{"id":7678,"date":"2026-09-26T23:04:17","date_gmt":"2026-09-26T23:04:17","guid":{"rendered":"https:\/\/www.visiting-angels.co.uk\/cheshire-east\/?p=7678"},"modified":"2026-09-26T23:24:53","modified_gmt":"2026-09-26T23:24:53","slug":"what-should-be-in-a-care-plan","status":"publish","type":"post","link":"https:\/\/www.visiting-angels.co.uk\/cheshire-east\/what-should-be-in-a-care-plan\/","title":{"rendered":"What should be in a care plan?"},"content":{"rendered":"\t\t
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Quick summary<\/b><\/h3>

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.<\/span><\/p>

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What is a care plan for?<\/b><\/h3>

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.<\/span><\/p>

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 (<\/span>NICE QS123<\/span><\/a>).<\/span><\/p>

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.<\/span><\/p>

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What should it include?<\/b><\/h3>

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Section<\/b><\/p><\/th>

What good looks like<\/b><\/p><\/th><\/tr><\/thead>

About the person<\/b><\/p><\/td>

What they like to be called, their routine, what matters to them, who is important in their life<\/span><\/p><\/td><\/tr>

What help is needed<\/b><\/p><\/td>

Each task, in the order it happens, and how the person likes it done<\/span><\/p><\/td><\/tr>

When<\/b><\/p><\/td>

Visit times, and which ones are time-critical, such as medication<\/span><\/p><\/td><\/tr>

What they can do themselves<\/b><\/p><\/td>

So carers support rather than take over<\/span><\/p><\/td><\/tr>

Preferences<\/b><\/p><\/td>

Bath or shower, tea or coffee, which cup, what time they like to get up, what they do not want<\/span><\/p><\/td><\/tr>

Communication<\/b><\/p><\/td>

Hearing aids, glasses, language, how best to explain things, signs they are distressed<\/span><\/p><\/td><\/tr>

Medication<\/b><\/p><\/td>

What support is given with medicines, and how it is recorded<\/span><\/p><\/td><\/tr>

Risks<\/b><\/p><\/td>

Falls, skin, eating and drinking, going out alone, and what to do about each<\/span><\/p><\/td><\/tr>

Missed visits<\/b><\/p><\/td>

What happens if a carer cannot get there, and who to contact<\/span><\/p><\/td><\/tr>

Contacts<\/b><\/p><\/td>

Family, GP, pharmacy, district nurse, key safe arrangements<\/span><\/p><\/td><\/tr>

Review date<\/b><\/p><\/td>

When it will next be looked at<\/span><\/p><\/td><\/tr><\/tbody><\/table>

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Preferences are not optional extras<\/b><\/h3>

They are what makes care feel like help rather than something done to someone.<\/span><\/p>

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.<\/span><\/p>

If the plan you are shown does not say anything about the person, ask for that section to be added.<\/span><\/p>

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Risks, and what to do about them<\/b><\/h3>

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.<\/span><\/p>

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.<\/span><\/p>

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 (<\/span>NICE NG21<\/span><\/a>).<\/span><\/p>

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Do I get a copy?<\/b><\/h3>

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 (<\/span>NICE NG21<\/span><\/a>).<\/span><\/p>

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.<\/span><\/p>

If the person you care for has capacity, they decide who else sees their plan. Ask them, and ask the provider to record it.<\/span><\/p>

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How often should it be reviewed?<\/b><\/h3>

NICE recommends an initial review of the home care plan within six weeks, and then regular reviews at least once a year.<\/span><\/p>

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.<\/span><\/p>

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Who writes it?<\/b><\/h3>

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.<\/span><\/p>

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.<\/span><\/p>

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Signs a care plan is not good enough<\/b><\/h3>

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