PERSON CENTRED CARE PLAN
PROVIDER NAME:
SERVICE MANAGER:
ONBOARDING DATE:
ADDRESS & CONTACT DETAILS
FIRST NAME:
LAST NAME:
PREFERRED NAME:
MOBILE NUMBER:
TELEPHONE NUMBER:
ADDRESS, POSTCODE & BOROUGH:
LOCAL AUTHORITY / BOROUGH:
GENDER, ETHNICITY & BELIEFS
GENDER:
ETHNICITY:
RELIGION:
NEXT OF KIN / ADVOCATES
NEXT OF KIN NAME:
RELATIONSHIP:
CONTACT NUMBER:
SECONDARY CONTACT NAME:
RELATIONSHIP:
CONTACT NUMBER:
ALLERGIES, DIETARY REQUIREMENTS
ALLERGIES:
DIET/DIET PREFERENCES:
GP / PROFESSIONAL CONTACTS
GP NAME & ADDRESS:
SOCIAL WORKER NAME & ADDRESS:
OTHER CONTACT (POSITION, NAME & ADDRESS):
LEGAL / AUTHORITY STATUS
☐ LASTING POWER OF ATTORNEY
☐ ENDURING POWER OF ATTORNEY
☐ COURT-APPOINTED DEPUTY
FURTHER NOTES:
INTRODUCTION TO ME, AND WHY I NEED CARE
This section should provide a concise, person-centered overview of the service user.
Include their age, living situation, and primary reason(s) they require care support.
Focus on what matters to them and how care enables their daily life.
Include the service user's life background (family, culture, career, interests) and their medical history (diagnoses, conditions, hospital admissions, ongoing health concerns).
WHO I AM & WHAT MATTERS TO ME
Describe the service user's personality, values, preferences, and what's important to them in their daily life.
Include their likes, dislikes, routines they value, and how they want to be supported.
This helps carers provide respectful, personalized care.
MY GOALS I WISH TO ACHIEVE FROM CARE RECEIVED
Outline the service user's care goals and what they hope to achieve with support.
Include maintaining independence, improving health, staying safe at home, or specific outcomes they're working toward.
DAILY SUPPORT REQUIREMENTS
MORNING SUPPORT:
AFTERNOON SUPPORT:
EVENING SUPPORT:
Describe the specific daily tasks the service user needs help with and the level of support required.
Break this down by time of day (morning, afternoon, evening routines) to show what a typical day looks like.
Include personal care, mobility support, meals, medication, and any other regular tasks where assistance is needed.
MENTAL CAPACITY DECISION
Under the Mental Capacity Act 2005, staff must presume capacity unless it is clearly shown otherwise.
Capacity is not lost because of an unwise decision, and every effort must be made to support the person to decide for themselves.
This section highlights if capacity may be in doubt in certain areas of care.
Where capacity is lacking, record clear evidence and ensure any decision is made in the person’s best interests and is the least restrictive option.
Areas of Care Where Capacity May Be In Doubt:
☐ Personal Care (e.g., washing)
☐ Feeding / Nutrition
☐ Toileting / Continence
☐ Dressing
☐ Medication
☐ Finances
☐ None
Capacity Test – Can the Service User...?
Question | Yes | No |
Understand the information relevant to the decision? | ☐ | ☐ |
Retain this information long enough to make a decision? | ☐ | ☐ |
Use/weigh up this information to discuss pros and cons? | ☐ | ☐ |
Communicate their decision (by any method)? | ☐ | ☐ |
☐ This person has capacity to make care decisions themselves
☐ This person lacks capacity to make care decisions themselves
CURRENT MEDICATION LIST
Medication Name | Storage | Dosage | What Does This Support With / Side Effects |
ㅤ | ㅤ | ㅤ | ㅤ |
This section is a record of the Service User’s current medication regime.
This is not to be used for administration guidance.
BEST INTERESTS DECISION MAKING
This section must be completed if the person is assessed as lacking capacity in one or more areas of their care.
The steps below should be followed to ensure any decision is made in line with the Mental Capacity Act and in the person’s best interests.
01 Identify the Capacity Decision
Clarify which area of care the person lacks capacity for.
02 Consider the Person’s Wishes
Take into account past and present views, beliefs, and values.
03 Explore Options
List all possible care or support approaches.
04 Balance Risks and Benefits
Use clear factors for making decisions.
05 Consult Others
Involve family, friends, carers, and professionals.
06 Decide in Best Interest
Choose the least restrictive option that keeps the person safe.
Details of Best Interest Decision Made:
Service User Signature:
Date of Assessment:
Assessor Name:
Next Review Date:
If the service user is unable to sign, the signature of their next of kin (NOK), appointed advocate, or a representative with Lasting Power of Attorney (Health & Welfare) must be obtained instead.
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