Standard of care review report
This form is to be used to record a standard of care review for children placed in out-of-home care. Refer to the
Child Safety Practice Manual, Chapter 9, Standards of care, for the procedures for conducting standard of care
reviews for care services.
To record a standard of care review:
1. create a ‘Matter of Concern’ (MOC) event in the child’s profile
2. add any other relevant parties to the MOC event, including the carer or care service and any relevant staff
members
3. complete the ‘Record of concerns’ form in the MOC event
4. delete the ‘Record of checks and consultation’ form from the MOC event
5. For an Aboriginal or Torres Strait Islander child, create a ‘Recognised entity participation form’ in the
‘Information gathering/decision-making’ block
6. do not create any additional forms, such as the ‘Child placement concern report’
7. when the ‘Standard of care review report’ is completed and approved by the team leader, attach it to the MOC
event under the ‘CPCR Assessment/Action’ block
8. create and complete the ‘Closure form’ in the MOC event, to close the event and enable data reporting.
Subject child/children
First name(s)
Last name
DOB
Indigenous status
Client
number
(add more rows as needed)
Carer / Care service details
Name of carer / Care
service
Carer entity /
Care service ID
Contact details
Affiliated FKC service /
Organisation
Name of
Coordinator/manager/
support worker and role
Contact details
Relevant staff members of a care service, where applicable
Name
Role
Contact details
ICMS Person ID
(add more rows as needed)
Standard of care review report
August 2013
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Standard of care review report
Concerns received (Include the concerns recorded in the ‘record of concerns ‘ in ICMS)
Information gathering and consultation (Record details of consultation and information gathered)
Decision to conduct the standard of care review
Rationale for decision
Decision made by
Name, position
CSSC
Allocated officer
Date
Name, position, CSSC
Plan
Key activity
Who is responsible
Key considerations
Discussion with carer /
care service
Discussion with child /
children
(add more rows as
needed for additional
activities)
Assessment
Record details of discussions with the carer or care service and the child. Provide rationale for the outcome
decision, making reference to the discussions with the staff and child, and information gathered from other
sources.
Discussion with carer/care service
Discussion with subject child/children
Other relevant information, including consideration of contextual factors
Standard of care review report
August 2013
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Standard of care review report
Outcome decision (record an outcome for each subject child)
Standards of care
(a) the child’s dignity and rights will be respected at all times
(b) the child’s needs for physical care will be met, including adequate food, clothing and shelter
(c) the child will receive emotional care that allows him or her to experience being cared about and valued and that
contributes to the child’s positive self-regard
(d) the child’s needs relating to his or her culture and ethnic grouping will be met
(e) the child’s material needs relating to his or her schooling, physical and mental stimulation, recreation and general living
will be met
(f) the child will receive education, training or employment opportunities relevant to the child’s age and ability
(g) the child will receive positive guidance when necessary to help him or her to change inappropriate behaviour
(h) the child will receive dental, medical and therapeutic services necessary to meet his or her needs
(i) the child will be given the opportunity to participate in positive social and recreational activities appropriate to his or her
developmental level and age
(j) the child will be encouraged to maintain family and other significant personal relationships
(k) if the child has a disability - the child will receive care and help appropriate to the child’s special needs.
Child
Outcome (Standards met or
Standards not met)
Standards not met (from list
below), where applicable
Eg Johnny Williams
Eg. Standards met
Eg. (a) (b) and (d)
(add more rows as needed)
Rationale for decision (include the factors contributing to the child’s care meeting or not
meeting the legislated standards)
Approval
Outcome approved by:
Signature:
Position:
CSSC:
Date:
Subsequent action
Review of placement agreement
completed? (must be completed for a
carer)
Y
Review of foster carer agreement to
occur?
Y
Standard of care review report
N
N/A
Date:
By whom:
N
N/A
Date:
By whom:
August 2013
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Standard of care review report
Review of carer suitability to occur?
Y
N
N/A
Date:
By whom:
Action plan developed?
(must be completed for care service)
Standard of care review report
Y
N
N/A
Date:
By whom:
August 2013
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Standard of care review report
Action plan
Care service
Name of care service:
Action plan (record action plan developed by the care service or attach a copy)
Action
Who is responsible
Complete date
Eg. Care service to provide staff
with training on positive behaviour
support techniques
Name, care service manager, to
arrange training and ensure all staff
attend.
Training to be organised by end of
Feb. Training to occur no later than
end or March.
Eg. CSO to attend team meeting to
discuss child’s history of sexual
abuse and implications for current
behaviour.
Name, care service manager, to
organise team meeting and invite
CSO.
Meeting to occur by end of February
Name, CSO, to compile relevant
information from child’s case files.
(add more rows as needed)
Action plan finalised
Action plan agreed to by
(Name of TL/CSSC
manager):
Signature:
Role:
Date:
Standard of care review report – action plan
Review date:
August 2013
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