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Asked by MagistrateResolve4684

  

 

Task 13- CHCCCS006 – Facilitate individual service planning and delivery

In this assessment task, you are required to work within the established guidelines at your organisation to contribute to the planning and reviewing of services which meet the needs of three (3) older adults.  

You are also required to contribute to the planning processes by communicating effectively with each of the clients and other stakeholders using active listening and questioning skills. 

The student will be required to  the following for each client: 

Develop a care support plan (CSP)
Implement a care plan
Review service delivery implementation

1.1-You must use the attached templates to  workplace project task. 

 

Care Support Plan (CSP) 

 

Client 1: Full name 

  

 

Age 

  

 

Summary of support services required by the client 

  

  

  

  

  

 

Checklist for planning, coordinating and contributing to the service delivery. 

 

  

Plan for a service delivery. 

Developing a support plan for one ongoing service delivery 

Coordinating development for more than one ongoing service delivery  

Contributing to a coordinated support plan but not coordinating it 

Ensure a support plan is prepared within 60 days of the person receiving the service 

  

  

  

 

Work with the person, their family or network to identify and invite participation of those who need to be involved 

  

  

  

Work with the person, their family or network to decide how and where planning will occur 

  

  

  

Work with the person, their family or network to decide what issues will be discussed in a group (publicly) and those that will be discussed more privately. 

  

  

  

Work with the person, their network or family to facilitate planning 

  

  

  

Make sure that the person has a copy of the plan in a format that is most meaningful to them 

  

  

  

Make sure other participants who have a role to play have a copy 

  

  

  

Make sure a review date is set and the person responsible is nominated 

  

  

  

Plan with the person according to the guiding principles for planning in the Act 

  

  

  

Record that a support plan has been prepared and the date for its review 

  

  

  

Implement strategies that relate to the ongoing service 

  

  

  

Monitor the person’s progress towards the goals that relate to the ongoing service 

  

  

  

Review the support plan according to the person’s need and legal requirements 

  

  

  

Ensure all ongoing service delivery providers participate in the planning process where the support plan is intended to cover their service. 

  

  

  

Negotiate administrative tasks with other service delivery providers including documentation and formatting the plan. 

  

  

  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 1.2-Care plan: Complete the following care plan for the client 1 

                                               Nursing Care Plan 

Care alerts (write in red)  For example: allergies, drug reactions, smoker, falls risk, diabetic 

 

 

 

 Communication        

 

Preferred name: 

Care needs:   

Goal: (expected outcome) 

 

Vision 

Hearing 

 

Aids 

Glasses   magnifying glasses 

Aids 

hearing aids (right    left) 

 

Other 

Other 

 

 

 

 

Speech and language 

Comprehension issues (For example: inappropriate responses) 

 

 

 

 

 

Speech disorder/s 

 

 

 

Other 

 

Mobility

 

Care needs:   

Goal: (expected outcome)  

 

Ambulation (walking) 

Transfers  

 

 

ambulant (able to walk) non-ambulant (unable to walk) 

independent weight bearing (able to stand) 

non-weight bearing (unable to stand) 

1-staff assist       2-staff assist hip replacement  knee replacement amputee ( left  right ) 

 

Aids 

walking stick  zimmer frame wheelchair      quad stick wheeled walker 

Aids  

bed rail  slide sheet  gait belt 

hoist           

standing hoist 

Hoist sling type and position of loop 

 

Other 

Other 

 

 

Provide direction 

Supervise movement 

Encourage to maintain mobility 

 

Toileting and continence 

 

 

Care needs:  

Goal: (expected outcome) 

 

 

 

Continence 

 

Bladder control 

continent      incontinent    

catheter     ( occasionally/frequently/total incontinence ) 

Bladder management 

fluid balance chart      toilet    (times   0800  1200   1600  2000 ) 

Other    Prefers male/female care worker with toileting assistance 

Bowel control 

continent  incontinent   constipation   

colostomy  ( occasionally   frequently   total incontinence ) 

