcare P. Ltd.

B.P. Patel Estate Nr. NavdurgaMandir

Dashrath, Vadodara-391740, Gujarat

Not Applicable

Annual Income Rs.6,50,000.00 Not Applicable

Health Status Normal Normal

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B. Family Background Information :

Details about Parents of Applicants

Male Applicants Female Applicants

Father Mother Father Mother Name in full Barthol

D’mello

Mary

D’mello

Anthony

Machado

Josphine

Machado

Age 75 Years 80 Years 85 Years 82 Years Nationality/ Citizenship Indian Indian Indian Indian

Occupation Retired House wife

Retired House Wife

Previous occupation Business House

wife

Farmer House wife

Presently residing with Me Me Their Son Their Son

(2) Adopted / Biological Children:

Name of the child Sex Date of Birth Education Status

Not Applicable Not Applicable Not Applicable Not Applicable

(3) Please describe how you believe the prospective adoption of a child will affect the lives of

your exiting children. ---------Not Applicable-----------

(4) Please indicate whether there are any other family members residing in the family home.

(b) No

(5) If yes, please complete the following table including the age, gender, occupation and

nature of the familial relationship of the other residing family members

Name Nature of the Relationship Age Gender Occupation

Not Applicable Not Applicable

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(6) Please describe how you believe the prospective adoption would affect these family

members. – It will not affect any one’s life but my parents will be more than happy

(7) Please indicate whether there are any other non-related adults/ children in the home

(b) No

(8) Please describe how you think the prospective adoption will affect non-related adults /

children residing in the familial home. --------- Not Applicable ------------

C. Professional/ Employment Details (Professional details for last 5 years : Please

complete the following details relating to your professional career.

Male Applicant

Organization Employer Details (Name & Address )

Job Title From - To

Glomed Healthcare P. Ltd.

Glomed Healthcare P. Ltd.

B.P. Patel Estate Nr.

NavdurgaMandir Dashrath, Vadodara-391740, Gujarat

Director 01.01.2014

Prime Medica

Promotion P. Ltd.

Prime Medica

Promotion P. Ltd. E/96, GIDC – Manjusar, Savli Road, Vadodara – 391 775, Gujarat

Senior Manager

Accounts

12.04.2004 to

31.12.2013

Female Applicant

Organization Employer Details (Name & Address )

Job Title From - To

Not Applicable Not Applicable Not Applicable Not Applicable

D. Financial Position ( Give a short description of your income from all sources , saving

investments ,expenditure and liabilities)

- Getting monthly salary of Rs.53000.00

- 30% Share Holding in Glomed Healthcare P. Ltd.

- Have Fixed Deposit of more than 5 Lacs & Investment in LIC/PPF

- Don’t have any Loan Liability

(1) Please provide your most recent tax invoices, bank statements etc. and the taxable

income of you and your partner.

(2) Do you have any outstanding debts, mortgages etc.

(a) No

E. Description of Home and Neighborhood: (Describe the accommodation details and

neighborhood relationship)

I have my own house (RCC) of app. 1200 sq. ft...House has Hall, Kitchen, Store

Room, 2 rooms & 2 toilet bathroom. We have good relation with neighbors

(1) How many rooms do you have in your home and describe the play area available

for the child.

We have 2 rooms. Our hall and kitchen area is big in size hence don’t find any

problem for child’s play area.

(2) Please describe the neighborhood in which you reside, including any aspects that

you believe makes it child friendly.

We don’t find any problem for child in neighborhood.

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F. Current marital relationship and quality of marital relationship (if applicable) (Give

details about the marriage, legal separation , if any, reasons for such separation,

present marital life and decision making procedures)

We are happily married for 17 years

(1) Please circle the term the best describes your marital status

(a) Married

(2) Please describe the procedures you and your partner use to reach a decision.

Not Applicable

G. Attitude and Motivation of PAP’s for adoption

(1) Please circle the term which best describe the reason why you wish to adopt,

you may circle more than one option, if applicable:

a) Infertility

b)

2. Please circle the statement which describe how you think the adoption will improve the

lives of your other children, you may circle more than one, if applicable:

a) Not applicable as I have no other children H .Attitude of grandparents /extended family members, other relatives and significant others towards the resent adoption: (Give a short description about the opinion of other important persons towards adoption who would have impact in the child rearing process when the child arrives in the receiving country. Our parents are happy about our decision of adoption

