Common Care Planning Blunders.

Care plans are essential for guiding the provisions of safe, responsive and effective person-centred care. Yet they are also one of the areas where providers can most easily fall into poor practice. A plan may exist, but if it reads as a generic list of tasks, fails to show the person’s involvement, or says little about what matters to them, it will not provide staff with the guidance they need. More importantly, it will not demonstrate that the person has been listened to, understood and supported to live as independently and meaningfully as possible.

We also know from countless studies and practice experience, that good care planning often equates with good outcomes for Service Users.

In this blog we examine some of the more frequently seen issues with care and support planning in social care settings and offer some suggestions for improving them.

Care plans should belong to the person

All too often when supporting providers with reviews of their care plans and other system, it is clear care plans are generic, that is cut and pasted between individuals, or the tasks (although we prefer the word activities) are not consistent with the assessment.

A care plan should never read as though it could belong to anyone with the same condition, diagnosis or need. It should capture the person’s life story, wishes, abilities, routines, risks, choices and preferred ways of being supported.

When care planning is done well, it becomes a practical guide for consistent, respectful and enabling care. When it is done badly, it can mislead staff, overlook important needs, reduce the person’s involvement and create avoidable concerns during inspection.

Involve the person from the start

One of the most common weaknesses in care planning is failing to consult the person properly. The plan belongs to them, so it cannot be genuinely person-centred, as required in the Care Quality Commission’s (CQC) fundamental standards, if they are not actively involved in creating, reviewing and agreeing it.

This means going beyond standard questions at admission. It means taking time to understand what matters to the person, what they can do for themselves, where they need support, what outcomes they want, what their priorities are, and how they prefer staff to provide that support.

Where the person has communication needs or lacks capacity for a particular decision, the process should still involve them as far as possible and draw appropriately on family members, advocates and others who know them well.

One way to capture this in the assessment and when creating actions and activities that staff need to engage with, is to simply be clear in identifying what the individual has said, for example, Vikram states that he likes to shower in the evening rather than the morning, Lucy says “I like to have my breakfast sitting at the kitchen table”. This shows engagement with the individual and suggests that the preference was is real.

One common issue we see is when providers write assessments and plans for care in the first person for people who are either non-verbal or otherwise could not have possibly said what the provider is recording. This is falsification and may suggest to any inspector that the provider does not really include people in their own assessments.

Use language that enables rather than labels

Language matters because it shapes attitudes and practice. A plan that repeatedly refers to “the Service User” can feel distant and impersonal and suggests a care plan is not person-centred, but task orientated.

A more helpful care plan uses the person’s name, preferences and own words where appropriate. For example, “Rex likes tea with two sugars and prefers staff to leave the cup on the small table beside his chair” tells staff far more than “the service user requires assistance with drinks”. This kind of detail shows that consultation has taken place and gives staff practical guidance they can use.

Templates should guide, not replace judgement

Templates can be useful when they prompt staff to consider the whole person, including physical, emotional, social, cultural, spiritual and communication needs. However, the template must not become the care plan. The risk is that staff complete sections mechanically, copy standard wording, or avoid areas that feel difficult to discuss.

We often see in digital care planning that assessors ignore sexuality and issues to do with end of life care planning because they mechanistically follow the template and feel they cannot discuss these issues because they arise too early in the conversation. Instead return to these issues when it feels natural to do so, perhaps towards the middle or end of an assessment or even at a later date. Let the conversation guide the assessment rather than the assessment guide the conversation.

Topics such as relationships, gender and sexual identity, mental wellbeing and end-of-life wishes are usually relevant for social care providers. If they are omitted because they are uncomfortable, the plan may miss what the person actually needs.

Interventions must be clear enough to guide practice

Care plans often fail because interventions are either too brief or too wordy. “Help Joan clean her teeth” is not enough guidance for a new or agency member of staff because it does not explain what Joan can do, what she needs help with, what equipment she uses, how she likes the task approached, or what outcome staff are supporting.

At the same time, interventions should not be so lengthy that the practical instruction is lost.

The aim is to write clearly enough so that a staff member new to the person can provide care in a way that is consistent with their wishes and usual routine by referring to their care plan. We like to call this the rule of the agency worker; that is can an agency worker pick up the care plan and know what to do?

Make care planning a team activity

Good care planning is a team activity. Senior staff may write or approve the plan, but the people delivering day-to-day care ALWAYS hold valuable knowledge about what works in practice, so ask them. Like capturing the voice of the Service User, adding statements like “care staff say Luis prefers a shower in the morning” or “care staff report that as well as his communication cards Piotr responds well to facial expressions when they are communicating with him.”

Families and friends may also provide essential life history, context and preferences, particularly when the person has reduced capacity or finds formal conversations difficult – subject to confidentiality and UK GDPR.

A plan that ignores these voices can be tidy but lack depth and meaning. A plan that brings them together is more likely to be more complete, accurate, enabling and meaningful.

Focus on strengths, abilities and outcomes

An enabling care plan focuses not only on risk and dependency, but more so on strengths, abilities and opportunities. If a plan records only what a person cannot do, it can unintentionally encourage staff to take over. This limits what the person does and over time will eat away at their independence.

A better plan identifies what the person can still do, what they would like to regain or maintain, and how staff should support involvement rather than replace it. This may mean prompting rather than completing a task, offering choices rather than making assumptions, or allowing more time so the person can remain active in their own care. This is what is often meant by the term “doing with, rather than doing to”.

Conclusion

There is no mystery to good care planning. The best plans are often the clearest: they show who the person is, what matters to them, what they can do, where they need support and how staff should provide that support in a way that protects dignity, choice and independence.

For us at Bettal, the central message is clear; care planning should not be a paperwork exercise completed for inspection. Rather, it should be an enabling conversation, captured in plain language, reviewed regularly and used every day to help people receive care that is genuinely their own.

Bettal works with adult social care providers to strengthen quality assurance, compliance and service improvement. Our digital systems and practical guidance help care organisations evidence good practice, prepare for inspection, manage risk and maintain continuous improvement.

If you are a social care provider and are looking for ongoing support with policies, procedures, browse our website or get in touch:
Email: info@bettal.co.uk
Telephone: 01697741411

Peter Ellis MA MSc BSc(Hons) RN
Consultant
Bettal Quality Consultancy