 

Bowel management 

high fibre diet      encourage fluid intake               

aperients             bowel chart 

Continence aids 

 Day             Night 

Toileting 

 

Toileting aids 

commode                urinal               uridome             

kylie             

bed pan 

Other    Urinal to be used at night 

Toileting regime 

independent       

supervise               

some assistance/prompt    fully assist Adjust clothing   

Position on toilet   

Encourage self care         

Clean perianal area 

Other  Prefers male/female care worker to assist with toileting 

Showering, dressing and grooming 

 

Care needs:    

Goal: (expected outcome)  

 

Shower and washing 

 

 

independent     supervise       some assistance/prompt          fully assist shower            bath              spa bath         bed sponge    flannel wash 

Frequency Daily                                   Preferred time  after dinner 

Adjust water temperature                                  Encourage to optimise selfcare 

Other    Prefers male care worker for showering assistance 

Transfer 

walk to shower               wheelchair               

hoist       

Other  

 

Showering aids 

bath trolley                     

shower chair                   

Other  

Toiletries 

normal soap     

deodorant         

aqueous cream moisturiser ( am   8pm ) Other 

Hair care 

wash in shower              wash in bath                   

Preferred days 

Dressing and undressing 

 

 

independent     

supervise         

some assistance/prompt 

fully assist callipers             

splints           

Other  

Cultural dressing 

 

Dressing assistance 

bra                    singlet              buttons              belt      zips 

stockings           socks               

jewellery         

make-up  shoes 

Assist with selecting clothing       

Other  

Grooming 

 

Hair care 

independent     supervise         some assistance/prompt fully assist 

Hairdresser  

Facial hair         wet shave         dry shave          Frequency  Daily 

Hair removal                                                               Frequency 

Nail/foot care 

independent     

supervise         

some assistance/prompt  fully assist 

 

 

Podiatry visits   6 weekly. 

Do not cut  nails – RN or podiatrist only N/A 

Teeth 

none           

some  ( upper lower )                  all 

Cleaning routine   

Toothbrush and paste: in morning after breakfast, in evening before bed 

Dentures 

none   

partial full ( upper  lower )       Night   in  out 

Cleaning routine 

Pressure area and skin care 

 

Care needs: 

 Goal: (expected outcome) 

 

Pressure Risk 

Score         [   ]  low risk             [  ]   medium risk             [  ]   high risk 

Pressure relief aids  

bed cradle     sheepskin   

cushion         

bedrail/protectors   

Other  

Pressure area regime  

Reposition in bed  2/24   Reposition in chair       

Frequency  

special mattress (type)       

personal chair Other/specific orders 

Skin care 

emollient cream to dry skin areas  ( daily twice daily )   Preferred time/s  2000 

Eating and drinking 

 

Care needs:    

Goal: (expected outcome)  

 

Eating 

 

 

 

independent     

supervise         

some assistance/prompt 

fully assist right-handed     left-handed 

Preferred place to eat 

dining room     

bedroom           Other 

Type of diet 

normal             

soft           

modified soft (minced)         puree 

Special diet 

high fibre         diabetic     

enteral feeding (PEG/NGT) 

Special instructions  

 

Aids 

modified crockery          modified cutlery   bowl   

lipped plate 

built up cutlery               

clothing protector                       

Other  

Drinking 

 

independent       supervise         some assistance/prompt fully assist 

right-handed       left-handed 

Aids 

modified cup                  clothing protector  

Thickened fluids 

level 1         

level 2         

level 3 

Type of thickener to be used 

Sleep and settling routines 

 

Care needs: 

Goal: (expected outcome)  

 

 

Usual time to rise  0700                   Usual time to bed  2030           

Rest time (am 1pm) 

Preferred sleeping position                                                         

Pillows required 

Sleep Aids 

massage music        hot packs        Other 

Room 

light on  door open    door closed      bedrail/protectors 

Other 

Night-time patterns 

 

Other preferences (For example: hot drinks or snacks) 

 

Night checks 

every hour                     

every 2 hours                   

Other 

Specialised care plans 

 

Refer to specialised care plans for 

[X]  Medications        [   ]  Pain management          [   ]  Wound care 

[  ]  Therapy                         [  ]   Restraint management 

Social and human needs/activities 

 

Care needs: 

Goal: (expected outcome) 

 

 

Frequency of visit/contact by family/friends       Family visit every day.   

