What is a Care Plan?

What is a care plan?

A care plan is integral to the success of the delivery of the care package. It is a legal document that outlines the service user’s identified needs and goals, and enables a small team of care workers to provide consistent, meaningful care. It is drawn up with the service user and their representative following a needs assessment.

Who has a copy of the care plan?

A copy is held at the office, but the service user also holds one in their own home. We do not issue a copy of this to the care worker to ensure your information stays safe. Staff identified as potential matches will read the care plan in the office before undertaking an Introductory Visit to the service user. If both parties feel they are a good match, then the care worker proceeds with their person-centred training and has access to the second copy of the care plan in the home.

What makes a care plan successful?

Our care plans aim to ‘put the person at the centre of the care’, ( i.e., person-centred) and cannot be used for other service users.  Care plans that are written in plain English and follow a simple format are easy for the care worker to read, and result in more consistent compliance.

What's included?

We gather information on the following key areas:-


  • An overall summary of the person, their background, family, religious/cultural needs
  • Aim of care plan, including goals
  • Medical history
  • Mental capacity
  • Cognition & behaviours
  • Personal care & mouthcare routine
  • Mobility & transfers, risk of falls
  • Continence & skin Integrity
  • Visual, hearing & communication needs
  • Medication requirements
  • Nutritional Needs and risk of choking
  • Health & wellbeing support
  • Night routine
  • End of Life requirements (where relevant)

What if your needs change?

The care plan is reviewed every 6 months or sooner on request or if there is a major change. Our care plans always include ‘revision numbers’ to ensure staff are working with the most up to date plan.


If you have any questions or concerns about a loved one’s care plan, be sure to contact their Registered Manager.