Quick summary
A care plan sets out what help is needed, when, how, and who does it. A good one names preferences and risks, not just tasks. You should be offered a copy, and NICE says it should be reviewed within six weeks and then at least once a year. You can ask for it to be changed at any time.
What is a care plan for?
It is the written agreement about how someone is supported at home. Every carer who visits should read it and follow it, which is why the details within it matter.
NICE’s home care quality standard says a care plan should reflect what support someone needs, what is important to them, what they feel they can do, and what they want to be able to do, taking account of any specific health problems or disabilities (NICE QS123).
A plan that only lists tasks, “wash, dress, breakfast, meds”, gives a carer nothing to go on the first time something does not go to plan.
What should it include?
Section | What good looks like |
|---|---|
About the person | What they like to be called, their routine, what matters to them, who is important in their life |
What help is needed | Each task, in the order it happens, and how the person likes it done |
When | Visit times, and which ones are time-critical, such as medication |
What they can do themselves | So carers support rather than take over |
Preferences | Bath or shower, tea or coffee, which cup, what time they like to get up, what they do not want |
Communication | Hearing aids, glasses, language, how best to explain things, signs they are distressed |
Medication | What support is given with medicines, and how it is recorded |
Risks | Falls, skin, eating and drinking, going out alone, and what to do about each |
Missed visits | What happens if a carer cannot get there, and who to contact |
Contacts | Family, GP, pharmacy, district nurse, key safe arrangements |
Review date | When it will next be looked at |
Preferences are not optional extras
They are what makes care feel like help rather than something done to someone.
Whether someone likes the radio on, how they take their tea, whether they want to choose their own clothes, which side of the bed they get out of. Small things, and they make a large difference to whether someone accepts help, particularly with dementia, where routine does a lot of the work that memory used to.
If the plan you are shown does not say anything about the person, ask for that section to be added.
Risks, and what to do about them
A risk section should say what the risk is, how likely it is, and what carers should do. “At risk of falls” on its own tells a carer nothing.
A useful version reads more like: uses a frame indoors, gets dizzy standing up in the morning, so sit on the edge of the bed for a minute first; if she falls, do not lift, call the office and follow the falls procedure.
NICE also expects plans to be in place for missed visits, such as arrangements for a family member or neighbour to visit, and the person’s risk assessment setting out clearly what should happen if a visit is missed (NICE NG21).
Do I get a copy?
You should. NICE guidance says a care diary, a day-to-day record of the care provided, should be kept in the person’s home, and that the person should be offered a copy. It also says everyone involved in providing care should have access to the care plan and the care diary (NICE NG21).
In practice that usually means a folder or an app the family can see. Reading the daily notes is one of the best ways to see how things are going between your own visits.
If the person you care for has capacity, they decide who else sees their plan. Ask them, and ask the provider to record it.
How often should it be reviewed?
NICE recommends an initial review of the home care plan within six weeks, and then regular reviews at least once a year.
That is the minimum. A plan should also be reviewed whenever something changes: a fall, a hospital stay, a new diagnosis, new medication, or a family carer who can no longer do what they were doing. You do not have to wait for a scheduled review to ask.
Who writes it?
If the council funds care, a support plan comes from the council’s assessment, and the provider then writes a more detailed care plan for how it is delivered day to day. If care is private, the provider writes it after an initial assessment visit.
Either way, the person receiving care should be involved in writing it, along with family if they want them to be. A plan written about someone without them is usually wrong in ways that matter.
Signs a care plan is not good enough
- It could be about anyone. No name, no preferences, no routine.
- It lists tasks with no detail about how they should be done.
- Nobody asked the person.
- It does not mention risks, or only mentions them with no action.
- There is no plan for a missed visit.
- It has not been updated since before the last hospital stay.
Frequently asked questions
Am I entitled to see my mum’s care plan?
If she has capacity, it is her decision who sees it. If she agrees, the provider should share it with you. If she lacks capacity and you hold a registered health and welfare Lasting Power of Attorney, you are usually entitled to see it.
Can I ask for it to be changed?
Yes. Ask the provider for a review, and say specifically what is wrong or has changed. A good provider will welcome it.
What is the difference between a support plan and a care plan?
A support plan usually comes from the council’s assessment and sets out eligible needs and the personal budget. A care plan is the provider’s detailed instructions for how care is delivered at each visit.
What is a care diary?
A daily record kept in the home, or in an app, of what was done at each visit, including anything unusual. NICE says it should be detailed enough to keep the person, their family and professionals informed.
Should the care plan mention end of life wishes?
If the person wants it to, yes. Some people prefer those wishes to sit in a separate advance care plan with their GP, which the care plan can refer to.
About Visiting Angels Cheshire East
Visiting Angels Cheshire East provides care at home across Macclesfield, Wilmslow, Knutsford, Congleton, Alsager and the surrounding villages, along with Buxton, Whaley Bridge and the Staffordshire Moorlands towns.
- You choose your caregiver. You meet them before care starts, and if it is not right you say so and we send someone else.
- Care plans written with you, including routine and preferences, not just tasks.
- No visit is ever shorter than an hour. There is time to follow the plan properly.
- You see the same faces. Our carer turnover is 12 per cent, against a sector figure of 23.7 per cent (Skills for Care, 2025).
- Carers trained in dementia, Parkinson’s, stroke recovery and complex care.
Alan’s wife is supported at home, and this is what he wrote:
“Excellent in every respect. Staff are caring, friendly and helpful. [Our carers] do everything they can to make my wife’s life easier. Management and staff are flexible in their approach and do the unpleasant jobs with a smile and willingness which is commendable. They are always willing to ‘go the extra mile.'”
Alan Hallett, Google review
Not sure what you need yet? Start with a free assessment
Our free home care assessment is a visit at a time that suits you, with no obligation afterwards. In it we will:
- Work out what is actually difficult, and which times of day, which is usually what a visit should be built around.
- Talk through a realistic package, and what it would cost.
- Look at the money with you, and point you towards the funding, benefits and grants you may be entitled to.
- Tell you honestly if you do not need us yet, or if someone else is a better fit.
If you want to see what a good care plan looks like before choosing a provider, call us on 01625 720157. You can also send an enquiry, and you can read more about how we work.
Authored by Dr Niall Jawad, Director, Visiting Angels Cheshire East.
Published 21 September 2026. Last updated 21 September 2026.
This article is general information about care planning, not legal or medical advice, and no substitute for advice about an individual’s circumstances. Rights to see another person’s records depend on their consent or on legal authority such as a registered Lasting Power of Attorney. Visiting Angels Cheshire East provides personal care at home rather than medical or nursing care. To the fullest extent permitted by law, GB Care at Home Ltd accepts no liability for any loss arising from reliance on this article.
