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· ‘I’ Statements and ‘Quality’ Statements
o Are Services Safe
o Are Services Effective
o Are Services Caring
o Are Services Responsive
o Are Services Well Led
o Quick Checklist
· Person centred plan
o Authorisation of People allowed to read plan
o Communication plan
§ Communication overview
§ How I communicate
§ My understanding of communication
§ How I like people to communicate with me
§ Communication aids and tools
§ Key words, phrases and gestures
§ Things that help me communicate better
§ Special considerations
§ Emergency communication plan
§ Important contacts and additional information
o My daily routines and preferences
§ (Morning)
o My daily routines and preferences
§ (Afternoon)
o My daily routines and preferences
§ (Evening)
o Things I like to do
o Things I don’t like
o How I like to be supported in my daily activities
o Relationship map
§ Closest to me
§ People who support me regularly
§ People I see occasionally
§ People in my life due to a specific role
o Health and well being
§ Medical conditions
§ Medication
§ Allergies
§ Dietary needs
§ Healthcare professionals involved
§ How I like to be supported with my health
§ Pain management
§ Exercise and physical activity
o My wellbeing Radar
o My personal preferences passport
o Skills for independence tracker
o My sensory preferences profile
o Quality of life journal
o My aspirations and Dreams planner
o My cultural and religious needs profile
o My life story timeline
o Personal calming strategies
o My strengths and achievements portfolio
o Decision making agreements
§ Dad to day decisions
§ Financial
§ Medical appointments
§ Who supports me
§ Sharing information
o Person centred skills matching form
§ Skills and experience matching
§ Personality and approach to care
§ Communication skills
§ Availability and flexibility
§ Additional preferences
o Restrictive practices
o Important FOR me
o Healthy and Safe
o PCP review Goals and Progress
§ Health and wellbeing
§ Social and community engagement
§ Life skills development
§ Communication skills
§ Emotional wellbeing
§ Summary
o Plan Confirmation / Signatures
· Initial needs assessment
o Health and medical history
o Personal care needs
o Communication and social interaction
o Mental health and emotional wellbeing
o Environmental compatibility
o Behaviour needs and support
o Risk assessments
o Compatibility assessment
o Personal goals and desired outcomes
o Family / care giver involvement
· Personal, behaviour and falls risk assessment and Plan
o Personal information
o Health and medical risks
o Health and medical plan
o Falls and mobility risks
o Falls and mobility plan
o Environmental risks
o Environmental plan
o Behaviour risks
o Behaviour plan
o Emotional and mental health risks
o Emotional and mental health plan
o Safeguarding risks
o Safeguarding plan
o Personal preferences and life goals
o Continuous monitoring and review plan
o Staff compliance signature page
· End of life care plan
o Person centred details
o Physical care needs
o Emotional and psychological support
o Spiritual, cultural and religious support
o Environment and comfort
o Support for family and friends
o After death wishes and arrangements
o Legislation and legal considerations
o Review and monitoring
o Final checklist
o Multi Profession signature sheet
· Daily Diary Log
o Morning routine
o Midday activities
o Afternoon / evening routine
o Night routine
o Additional notes and communication
o Role signatures
· Well-being and social interaction log
o Personal details
o Emotional wellbeing
o Physical wellbeing
o Social interaction
o Behaviour notes
o Personal preferences and feedback
o Daily summary
o Wellbeing actions for next 24 hours
· Weekly activity planner
o Personal and commissioned details
o Weekly schedule
o Commissioned utilisation and feedback form
· Advanced care plan
o Personal information
o Medical information
o Personal preferences
o Care preferences
o End of life preferences
o Emergency care plan
o Decision making and legal information
o Health and wellbeing goals
o Social and emotional support
o Review and updates
o Consent agreement
· Therapy and rehabilitation plan
o Personal information
o Preference and needs
o Therapy session log
o Review targets and outcomes
o Signatures
o Guidance notes
· Personal emergency evacuation plan (PEEP)
o Personal information
o Evacuation details – types of assistance required
o Mobility level
o Primary evacuation route
o Secondary evacuation route
o Assistance details
o Communication
o Specific instructions to evacuation
o Safety measures
o Training drills
o Review and updates
o Signatures
· My person budget planner
o Personal details
o Personal budget income overview weekly, monthly, yearly
o Monthly expenditure
o Goals and aspirations
o Emergency fund and contingency planning
o final decision making and support
o review and monitoring
o signatures
· Nutrition and hydration plan
o Personal details
o General information
o Nutrition requirements and dietary needs
o Hydration requirements
o Monitoring and assessment of nutritional and hydration intake
o Special considerations
o Encouraging independence
o Nutritional and hydration risk assessment
o Review and adjustments
