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Care Planning
This is one of the key areas that gets criticised in inspection reports time and time again. Legislation requires that:-
• People using a service have care or treatment that is personalised specifically for them.
• Providers work in partnership with the person
• Providers make any reasonable adjustments and provide support to help them understand and make informed decisions about their care and treatment options, including the extent to which they may wish to manage these options themselves.
• Providers make sure that they take into account people’s capacity and ability to consent, and that either they, or a person lawfully acting on their behalf, must be involved in the planning, management and review of their care and treatment.
• Providers make sure that decisions are made by those with the legal authority or responsibility to do so, but they must work within the requirements of the Mental Capacity Act 2005, which includes the duty to consult others such as carers, families and/or advocates where appropriate.
Detail
Probably the greatest criticism of care plans by regulators, safeguarding offices and local authorities is that they lack detail. An effective care plan is one which is:-
• Related to the person i.e person centred
• Written from the perspective of the person
• Informative about health conditions and how these affect the persons needs
• Focused on what the person can do and the support they need with things they cannot do
• Able to be easily understood by the person and anyone supporting them.
• Current and up to date, so if a person has a fall today then the care plan and risk assessment should be reviewed today, with evidence of that review kept
The key ethos of effective care planning is to say HOW:-
• The person prefers their needs to be met
• The persons health conditions affect them
• Staff should support the person
• Staff should respond when the persons needs change
• Staff should record the support provided
• Staff recordings are used to inform care plan and risk assessment reviews
As well as saying HOW, a good care plan provides sufficient detail so that the person providing the support knows exactly what the persons needs are and how these affect the person. One area where care plans often lack detail is on health conditions. If a person has any health condition, physical or mental then the care plan should include a brief description of this and how it affects the person. This is a two stage process, the first is to provide the brief description on the condition. The simplest way to do this is to visit www.nhs.uk and search the condition. You will find an overview of the condition, this can be copied and pasted into the care plan. It may need editing a little. The second step is to describe how the condition affects the person, this will be specific to the person (person centred). To do this go back to the NHS website for that condition and review the symptoms, see which of these apply to the person and copy them into the care plan. You will need to change the text to the first person.
NEVER copy and paste from one person’s care plan to another. This is poor practice and will lead to errors that may put people at risk of harm or neglect.
Cross referencing
Parts of a care plan should not exist in isolation, each part of the care plan will be related to and affect other parts and vice versa. The same is true for risk assessments, mental capacity and Deprivation of Liberty (DoLS). One common mistake made with care plans is to review one aspect of the care plan and not consider which other things will be affected. The result is that there will be discrepancies and disconnects between parts of the care plan and between the care plan and other key documents. Mental capacity is a common area for this to occur. If the care plan states in the Mental Health section that “I have no memory problems” and in the Mental Capacity section that the person cannot retain the information long enough to make a decision, this is a clear disconnect.
Links to risk assessment
Another common pitfall is not to link care plans to risk assessments. If we look at falls risk assessments as an example. The initial falls risk assessment will be undertaken for EVERYBODY prior to provision of care. This will be based upon information provided by the person and others, this should be treated with respect and professional scepticism. The initial falls risk assessment should be reviewed when further information is gathered about the person, this includes any incident of; a witnessed fall, a near miss fall i.e unsteadiness, and an unwitnessed incident where the person is found on the floor. The care plan for managing the risk of falls should be; person centred, say HOW and be detailed as described above. The care plan must be reviewed in RESPONSE to every incident and even if no changes are required evidence that the review has been undertaken must be kept. Action to reduce the risk of further falls must be ; person centred, say HOW and be detailed.
Recording and reviews
The quality of recordings will directly affect the quality of care plans. Poor records mean poor care plans.
Recordings should be:-
• Person centred – i.e related to the person
• Related to the care plan, if you look at the recordings about an aspect of the care plan alongside the care plan you should see an obvious link
• Detail what the person did, what support they needed and the outcome for the person (the end result)
• Identify any issues AND how these were followed up and RESPONDED to.
• Detail any instance when the support could not be provided and how this was RESPONDED to.
• Detail any changes in need and how these were RESPONDED to
• Informative about the persons daily life
Reviews should be both:
• Planned – at fixed intervals i.e monthly
• Responsive – when there is need to do so i.e change in need, response to incident etc
Not all of a care plan may be reviewed in a responsive review, the review notes should make it clear what type of review it is i.e planned or responsive. All types of review should make it clear that the care plan has been reviewed – even if there are not changes required. It is poor practice to review a care plan just by adding a date and a signature to the care plan or entering onto the computer that the care plan has been reviewed. Something will always have changed be it better or worse.
