Record Keeping and Care Planning

Course Aims/Objectives:

By the end of the session learners will be able to better understand the importance of Record Keeping within their own work environment.

Course Duration:

3 hours

Staff Who Should Attend:

All designated staff members within the care sector, essentially if you are designated to keep clear & concise records within the workplace

Assessment method:

  • Formative through activities, scenarios and Q&A
  • Summative: Quiz, Q&A

Contents of Course:

  • Effective Record Keeping
  • Policy and Procedure
  • Reporting: Why When How
  • Enforceable Principles
  • Legislation, Accountability and CQC Standards
  • Key Documents, Commonly used forms and when to use them
  • The importance of writing in a clear, accurate and concise manner
  • The Do’s and Don’ts of Record Keeping
  • Documentation relating to care and to individuals care needs
  • Maintaining effective record
  • Person Centred Records
  • Information to record and how to record information accurately
  • The need for transparency
  • Sharing of information
  • Different types of data and data protection
  • The importance of storing records
  • Fact v Opinion
  • Avoidance of Jargon and personal comments
  • Understanding your audience
  • Confidentiality
  • Care plans

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