o Action plan
o Signature section
· Service user Event / holiday form
o Personal details
o Holiday / Event details
o Safety and medical considerations
o Financial planning
o Risk assessment and management
o Daily schedule
o Additional notes and preferences
o Consent & Authorisation
o Evaluation and review
o signature
· Family, friends and residents meeting
o General information
o Attendees present
o Apologies
o Agenda items
o Discussion points and feedback
o Outcomes and agreed actions
o Action plan with examples
· Medication support plan
o Personal information
o Current medications
o Administration details
o Monitoring and side effects
o Allergies and adverse reactions
o Level of assistance required
o Specific support needs during medication administration
o Storage and handling
o Emergency procedures
o Review and updates
o Consent and agreement
o Manager and staff acknowledgement signatures
· Medication stock check form
o Provider and resident information
o Disclosure
o Medication stock check chart to complete
o Comments and notes
o Actions required (if any discrepancies noted)
· Staff medication competency checklist
o Provider and employee information
o Knowledge and understanding
§ Legislation and guidelines
§ Type of medication
§ Medication administration
o Practical skills
§ Preparation and storage
§ Administration techniques
§ Recording and reporting
o Person centred care
§ Communication
§ Respect and dignity
§ Observations and monitoring
o Training and development
§ Continuing professional development
§ Visual stage practice of administration (3 separate occasions)
o Acknowledgement and sign off as competent
· Medication identification record (completed for each medication)
o Provider and resident information
o Description of medication
o Possible side effects
o Monitoring and reporting
o Any observed side effects
o Comments / notes
o Disclosure and signatures
· Medication administration form
· Health action plan
o Communication
o diagnosis information and past medical history
o physical health screening
o medication
o diet and nutrition
o swallowing problems
o bowels
o urinary system
o eyes and vision
o ears and hearing
o oral hygiene
o skin
o feet
o mental health
o dementia, LD etc
o sleep
o epilepsy
o behaviour
o breathing
o circulation
o smoking
o alcohol
o men’s health
o women’s health
o review sheet
· Hospital admission form
o Personal information
o Medical history
o Current medications
o Mental and emotional wellbeing
o Functional status
o Person centred preferences
o Consent and legal information
o Signatories
o Additional information
· G.P and Specialist outcome form
o Personal information
o Input appointment matrix for staff to complete
· Staff Training record
o Provider and employee details
o Training overview
o Completed training courses
o Ongoing training courses
o Upcoming training courses
o Training needs analysis
o Compliance with CQC standards
o Review and acknowledgement
o Signatories
· Local health authority contact list
o Prompt and information gathering form
· Recruitment and induction form
o Provider details
o Application details
o Pre employment checks
o Interview assessment
o Induction programme
o Policy and procedures
o Training record
o ongoing support and development
o Employee and manager acknowledgement
· Supervision record
o Staff and supervisor information
o Attendance
o Training record
o Employee handbook acknowledgment
o Performance and development
o Professional development goals
o Compliance and polices
o Feedback and communication
o My personal development and reflection journal
o Staff wellbeing and support plan
o Communication and collaboration passport
o Skills sharing and mentorship tracker
o My value and care philosophy statement
o Agreement and signatures
· Annual appraisal form
o Employee information and review period
o Job description review
o Previous objectives
o Performance review
o Strengths and achievements
o Areas for improvement and development
o Staff training record
o Optional additional training
o General Knowledge test
o Training and development needs / requirements
o step by step action plan
· Staff rota
o Identifies shift leaders
o Commissioned hours calculator
· Environmental risk assessment and plan
o General information
o Risk identification and assessment
o Fire hazards
o Inadequate ventilation
o Health and safety hazards
o Manual handing risks
o Specific residents’ risks
o Environmental hazards (lighting, temperature, accessibility)
o Risk rating
o Action plan
o Review and monitoring
· Legionella risk assessment and plan
o Introduction
o Risk assessment details
o Description of water systems
o Risk identification and assessment
o Control measures and prevention actions
o Monitoring and record keeping
o Staff training and awareness
o Emergency procedures
o Action plan
o Action plan integration into cleaning schedule
o Signatories
· Equipment maintenance log
o General information
o List of Equipment to be checked
o Risk assessment and Action plan
· Cleaning schedule
o List of mandatory tasks
o Section for record of water temperatures
o Daily, weekly and monthly completed schedules
o Information e infection control
o Information re health and safety
o Information re compliance.