Frequent visits by friends intermittently during the week also. Religion beliefs/practices   

Anglican 

Pastoral requirements                                          

Attends place of worship (attends Anglican service at Fitzroy Falls Aged Care Facility)                                       Cultural needs 

Hobbies/interests   

Reading, chess, classical music     

Employment history   Retired Bank Manager 

Behaviour 

Care needs:  

Goal: (expected outcome)  

 

Additional comments (For example: special needs, restraint, routines, pain, palliative care, pacemaker) 

 

Terminal care recorded  Yes                 No 

Date care plan evaluated (document in progress notes) 

Signature 

 

 

Rosedale Aged Care Facility 

Entered in progress notes                                                  Date 

Print Name       

Position Title 

Date Completed 

3-Review service delivery implementation

Write in the comments section how you met each of the following criteria: 

Establish a trusting, courteous and supportive relationship with clients 

  

  

  

  

  

Assessor comments: 

  

  

  

  

Provide documentation / information to clients to aid in decision making 

  

  

  

  

  

  

  

 

Assessor comments: 

  

  

  

  

  

Work with clients to develop an individualised plan following workplace procedure, including: 

                        ·     Include appropriate stakeholders and personnel in decision making and discussions 

                        ·     Undertake basic assessments appropriate to client 

                        ·     Maintain personal and strength-based focus 

                        ·      Correctly document assessment results and activities 

  

 

Assessor comments: 

  

  

  

  

  

Undertake risk assessment for plan, including: 

·                     Identify risks associated with the plan 

·                     Develop strategies to reduce / remove risks 

  

 

 

Assessor comments: 

  

  

  

  

Implement the individualised plan, including: 

                        ·     Provide support as outlined in the plan

                        ·      Provide information and support others to implement the plan 

                        ·     Identify any need for adjustments to plan and implement changes accordingly 

·      Undertake discussions with client, supervisor and family members to determine success of individualised plan and identify any areas that require adjustment 

  

 

 

 

 

 

 

 

 

 

 

 

Assessor comments: 

  

  

  

  

Deliver quality services, and demonstrate the ability to capably perform normal work duties and manage their time during the period of this assessment 

  

 

 

 

 

 

 

 

Assessor comments: 

  

  

  

  

Follow all workplace procedures, including documentation and reporting procedures 

  

 

 

Assessor comments: 

  

  

  

  

  

Communicate and work effectively with client, family and other staff at all times 

  

 

Assessor comments: 

  

  

  

  

  

Use workplace equipment correctly and follow WH&S / infection control procedures 

  

 

 

 

 

 

 

 

 

 

 

Assessor comments: 

  

  

  

  

  

  

 

                 
 

2.1 -You must use the attached templates to  workplace project task. 

 

Care Support Plan (CSP) 

 

 

Client 1: Full name 

 

  

 

Age 

  

 

 

Summary of support services required by the client 

  

  

  

  

  

 

 

Checklist for planning, coordinating and contributing to the service delivery. 

 

 

  

Plan for a service delivery. 

Developing a support plan for one ongoing service delivery 

Coordinating development for more than one ongoing service delivery 

Contributing to a coordinated support plan but not coordinating it 

Ensure a support plan is prepared within 60 days of the person receiving the service 

  

  

  

Work with the person, their family or network to identify and invite participation of those who need to be involved 

  

  

  

Work with the person, their family or network to decide how and where planning will occur 

  

  

  

Work with the person, their family or network to decide what issues will be discussed in a group (publicly) and those that will be discussed more privately. 