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I Anticipated plans of the PAPs for adopted child and rearing in the family: 1) Please describe how you will manage caring for the adopted child and other life Commitments such as work. We have seen our parent’s life. Hence don’t find any problem while managing things. 2) Who will be responsible for caring for the child when you are at work, or absent from the Familial home (Domestic help, grandparents, spouse) We both are responsible but wife will take maximum responsibility 3) Please describe your disciplinary approach to parenting. We are mentally & physically ready for parenting. We have not decided any disciplinary

approach to parenting. 4) In case the adopted child demonstrates adjustment difficulties, please describe the steps that you plan to take to ease his/her transition into the family. We will try to give maximum time to the child. 5) Would you be prepared to utilize additional family counseling if the adopted child continues to have difficulties adjusting?

a) Yes

J Preparation and training for adoption: (Give details about the counseling sessions the

PAPs have Undergone on adoption, child care, handling of the needs of the children, etc. and their capacity, PAPs training and /or experiences in parenting children with their special need if any. K Possible rehabilitation plan for the child in case of any eventuality with PAPs:( Give a short description about your plan for the security of the child in case you face any short or long term eventuality. In case you are a single PAP, please give a short description about the close relative who would be giving undertaking for the security of the child)

1 Does your work require you to travel? – No. 2 Who would care for the child in your absence? Please provide a brief description

including his/ her age, gender, occupation and relationship. – Not Applicable

3 In the event of unforeseen misfortune do you have someone who would take legal guardianship of child? If so, details thereof: - My elder brother

4 In case relationship does not work out would you part with custody of this child/ren to someone else, send back to homes, consult a counselor. – Not applicable

L Plans for disclosure of facts of adoption of the child: We plan to disclose to the child about the adoption in a very friendly way or in a story form as an when the child is able to understand.

M Health status (Emotional and physical) (Give details of the state of emotional and

physical health status of the applicant (s), if any. If a family member suffers from a

particular disease, condition or syndrome, describe how the family copes with it and

how this might affect any proposed adoption.

We both are 100% fit with don’t have any health issues.

PART - II ASSESSMENT REPORT OF THE SOCIAL WORKER

1. Factual Assessment

(i) Have you verified the contents of the facts mentioned in Part I of the template

Yes

(ii) Are you satisfied about the facts mentioned in the documents vies-a-visa

observation Yes

2. Psychological Assessment :

Mr. Anil is 45 years old. He is of tall, thin and of fair complexion. Anil finished his

initial studies up to Std. XIIth at St. Thomas Baptista High School, Papdi, Vasai and

completed his B. Com from Gonsalo Gracia College, Vasai. After his B. Com he did

a year’s NIT course in computers. Anil is specialized in accounts. After his

education he worked in various firms and held a good post. At present he has his

own factory at Varodara, Gujarat. His father Mr. Barthol is 75years old. His father

had his own business in Air Conditioning. Now because of age and ill health he

does not continue with this business. His Mother Mrs. Mary is 81 years old. She

has been a house wife. Anil has a brother 50 years old; married has one daughter

and runs a business in Air Conditioning. He has two sisters; both are married and

well settled. His sister Sunita has a joint business in Interior Decoration at Sharja.

The other sister Anita is a house wife. Anil shared that since they stayed in a joint

family he has a good and happy memory of his childhood. He also shared that as a

youth belonged to a youth group and took a very active part in the church

activities etc. His mother he said very loving person, his father was a very

disciplinary man. Who would insist on inculcating good values and studies.

Mrs. Neelima is 43 years old. She is tall, and has fair complexion. Did her initial

years of studies from St. Thomas high School, Vasai and completed her B.A. from

Gonsalo Garcia College, Vasai. She has also dome one Basic course in Computers.

Soon after her education Neelima worked for more than 10 years, due to added

responsibilities Neelima was unable to continue working and decided to quit her

join, at present she is a house wife. Her Father Mr. Anthony is 85 years old. Her

mother Mrs. Josephine is 82 years old and is a house wife. They both live with

their son in Vasai. Neelima shared that she too had a very happy childhood.

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2.1 Interaction with PAP’s

(i) Have you interacted with PAP’s individually and /or jointly?

Yes, the social worker has interacted with the PAPs individually and jointly during the

interviews and home visit.

(ii) Are the PAP’s well prepared for adoption? In case of single PAP, please

mention about family support system.

The PAPs have been married for last 17years. At the initial stage they tried

having their own biological child, since this was not happening they consulted

a doctor. According to the doctor there is nothing medically wrong. The couple

has been very patiently waiting for the gift of a child. They both shared, they

gone through almost two years of discernment while deciding about the

adoption. Once they were convinced about their decision they communicated

the same to their close family members. They couple and their family

members are prepared and are very much convinced about the decision they

have taken about the adoption.

Do you think that PAP’s have expressed their genuine feeling for parenting

Yes / No

2.2 Home Visit findings

(i) When did you visit the home of the PAP’s / Who were there the members

present during the visit ?

