Care Planning and Risk Enablement Audit - Supported Living

Evidence to check

• • Tenant views are recorded in their own words where possible
• • Representative, advocate or family involvement is recorded where the tenant agrees or where legally appropriate
• • Support plan reflects what the tenant wants, refuses and chooses
• • The tenant is involved in agreeing how support will be delivered

Evidence to check

• • Plan records personal goals, routines, interests and important relationships
• • Staff can describe what matters to the tenant beyond care tasks
• • Daily notes show routines and preferences are respected
• • Goals and routines are reviewed when the tenant’s wishes change

Evidence to check

• • Support plan identifies strengths, abilities and existing skills
• • Plan describes what staff should encourage the tenant to do for themselves
• • Staff avoid taking over tasks unnecessarily
• • Progress toward increased independence is recorded and reviewed

Evidence to check

• • Review dates are recorded and up to date
• • Plans are updated after incidents, hospital admission, safeguarding concerns, changes in health or changed preferences
• • Outdated or contradictory information is removed or archived
• • Staff are informed of important changes before providing support

Evidence to check

• • Plan covers more than personal care or task-based support
• • Housing and tenancy-related support is included where relevant
• • Relationships, community access and wellbeing are considered
• • Staff understand how their support contributes to the tenant’s wider life goals

Evidence to check

• • Tenant has a copy or access to their plan where appropriate
• • Plan is available in accessible format where needed
• • Tenant comments, agreement, disagreement or requested changes are recorded
• • Advocacy or communication support is used where needed

Evidence to check

• • Plan uses respectful, empowering and easy-to-understand language
• • Cultural, religious, identity, communication and lifestyle needs are recorded where the tenant wishes
• • No judgemental, institutional or deficit-based wording
• • Staff can explain how they support the tenant’s identity and preferences in practice

Evidence to check

• • Risk assessments are specific to the tenant, not generic
• • Tenant’s views are included in risk decisions
• • Controls are practical, proportionate and least restrictive
• • Risk assessments link clearly to the support plan and daily practice

Evidence to check

• • Positive risk-taking records or risk enablement plans
• • Plan balances safety with autonomy and tenant choice
• • Tenant’s reasons and goals are recorded
• • Staff support risk-taking without creating unnecessary restrictions

Evidence to check

• • Restrictions such as locked access, monitoring, limited visitors, medication controls or physical interventions are clearly recorded
• • Capacity, consent or best-interest records are in place where relevant
• • Least restrictive alternatives are considered
• • Restrictions are reviewed and reduced where possible

Evidence to check

• • Support plan gives clear guidance for common risk scenarios
• • Staff know when to respect choice and when to escalate
• • Refusals and missed appointments are recorded and reviewed for patterns
• • Capacity, safeguarding and risk escalation are considered where needed

Evidence to check

• • Emergency contacts are current
• • Escalation routes are clear for health, safeguarding, housing, police, ambulance or out-of-hours concerns
• • Staff can access emergency information during support
• • Contingency arrangements are reviewed after incidents or changes

Evidence to check

• • Records of input from housing provider, GP, social worker, community nurse, OT, mental health team or other professionals
• • Professional advice is reflected in the support plan
• • Responsibilities are clear between agencies
• • Actions from external professionals are followed up

Evidence to check

• • Communication needs and preferred methods are recorded
• • Mental health, emotional wellbeing or distress triggers are identified where relevant
• • Plan includes prevention, reassurance and escalation strategies
• • Staff can explain how the tenant communicates consent, distress, pain or concern

Evidence to check

• • Goals are personal and outcome-focused
• • Plan describes actions staff will take to support progress
• • Progress, barriers and achievements are recorded
• • Goals are reviewed and changed when achieved or no longer relevant

Evidence to check

• • Plan distinguishes care/support responsibilities from tenancy or housing responsibilities
• • Staff respect the tenant’s home, privacy and right to visitors
• • Tenancy-related risks are supported without unlawful restriction
• • Housing issues are escalated to the correct responsible party

Evidence to check

• • Preferences about staff, gender, timing or routines are recorded
• • Rota reflects preferences where possible
• • Reasons are recorded where preferences cannot be met
• • Tenant feedback about continuity and timing is reviewed

Evidence to check

• • Decision-making section in the support plan
• • Capacity and consent records are decision-specific where needed
• • Plan identifies how to support the tenant to understand and decide
• • Attorney, deputy, advocate or representative involvement is recorded where relevant

Evidence to check

• • Review records include tenant views
• • Accessible methods are used where needed
• • Actions from reviews are followed up
• • Tenant disagreement, refusal or requested changes are recorded and considered

Evidence to check

• • Consent to involve others is recorded
• • Family, friend or advocate input is documented where appropriate
• • Tenant’s own views are clearly recorded separately from others’ views
• • Advocacy is offered where the tenant needs support to be heard

Evidence to check

• • Daily notes record changes in health, mood, behaviour or ability
• • Concerns are escalated to the appropriate professional or manager
• • Support plan and risk assessments are updated after changes
• • Staff are informed of new risks or support requirements

Evidence to check

• • Medication support plan clearly defines the staff role
• • Risk assessment considers safe self-management and storage
• • MAR or medication records match the agreed support level
• • Changes, refusals, errors or concerns are recorded and escalated

Evidence to check

• • Health action plan, hospital passport or communication passport available where relevant
• • Documents are current and accessible to staff
• • Information supports hospital admission, appointments or emergency care
• • Tenant consent and preferences are considered

Evidence to check

• • Staff can explain the tenant’s current needs, risks, preferences and goals
• • Staff know where to find the current plan
• • Handovers or alerts communicate changes
• • Spot checks show staff follow the plan in practice

Evidence to check

• • Daily notes match the support plan
• • Different staff record support consistently
• • Gaps between planned and delivered support are investigated
• • Contradictory or outdated information is corrected promptly

Evidence to check

• • Incident and safeguarding records trigger plan review
• • Risk assessments are updated after near misses or changes
• • Protective actions are proportionate and least restrictive
• • Learning from incidents is reflected in the support plan

Evidence to check

• • Care planning system access is controlled
• • Staff can access current plans when needed
• • Paper records are stored securely in offices or tenant settings
• • Digital and paper records match where both are used

Evidence to check

• • Plans avoid labels, blame or institutional language
• • Strengths, choices and preferences are included
• • Information is written clearly and practically
• • Tenant-friendly versions are provided where needed

Evidence to check

• • Life goals are recorded in the support plan
• • Actions identify how staff will support progress
• • Community, employment, education or relationship goals are reviewed
• • Achievements and barriers are documented

Evidence to check

• • Care planning audit records
• • Audits include tenant feedback, staff questioning and record sampling
• • Actions from audits are tracked through quality improvement
• • Repeated issues such as generic wording, outdated plans or poor staff awareness are escalated

Evidence to check

• • Support plan records tenancy-related support needs
• • Responsibilities between tenant, housing provider and care provider are clear
• • Housing concerns are escalated and followed up
• • Plan supports tenancy sustainment without taking away the tenant’s rights

Evidence to check

• • Plans promote independence and ordinary life opportunities
• • Staff support the tenant to do things for themselves where possible
• • Restrictions are reviewed for proportionality
• • Tenant feedback confirms they feel in control of their support

Evidence to check

• • Positive risk-taking guidance is included
• • Staff understand when to respect a capacitous decision
• • Escalation guidance is clear for serious or changing risk
• • Tenant’s views and rights are central to risk decisions