| 1 | Understand the principles of person centred assessment and care planning | 1.1 | Explain the importance of a holistic approach to assessment and planning of care or support |
| 1.2 | Describe ways of supporting the individual to lead the assessment and planning process |
| 1.3 | Describe ways the assessment and planning process or documentation can be adapted to maximise an individual’s ownership and control of it |
| 2 | Be able to facilitate person centred assessment | 2.1 | Establish with the individual a partnership approach to the assessment process |
| 2.2 | Establish with the individual how the process should be carried out and who else should be involved in the process |
| 2.3 | Agree with the individual and others the intended outcomes of the assessment process and care plan |
| 2.4 | Ensure that assessment takes account of the individual’s strengths and aspirations as well as needs |
| 2.5 | Work with the individual and others to identify support requirements and preferences |
| 3 | Be able to contribute to the planning of care or support | 3.1 | Take account of factors that may influence the type and level of care or support to be provided |
| 3.2 | Work with the individual and others to explore options and resources for delivery of the plan |
| 3.3 | Contribute to agreement on how component parts of a plan will be delivered and by whom |
| 3.4 | Record the plan in a suitable format |
| 4 | Be able to support the implementation of care plans | 4.1 | Carry out assigned aspects of a care plan |
| 4.2 | Support others to carry out aspects of a care plan for which they are responsible |
| 4.3 | Adjust the plan in response to changing needs or circumstances |
| 5 | Be able to monitor a care plans | 5.1 | Agree methods for monitoring the way a care plan is delivered |
| 5.2 | Collate monitoring information from agreed sources |
| 5.3 | Record changes that affect the delivery of the care plan |
| 6 | Be able to facilitate a review of care plans and their implementation | 6.1 | Seek agreement with the individual and others about: • who should be involved in the review process • criteria to judge effectiveness of the care plan |
| 6.2 | Seek feedback from the individual and others about how the plan is working |
| 6.3 | Use feedback and monitoring/other information to evaluate whether the plan has achieved its objectives |
| 6.4 | Work with the individual and others to agree any revisions to the plan |
| 6.5 | Document the review process and revisions as required |