The social worker went for the home visit on the 10th February 2016. During the

home visit the PAPs, Anil’s parents and his sister in law was present.

(ii) Whom did you interact during the visit?

The social worker interacted with the PAPs, Anil’s parents, and his sister in law.

(iii) Have you met any neighbour / relative? Give a detailed about the interaction.

The PAPs reside in a village setting, hence where the houses are situated very

close to each other. The neighbours are very friendly, helpful in any situation.

They have very good relationship with their neighbours.

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(iv) Whether the home environment is conducive for the child? If no, what steps

can be taken to improve the situation? Have you advised the PAP’s?

The PAPs have their own big (RCC) bungalow; app. 1200 sq. Ft. With enough

open space around the house. The house has a big Hall, kitchen, Store Room, 2

rooms & 2 toilet bathrooms. Since the house is situated in the village setting

there is ample open space, play ground for play etc. The PAPs reside at the

heart of the village; they are very close to the market, school and medical

facilities. The PAPs have their own car.

(v) Are the PAP’s well prepared for adoption?

The social worker has met PAPs at various times at one to one level and jointly. She

has discussed with them on various topics regarding adoption. She spoke to them in

detail about their decision to adopt a child. During the home visit the PAPs shared

that they have discussed the issue of adoption with each other among the family

members, relatives and friends and have a very positive attitude towards adoption.

The worker strongly feels the PAPs are well aware and are prepared to take this step

in their life and complete the family.

(vi) Do you think that the PAP’s have expressed their genuineness during the

interaction?

Yes, during the number of interviews and home visit the worker observed that the

PAPs were very open, frank and co-operative. The PAPs shared that at the initial stage

it was a difficult to make a decision. Presently they are very clear about the decision

they have taken. The PAPs have also discussed this matter with the couples who have

already adopted a child.

(vii) Did the PAP’s have any doubts about parenting issues or any other issues?

Have you cleared their doubts?

During the interviews and Home Visits the PAPs were open in asking their doubts

about parenting and the adoption procedure. The Social Worker was able to clarify

their doubts and explain to them the adoption procedure.

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Interaction with the family members

(i) Have you interacted with the family members of the PAP’s? What is their

opinion about the proposed adoption? Are they positive about the adoption?

The Social Worker was happy to interact with Anil’s parents and his sister in law. They

are all very positive about the decision they have taken to adopt a baby. They are all

looking forward to the arrival of the baby.

(ii) Are there any other family members (s) whom you could not interact but they

might have a large role in the proposed adoption? If so, how did you interact?

Would you plan to take their views?

No.

(iii) Have you interacted with older child/children present in the home of the PAP’s

If yes, please give details.

No.

(iv) Have you noticed any adverse remark from the family members? If so, how far

those remarks may have an impact on the adoption process?

No

(i) Financial Position ( Give a short description of your income from all sources ,

saving investments

Mr. Anils owns Glomed Healthcare Pvt. Ltd. factory at Vadodara, Gujarat. His

annual income is RS. 650000/- The have fixed investments, a car, gold and a big

specious RCC bungalow. The financial situation of the PAPs is stable. They are

in position to take care of the educational, physical and medical needs of the

adopted child.

(ii) Have you observed any financial situation which is hidden in the template?

No. The PAPs have very openly shared about their financial situation during the

Home Visit & interviews.

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2.5. Physical and emotional capacity

(i) Are the PAP(s) in a good physical and emotional state to take care of a child?

The Social Worker did not observe any physical or psychological issues with

the PAPs nor did the PAPS share anything with regard to this during the

Interview or home visit. They are very happy married couple for last 17years.

Both shared that so far they have never had a heated argument with each

other. There is much understanding among them. Anil’s parents suffer from

diabetes, they under medication, it is under control.

(ii) Have you observed any physical or psychological issues with the PAPs or any

other family members that is going to affect the life of the upcoming child? If

so, give details.

The PAPs do not suffer from any serious illness. They both keep good health.

They are able to make important decisions and abide by them. They are

healthy and mature people.

(iii) Are the PAPs emotionally equipped enough to take care of a child?

The Social Worker did not observe any physical or psychological issues with

the PAPs nor did the PAPS share anything with regard to this during the

Interview or home visit.

Recommendation for adoption:

3.1 Do you recommend the PAPs for adoption? Put your views and rational for

recommending the PAPs for adoption including parents suitability.

Anil and Neelima have a very stable married life for last 17 years. There is very healthy

marital relationship among them. There seems to be loving, trusting and caring marital

relationship between them. They are matured couple who can take responsibility and are

able to make decision. They both are physically; mentally fit to adopt a child. Their