Assessment, Care Planning and Review
Time: Half day
Aim: The domiciliary care organisation representative will understand holistic assessment and its relevance to Advance Care Planning. They will explore systems to discuss, record, review and share assessments appropriately

Objectives: By the end of the session the domiciliary care organisation representative will be able to:
Recognise the importance of holistic care assessment and planning
Demonstrate awareness of assessing an individual’s mental capacity
Produce an action plan to implement a system to support Advance Care Planning
Develop further the domiciliary care organisation’s End of Life Care Policy

Handouts and Leaflets
Support Sheet - Holistic Assessment
Provides information on how holistic assessment should be carried out
Download: Support Sheet - Holistic Assessment
Case Study - Margaret
A learning aid providing a case study around a service user following a stroke
Download: Case Study - Margaret
Care Plan Template
A template to be used to record an individual’s needs used in conjunction with the case study above
Download: Care Plan
Support Sheet - MCA
Information on the Mental Capacity Act
Download: Support Sheet - MCA
Support Sheet - BID
Information on Best Interest Decision Making
Download: Support Sheet - BID
Support Sheet - ACP
Provides information on Advance Care Planning
Download: Support Sheet - ACP
Support Sheet - ADRT
Provides information on Advance Decisions to Refuse Treatment
Download: Support Sheet - ADRT
Support Sheet - PPC
Provides information on Preferred Priorities for Care
Download: Support Sheet - PPC
Supportive Care Record
A record for the domiciliary care organisation to record and monitor patient care
Download: Supportive Care Record
Role of the Care Worker
Provides information on the care worker’s role in holistic assessment
Download: Role of the Care Worker
Other Supporting Materials
Attendance Register
A register that can be used at any events and workshops
Download: Attendance Register
Step 2 Workshop PowerPoint Presentation
An overview of workshop 2
Download: Step 2 Workshop PowerPoint Presentation
The Route to Success
The programme is based on The Route to Success and guides each workshop
Download: The Route to Success in Domiciliary Care
Holistic Common Assessment Guide
Guidance to understand a patient’s needs, preferences and priorities for care
Download: Holistic Common Assessment Guide
Mental Capacity Act Guidance
A guide to help health and social care professionals to help people who are are unable to make some decisions for themselves
Download: Mental Capacity Act Guidance
Planning for Your Future Care
A simple guide to Advance Care Planning and the different options open to people approaching end of life
Download: Planning for Your Future Care
Capacity Care Planning
Provides information on capacity and care planning for health and social care professionals
Download: Capacity Care Planning
Preferred Priorities for Care Document
Useful planning guide to help an individual decide their preferences and wishes to plan for the future
Download: Preferred Priorities for Care Document
Guide to Preferred Priorities for Care
Provides information on how the Preferred Priorities for Care Document can be used
Download: Guide to Preferred Priorities for Care
Flip Chart
Visual of the six steps of the Programme
Download: Flip Chart
Step 2 To Do List
Provides a checklist of actions to be carried out for the next workshop
Download: Step 2 To Do List
Workshop Evaluation Form
Provides feedback to the facilitators, which will help continually develop and improve the delivery of the programme
Download: Workshop Evaluation Form