CARE/SUPPORT PLANNING MODULE
Service name:_____________________________________________
Date completed:_________________________________
INTRODUCTION: As part of HDANZ’s onTrack programme, the following questionnaire is intended to provide you with a self-assessment review of your
service, in relation to key areas of service delivery for your business planning and quality/risk system. Note that this question sub-set is intended as a
guide only and reflects the relevant sector standards and possible good practices. The self-assessment allows you to identify areas that are working well
(Yes) and areas that may need further preparation for your quality system and service delivery (No). There is an action plan template at the end of the
question set. For any “No” responses you can copy and paste that into the action plan and monitor its completion.
Ref #
Self-assessment questions
1.1
Is an initial assessment completed upon entry to the service, by a suitably qualified person? (Note in aged care this is the
registered nurse)
1.2
Do assessments include input from resident/client and family/whanau (where appropriate) and those involved documented?
(Answer Yes if they DO NOT apply)
1.3
Is there is a policy that describes the timeframe for completion of the initial assessment, care plan/support plan and evaluation?
(Answer Yes if they DO NOT apply)
1.4
Do all residents/clients have an initial assessment completed that includes relevant information to assist with planning care?
1.5
Are assessment tools utilised, relevant to the type of service and risk? (in aged care such as (but not limited to) a) falls risk
assessment, b) continence assessment, c) pain assessment, d) pressure risk assessment, e) nutrition assessment, and f)
interRAI assessments)
1.6
Do all residents/clients have an up to date care/support plan that has been developed, with input from the resident and whanau
(where appropriate)?
1.7
Do all residents/clients have goal focused care/support plans?
1.8
Do all care/support plans include goals, interventions and evaluations?
1.9
Is there evidence that care/support plans are individualised?
1.10
Does the care/support plan show choices and preferences of the resident/client?
1.11
Are the resident/client's cultural and/or spiritual needs identified in the care/support plan?
1.12
Does the care/support plan show participation in the resident/client's preferred activities and/or involvement in the community?
Yes
No
Comments
1
1.13
Are special dietary or nutritional needs identified in the care/support plan?
1.14
Where required are strategies/interventions identified to manage behaviour and is this in the care/support plan (including any
intervention for restraint or enablers)?
1.15
Are all care/support plans signed and dated by the person completing the care/support plan? (Note in aged care this is the
registered nurse).
1.16
Is there evidence of changes to care/support plans that are signed and documented?
1.17
Are acute changes to health status documented on the care/support plans or utilised on short term care plan?
1.18
Do resident/client files demonstrate integration of medical practitioners, specialists or allied?
2
ACTION PLAN: CARE/SUPPORT PLANNING MODULE
Ref #
Self-assessment questions
(for “No” responses above)
Improvement action to be taken
Due
date
Person
responsible
Date
completed
(Add additional rows as necessary)
3