  

  

  

Work with the person, their network or family to facilitate planning 

  

  

  

Make sure that the person has a copy of the plan in a format that is most meaningful to them 

  

  

  

Make sure other participants who have a role to play have a copy 

  

  

  

Make sure a review date is set and the person responsible is nominated 

  

  

  

Plan with the person according to the guiding principles for planning in the Act 

  

  

  

Record that a support plan has been prepared and the date for its review 

  

  

  

Implement strategies that relate to the ongoing service 

  

  

  

Monitor the person’s progress towards the goals that relate to the ongoing service 

  

  

  

Review the support plan according to the person’s need and legal requirements 

  

  

  

Ensure all ongoing service delivery providers participate in the planning process where the support plan is intended to cover their service. 

  

  

  

Negotiate administrative tasks with other service delivery providers including documentation and formatting the plan. 

  

  

  

 

                 

2-Care plan: Complete the following care plan for the client 1

                                               Nursing Care Plan 

Care alerts (write in red)  For example: allergies, drug reactions, smoker, falls risk, diabetic 

   

 

   

 Communication        

   

Preferred name: 

Care needs:   

Goal: (expected outcome) 

   

Vision 

Hearing 

   

Aids glasses   magnifying glasses   

Aids      hearing aids (right  /left) 

   

Other 

Other 

   

 

 

   

Speech and language 

Comprehension issues (For example: inappropriate responses) 

   

 

   

 

   

Speech disorder/s 

   

 

 

   

Other 

   

Mobility

   

Care needs:   

Goal: (expected outcome)  

 

 

 

 

 

 

 

 

 

 

Ambulation (walking) 

Transfers  

 

 

ambulant (able to walk) non-ambulant (unable to walk) 

independent weight bearing (able to stand) 

non-weight bearing (unable to stand) 

1-staff assist       2-staff assist hip replacement  knee replacement amputee (left/right) 

 

Aids 

walking stick  zimmer frame wheelchair      quad stick wheeled walker 

Aids bed rail       

slide sheet  gait belt 

hoist           

standing hoist 

                Hoist sling type and position of loop          

 

Other 

Other 

 

  Provide direction 

Supervise movement 

Encourage to maintain mobility 

 

Toileting and continence 

 

 

Care needs:  

Goal: (expected outcome) 

 

 

 

Continence 

 

Bladder control 

continent      incontinent     

catheter     ( occasionally/frequently/total incontinence ) 

Bladder management 

fluid balance chart      toilet    (times  0800  1200   1600  2000) 

Other  Prefers male/female care worker with toileting assistance 

Bowel control 

continent incontinent  constipation  colostomy   ( occasionally   frequently   total incontinence ) 

 

Bowel management 

high fibre diet      encourage fluid intake               

aperients             bowel chart 

Continence aids 

 Day              Night 

Toileting 

Toileting aids 

commode                urinal               uridome             

kylie             

bed pan 

Other Urinal to be used at night 

Toileting regime 

independent       

supervise               

some assistance/prompt    fully assist Adjust clothing   

Position on toilet   

Encourage self care         

Clean perianal area 

Other  Prefers male/female care worker to assist with toileting 

Showering, dressing and grooming 

Care needs:    

Goal: (expected outcome)  

Shower and washing 

 

independent      supervise       

some assistance/prompt           fully assist shower             

bath               

spa bath         bed sponge     

flannel wash 

Frequency Daily                                 

Preferred time  after dinner 

Adjust water temperature                                   

Encourage to optimise self-care 

Other    Prefers male care worker for showering assistance 

 

Transfer 

walk to shower               wheelchair               

hoist       

Other  

Showering aids 

bath trolley                     

shower chair                   

Other  

Toiletries 

normal soap      deodorant         

aqueous cream moisturiser (am 8pm) Other 

Hair care 

wash in shower              wash in bath                   

Preferred days 

Dressing and undressing 

 

