Care planning, what is it?
The Social Care Institute for Excellence’s definition of care planning is:
“Care planning is a conversation between the person and the healthcare practitioner about the impact their condition has on their life, how they can be supported to best meet their health and wellbeing needs in a whole-life way. Care plans in care homes are owned by the individual and shared with others with their consent”.
There is no prescribed way or approach to how you set about writing care plans. The plan itself is merely a tool with which you and your teamwork to ensure that the individual is supported in a way that enhances their strengths and assets. One of the keys being that you must capture the spirit of this definition within your approach to supporting an individual.
How does it impact the different types of UK social care providers?
Regardless of the type of care you deliver, whether it’s learning disabilities, home care, mental health, elderly etc. It would be fair to say that all plans are based on the same holistic formula. There is no need for the core plan or its approach, to differ between different needs and providers. However different needs will require more detail in certain areas. For example, within nursing, expect to see much more around detailed Health interventions. In services for people with LD and Complex Behaviours, we would expect to see much more around Restrictive Practice or Positive Behaviour Support. There are the same core requirements needed however, within all plans, whatever the setting.
What are the standards?
Within the Fundamental Standards of the Health & Social Care Act 2008 Regulations the expectation is that it is everyone’s right to have Person Centred Care. Every individual must have care or treatment that is tailored to them and meets their needs and preferences. CQC measures this within their inspections and expect to see that the care plans in care homes have been agreed with the individual. Their consent (or a person with the legal duty to consent on their behalf) should have been gained, the plans have been risk assessed and that they are easily understood by staff to ensure that they are consistent. Care plans for care homes must protect an individual’s dignity.
Who should be involved in care planning?
The first thing to remember, is that the most important person who needs to be involved in care planning is the individual being cared for or supported. They own their care plan and they need to sign it to confirm that they are happy with it and that they’ve read it. It is written for the staff, so they can carry out their support for that person. The document is guided by the person’s strengths and wishes. Members of staff who will be caring for the person need to be very familiar with their care plan, but they don’t need to be the authors of it. Generally, it will be a Senior or Team Leader who will write the care plan – someone who has some experience of doing so and has some knowledge of the person in question – ideally they will have done their initial assessment too.
What are the different types of care plans for care homes? (paper vs. electronic)
Up until fairly recently, care plans have always been written on paper. Some are great tomes stretching to dozens of pages and contain everything possible about the person and some are just a few pages long. The length of the plan does not reveal its accuracy or effectiveness. Longer plans can often be unwieldy and difficult to navigate for staff. Shorter ones can lack detail.
Electronic care plans in care homes can be a bit of fresh air in this respect. They are logically laid out and much easier to update and ensure that everybody gets those updates immediately, and at the same time. The caveat here though, is that one needs to be careful that the plans remain person-centred and are owned by the person being supported. It also needs to be signed. There are still some CQC inspectors that are mistrustful of electronic care plans, although the direction of travel is most definitely that the regulator will be more accepting of them once they have their electronic ducks in a row.
Katie Barton, CQC’s senior designer of Strategy & Intelligence said earlier this year that inspectors; “Should categorically not be insisting on seeing paper versions of electronic records”. So we can expect some changes in this regard in line with their 2020 strategy.
So what should care plans contain?
All care plans for care homes should be Strengths-based. They should take as their starting point how much the person can do for themselves. Focus only upon those areas where the person needs support from staff. They should reflect the person’s needs and wishes in how their care should be provided – so, be person-centred in their approach. The narrative of the plan needs to contain clear instructions for staff on exactly how they are to support the person with any particular task. Some of the best plans, including the electronic ones, tend to split Activities of Daily Living (ADL) up into sections. This way, it’s easier to describe the areas that staff need to support. That can be Mobility, Medication, Eating & Drinking etc.
When risks are identified in any particular ADL, care plans need to either contain clear instructions for staff on the level of that risk and the measures that the team needs to undertake to mitigate that risk, or be closely linked to Risk Assessments. Finally, and repeatedly, they need to show that the person being supported gives consent for the staff to care for them in the manner described in the care plan. This is a signature by them, or by someone authorised to sign on their behalf, either because the person has given that authority directly, or where they lack the capacity to do so, where a Best Interest Decision has given that authority.