· Food hygiene and assessment plan
o Purpose
o Food storage
o Food preparation
o Meal planning and nutrition
o Food serving and safety
o Monitor and review
o Staff signatures
o Daily temp checks record to complete
§ Fridge and freezer temps
§ Food temperature checks
· Fire risk assessment
o General information about premises
o Identification of fire hazards
o People at risk
o Fire detection and warning systems
o Firefighting equipment
o Emergency escape routes
o Fire evacuation procedures
o Training and drills record
o Fire incidents record
o Fire risk action plan
o Legislation and compliance checklist
o Review and monitoring with signatories
· Fire Drill and Equipment check form
o Purpose
o General information
o Fire drill procedure
o Fire drill checklist
o Fire equipment checklist
o Fire extinguishers
o Fire doors and emergency lighting
o Smoke detectors
o Risk assessment and action plan
o Notable: emergency lighting faults, evacuation delays, non-functional fire alarms, reporting and record keeping
· COSHH risk assessment and Plan
o Introduction
o Service details
o Hazardous substances identified
o List of substances
o Risk identification and assessment
o Control measures and preventative actions
o Risk reduction plan
o Emergency procedures
o Staff training and awareness
o Monitoring and record keeping
o Legislative and regulatory compliance and example
· Material Safety Data Sheet (MSDS)
o Introduction
o Hazard identification
o Composition / information on ingredients
o First aid measures
o Firefighting measures
o Accidental release measures
o Exposure controls / personal protective equipment
o Physical and chemical properties
o Stability and reactivity
o Toxicological information
o Ecological information
o Disposal considerations
o Transport information
o Regulatory information
o Action plan for minimising risks
· Pest control record
o Service information
o Pest control monitoring log sheets
o Detailed investigation and follow-up actions
o Regular pest control maintenance record
o Staff training and awareness
o Environmental health and safety monitoring
o signatories
· Visitors log
o Provider information
o Visitor guidelines
o Visitor log form disclosure statement
o Guidance notes and signature
· Emergency contact numbers form
o Provider information
o Staff emergency contacts
o Family emergency contacts for residents
o Key external contacts
o Key points to review
· Shift handover log
o Outgoing, incoming staff
o Residents’ updates
o Medication information
o Dietary information
o Personal care
o Activities and social engagement
o Behaviour and mood
o Medical appointments and visits
o Safety and environment checks
o Family and visitor updates
o Incidents and accidents
o Additional notes and handover instructions
· Staff meeting minutes
o Service information
o Attendance
o Agenda
o Review previous minutes
o Policy discussions
o Compliance and regulatory updates
o Upcoming Evo Sphere System
o Health and safety
o Quality assurance
o Resident centred care
o Training and development
o Team and staff welfare
o New business
o Plans and future objectives
o Next meeting
o Actions items
o Signatories staff acknowledged
· Emergency evacuation plan
o Provider information
o Introduction
o Purpose
o Emergency contact information
o Emergency procedures
o Evacuation roles and responsibilities
o Personal emergency evacuation plans (PEEPs)
o Evacuation drills
o Communication plan
o Post evacuation procedures
o Review, training and signatories
· Contingency plan for critical Incidents
o Provider information
o introduction
o purpose
o definitions of critical incidents examples given
o emergency contact information
o roles and responsibilities
o initial response procedures
o specific critical incident responses
o pandemic outbreak
o communication plan
o post incident procedures
o review, training and signatories
· Pandemic Response Plan
o Provider information
o Introduction
o Purpose
o Definitions of pandemic examples given
o Emergency contact information
o Roles and responsibilities
o Initial response procedures
o Residents care procedures
o Staff procedures
o Communication plan
o Visitors’ policy
o Post pandemic procedures
o Review, training and signatories
o Disclosure
· General Correspondence Plan
o Provider information
o Correspondence details
o Description of correspondence
o Action required
o Notes and comments
o Focus guidelines
· Staff contact list
o Provider information
o Staff member information form
o Key contacts form
o Acknowledgement section
· Social media and website content record
o Provider information
o Content type
o Content description
o Image and media attachments
o Compliance and permissions
o Privacy and data protection considerations
o Action plan
o Guidance
· Newsletter template
o Template of key areas to update service users, families and friends – examples of content throughout whole document
§ Welcome
§ Care / support updates
§ Medication management
§ Quality and safety measures
§ Staff training and development
§ Upcoming events and family engagement
§ Innovation and compliance
§ Feedback and complaints
§ Emergency contingency planning
§ Stay in touch
· Communication template for families and media
o Service details
o Introduction
o Family communication
o Media communication
o General communication guidelines
o Communication log
o Acknowledgement and signatories
· Complaints and feedback log
o Service information
o Summary of complaints and feedback
o Detailed investigation and follow up (if applicable)
o Complaints and feedback monitoring overview
o Record of communications
o Signature section