 

independent     supervise         some assistance/prompt fully assist callipers            splints          Other 

Cultural dressing 

 

Dressing assistance 

bra                   singlet             buttons             belt     zips stockings          socks               jewellery         make-up  shoes 

Assist with selecting clothing      Other 

Grooming 

 

Hair care 

independent     supervise         some assistance/prompt fully assist 

Hairdresser  

Facial hair         wet shave         dry shave          Frequency  Daily 

Hair removal                                                               Frequency 

Nail/foot care 

independent     supervise         some assistance/prompt fully assist Podiatry visits   6 weekly. Do not cut  nails – RN or podiatrist only N/A 

Teeth 

none           some  (upper/lower)                  all 

 

 

Cleaning routine   

Toothbrush and paste: in morning after breakfast, in evening before bed 

Dentures 

none   partial    full (upper/ lower)       

Night  in   out 

Cleaning routine 

Pressure area and skin care 

 

Care needs: 

 Goal: (expected outcome) 

 

Pressure Risk 

Score         [   ]  low risk             [  ]   medium risk             [  ]   high risk 

Pressure relief aids  

bed cradle    sheepskin  cushion         bedrail/protectors   Other 

Pressure area regime  

Reposition in bed  2/24   Reposition in chair       

Frequency  

special mattress (type)     

personal chair Other/specific orders 

Skin care 

emollient cream to dry skin areas (daily/twice daily)   Preferred time/s  2000 

Eating and drinking 

 

Care needs:    

Goal: (expected outcome)  

 

Eating 

 

 

independent      supervise          some assistance/prompt fully assist right-handed      left-handed 

Preferred place to eat 

dining room      bedroom           Other 

 

Type of diet 

normal             

soft           

modified soft (minced)         puree 

Special diet 

high fibre         

diabetic     

enteral feeding (PEG/NGT) 

Special instructions  

 

Aids 

modified crockery          modified cutlery   

bowl lipped plate 

built up cutlery               

clothing protector                       

Other  

Drinking 

 

 

independent       supervise         

some assistance/prompt fully assist 

right-handed       left-handed 

Aids 

modified cup                  clothing protector  

Thickened fluids 

level 1         

level 2             level 3 

Type of thickener to be used 

Sleep and settling routines 

 

Care needs: 

Goal: (expected outcome)  

 

 

 

Usual time to rise  0700                   Usual time to bed  2030           

Rest time ( am  1pm )  

Preferred sleeping position   

Pillows required 

 

Sleep Aids 

massage music        hot packs        Other 

Room 

light on  door open   door closed     bedrail/protectors 

Other 

Night-time patterns 

 

Other preferences (For example: hot drinks or snacks) 

 

Night checks 

every hour                     

every 2 hours                   

Other 

Specialised care plans 

Refer to specialised care plans for 

[X]  Medications           [   ]  Pain management              [  ]   Wound care 

[  ]  Therapy                   [  ]   Restraint management 

Social and human needs/activities 

Care needs: 

Goal: (expected outcome) 

Frequency of visit/contact by family/friends      Family visit every day.   

Frequent visits by friends intermittently during the week also. 

Religion beliefs/practices    Anglican 

Pastoral requirements                                         

Attends place of worship (attends Anglican service at Fitzroy Falls Aged Care Facility) Cultural needs 

Hobbies/interests    Reading, chess, classical music       

Employment history   Retired Bank Manager 

Behaviour 

Care needs:  

Goal: (expected outcome)  

 

Additional comments (For example: special needs, restraint, routines, pain, palliative care, pacemaker) 

 

Terminal care recorded  Yes                 No 

Date care plan evaluated (document in progress notes) 

Signature 

 

 

Rosedale Aged Care Facility 

Entered in progress notes                                                  Date 

Print Name        Position Title 

Date Completed 

 

                 

