Please use the information above and create a detailed plan for the individual to be supported with their domestic needs. Please specify days and times and who would carry out this task (family, support workers, friends etc.

Support required:

  • Do not need any support
  • Need some support
  • Verbal prompt
  • Need full support
  • Need equipment
  • do not use/need that

Please highlight the support required from the list below.

  • Deep cleaning of my house/ flat
  • Washing up daily
  • Cleaning my toilet
  • Cleaning my shower
  • Cleaning my bathroom
  • Cleaning my sink
  • Making my bed
  • Changing my bedsheet  
  • Clean my floor
  • Hoover
  • Dust
  • Laundry
  • Ironing
  • Emptying bins
  • Other

My Domestic Support Plan

Please use the information above to create a detailed plan that supports the person with their domestic and cleaning support.

My Desired Outcomes for Domestic Support

In this section, please highlight the person’s desired goals in relation to domestic support e.g., ‘I would like to be able wash up after myself/ do some dusting in my room’. Please detail how this goal will be met and what/who needs to be involved.

Shopping Care and Support Plan

Being able to shop for food is an important part of staying well and independent. This section of the care and support plan should aim to support the person to be in control of what food they purchase, grocery delivery and/or being escorted to the supermarket.

Support required:

  • Do not need any support
  • Need some support
  • Verbal prompt
  • Need full support
  • Need equipment
  • I do not use/need that

Please highlight the support required from the list below:

  • Making a list
  • Able to carry my shopping
  • Able to pick my shopping
  • Able to put away my shopping
  • Able to divide my shopping
  • Able to go to shop on my own
  • Able to make the right purchase options
  • Able to pay for my shopping
  • Able to go by myself to do the shopping
  • Other

My Shopping Support Plan

Please use the information above to create a detailed plan that supports the individual with their shopping support needs. Please specify the days and times and who would carry out this task (family, support workers, friends etc.) Please add if they are able to access the shops, with or without support, or whether they do online shopping, and if they need support to do this.

My Desired Outcomes for Shopping Support

In this section, please highlight the person’s desired goals in relation to their shopping support needs e.g., ‘I would like to be able to order my shopping online with some support/ help’. Please detail how this goal will be met and what/who needs to be involved.

Companionship Care and Support Plan

Companionship care is a type of service designed for individuals who may be at risk of loneliness or who have been experiencing loneliness for some time.  Please use the checklist below to discuss what support is required.

Support required:

  • Do not need any support
  • Need some support
  • Verbal prompt
  • Need full support
  • Need equipment
  • I do not use/need that

Please highlight the support required from the list below:

  • Emotional support
  • Going to places
  • Interaction with others
  • Being able to socialise
  • Carry out daily living acitivties
  • Attending appointments
  • Carry out my hobbies
  • Keep in touch with family and friends and/or community groups of significance
  • Other

My Companionship Support Plan

Please use the information above to create a detailed plan that supports the individual with their companionship. Please add how you would help the individual with their companionship wishes and needs, when and where this would take place, and for how long, and who would carry out this task (family, support workers, friends etc).

My Outcomes for Companionship Support

In this section, please highlight the person’s desired goals in relation to their companionship support e.g., ‘I would like to be able to invite some friends around so I can socialise on a regular basis’. Please detail how this goal will be met and what/who needs to be involved.