Ensuring accuracy in care planning
This is a tricky one, as there is no fail-safe way to write care plans for care homes. If you go down the electronic route however, then the template is clearly laid out for you so you don’t overlook anything, and of course electronic planning packages excel at managing the administrative side of planning. Risk Assessments are laid out alongside the relevant ADLs and you can’t progress through the plan unless you have completed them. They can remind you when a scheduled review is due and remind you to review the relevant risk assessments if you make changes to an ADL.
Of course, version control is a cinch, with the author and date already stamped on every version and only the latest versions being available for staff to view – and they can see them immediately, with no need to circulate notes. The best ones have smartphone access for remote working staff, so they get these updates immediately also, no matter how frequently Mrs Jones’ meds change. Naturally, there is controllable write access, so that only those staff with the authority can write or amend the Care Plans – other staff have read-only access.
Even if the structure of your care plan is great, there is no guarantee that your content will be the best. There is no substitute of course for trained staff having a guided conversation with the person to be supported so that their strengths and needs can be captured and translated into a care plan along with the associated risks and mitigating actions. Easy-peasy.
Ensuring care plans evidence correctly for CQC
If you end up pretty wide off the mark, then your friendly CQC inspector will most certainly point it out to you in your next inspection – and that is their job. They will be looking for person-centred, strengths-based plans, owned by the person being supported and signed by them (or someone in authority) with closely corresponding risk assessments. They will be looking for accurate updates that everybody relevant has access to at the same time. Inspectors won’t insist on electronic or paper copies (see previous comment) or on any particular template or way of doing it – just on the above criteria.
Should you review care plans often?
Not reviewing Care Plans at all is naturally a major fail. Care Plans should be reviewed as a matter of course at least twice per year. This is to ensure that the care being provided is up to date and in line with what the person wants and needs. Some providers though fall into the trap of only doing them twice a year and not when they need to be reviewed – that is, whenever something changes. What if a person’s medication changes, or maybe just the dose, or the amount and flow of food via their PEG needs to change? Anything that changes in a person’s care should prompt a review of their Care Plan. In these instances, the whole plan does not need to be reviewed, but the section relevant to the change. In the examples above, that would be Medication, or Eating & Drinking/Nutrition.
If you do update someone’s Care Plan, it will mean nothing if the staff using it are not aware of the change, or do not have the latest version to work from. This can be particularly difficult in home care, where staff and customers are dispersed across the community. You must find a mechanism that works for your organisation to review and update a plan and ensure all the relevant staff are aware of the change immediately. It is essential that updates or reviews are therefore dated and that any old versions are removed from folders or plans so that staff only see and use the latest version.
The 5 main pitfalls you can avoid in your care plans.
There are 5 main pitfalls when it comes to care planning:
- Not understanding what and who the care plan is actually for
- Focussing too much on the template
- Failing to be person-centred
- Failing to align Risk and Intervention
- Neglecting reviewing and updating
We have pretty much covered these in this blog, but we’ve also written an entire blog on them, which you can read here: 5 Care Planning Pitfalls (and how to avoid them).
However, if you’re still unsure, our care planning module provides a useful assessment tool that helps guide you on creating elegant person-centred care plans in a fraction of the time it would take on paper.
Below are some key websites and resources that you can access to help you with care planning queries and information:
- CQC won’t give you a template or tell you what’s right and wrong, but they will tell you what the Fundamental Standards are that you should observe when developing care plans
- Social Care Institute for Excellence (SCIE) is an invaluable resource and source of training too and has pages on care planning.
- National Institute for Health & Care Excellence (NICE) is another great resource around Quality Standards across a range of care service types.
Remember, in terms of electronic care planning resources, Log my Care is a burgeoning leading provider with a package that can take the care provider right through from assessment into care plans and ensure that everything is in the right place and at the right level and things are done at the right time.
Is Log my Care right for your care service?
We don’t like to brag, but we think any care home should at least give Log my Care a go – you’ll be part of a growing community in the care industry’s digital revolution. Simply create a free account, add your service-users and staff, in minutes and away you go. We’ll even talk you through the process if you need a little bit of help.