3-Review service delivery implementation

Write in the comments section how you met each of the following criteria: 

Establish a trusting, courteous and supportive relationship with clients 

  

  

  

  

  

Assessor comments: 

  

  

  

  

Provide documentation / information to clients to aid in decision making 

  

  

  

  

  

  

  

 

Assessor comments: 

  

  

  

  

  

Work with clients to develop an individualised plan following workplace procedure, including: 

                        ·     Include appropriate stakeholders and personnel in decision making and discussions 

                        ·     Undertake basic assessments appropriate to client 

                        ·     Maintain personal and strength-based focus 

                        ·      Correctly document assessment results and activities 

  

 

Assessor comments: 

  

  

  

  

  

Undertake risk assessment for plan, including: 

·                     Identify risks associated with the plan 

·                     Develop strategies to reduce / remove risks 

  

 

 

Assessor comments: 

  

  

  

  

Implement the individualised plan, including: 

                        ·     Provide support as outlined in the plan

                        ·      Provide information and support others to implement the plan 

                        ·     Identify any need for adjustments to plan and implement changes accordingly 

·      Undertake discussions with client, supervisor and family members to determine success of individualised plan and identify any areas that require adjustment 

  

 

 

 

 

 

 

 

 

Assessor comments: 

  

  

  

  

Deliver quality services, and demonstrate the ability to capably perform normal work duties and manage their time during the period of this assessment 

  

 

 

 

 

 

 

 

Assessor comments: 

  

  

  

  

Follow all workplace procedures, including documentation and reporting procedures 

  

 

 

 

 

 

Assessor comments: 

  

  

  

  

  

Communicate and work effectively with client, family and other staff at all tim 

 

 

 

 

 

 

 

 

Assessor comments: 

  

  

  

  

  

Use workplace equipment correctly and follow WH&S / infection control procedures 

  

 

 

 

 

 

 

 

 

Assessor comments: 

  

 

 

 

   

 

 

 

 

 

 

 

 

 

 

 

 

 

 

   

1-You must use the attached templates to workplace project task. 

 

Care Support Plan (CSP) 

 

 

Client 1: Full name 

 

  

 

Age 

  

 

 

Summary of support services required by the client 

  

  

  

  

  

 

 

Checklist for planning, coordinating and contributing to the service delivery. 

 

 

  

Plan for a service delivery. 

Developing a support plan for one ongoing service delivery 

Coordinating development for more than one ongoing service delivery 

Contributing to a coordinated support plan but not coordinating it 

Ensure a support plan is prepared within 60 days of the person receiving the service 

  

  

  

Work with the person, their family or network to identify and invite participation of those who need to be involved 

  

  

  

Work with the person, their family or network to decide how and where planning will occur 

  

  

  

Work with the person, their family or network to decide what issues will be discussed in a group (publicly) and those that will be discussed more privately. 

  

  

  

Work with the person, their network or family to facilitate planning 

  

  

  

Make sure that the person has a copy of the plan in a format that is most meaningful to them 

  

  

  

Make sure other participants who have a role to play have a copy 

  

  

  

Make sure a review date is set and the person responsible is nominated 

  

  

  

Plan with the person according to the guiding principles for planning in the Act 

  

  

  

Record that a support plan has been prepared and the date for its review 

  

  

  

Implement strategies that relate to the ongoing service 

  

  

  

Monitor the person’s progress towards the goals that relate to the ongoing service 

  

  

  

Review the support plan according to the person’s need and legal requirements 

  

  

  

Ensure all ongoing service delivery providers participate in the planning process where the support plan is intended to cover their service. 

  

  

  

Negotiate administrative tasks with other service delivery providers including documentation and formatting the plan. 

  

  

  

 

                 

  3.2-Care plan: Complete the following care plan for the client 1 

                                               Nursing Care Plan 

Care alerts (write in red)  For example: allergies, drug reactions, smoker, falls risk, diabetic 

 

 

 

 Communication        

 

Preferr

 

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