Recurring concern
Unreliable care-planning processes
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Request correctionFirst reported 1 Aug 2013•Latest report 2 Jun 2026
What this concern includes
Includes missing, incomplete, unclear, outdated, uncoordinated, unreviewed or unimplemented formal person-level care plans and established named equivalents such as integrated care or care-and-crisis plans.
Not included
- Excludes standalone procedural instructions, treatment steps, extubation plans and immediate deterioration-management plans unless the source explicitly identifies them as part of the person's formal care plan.
- Excludes organisational improvement plans, staffing plans and operational contingency plans.
- Excludes discharge planning, risk assessment, family involvement or generic records when that separate control is the concern and formal care-plan reliability is not directly asserted.
- Reports
- 120
- Individual concerns
- 141
- Date range
- 2013–2026
- Stated actions
- 200
Distinct published reports
A report can raise multiple concerns
First to latest report issue date
Described in published responses
Reports over time
Reports over time
Reports about this concern issued each year.
* 2026 is projected from reports observed to 7 Sep 2026.
Most frequent recipients
Most frequent recipients
Reports about this concern sent to each recipient.
Concerns and responses across reports
Only concerns grouped under this recurring concern are included. Select any concern, action or position to view the source wording.
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Concerns raised1
Lack of nursing care planning for patients at increased risk from illicit drug use
This report raised 6 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
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Action
Remind nursing teams to document suspected illicit drug use in care plans and include it in nursing handovers.
Stated by Barts Health NHS Trust
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
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Position
The Trust lacks the legal powers to prevent patients with capacity from leaving the ward voluntarily.
Stated by Barts Health NHS Trust
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Concerns raised1
Failure to maintain sufficiently robust and informative care, risk and crisis management plans
This report raised 14 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
No linked response statementsNo respondent-stated action or position is linked to these concerns in the published data.
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Concerns raised1
Failure to record relevant mental health history in care plans
This report raised 2 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
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Action
Implement collaborative My Safety & Crisis Plans with regular completion and update prompts, including after significant risk changes.
Stated by Hampshire and Isle of Wight Healthcare NHS Foundation Trust
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Concerns raised1
Care plans and needs assessments failing to incorporate complete available information
This report raised 2 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.2
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Action
Introduce a revised home-assessment document for completion before new placements.
Stated by The Haven Day Centre -
Action
Review existing and new placements to ensure suitable care plans address minibus access by steps or tail lift.
Stated by The Haven Day Centre
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Concerns raised1
Failure to update care plans
This report raised 14 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
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Action
Implement and evaluate the e.care electronic care-planning system, with organisation-wide rollout scheduled for October 2018.
Stated by Hc-One Limited
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Concerns raised1
Failure to review care plans and dietary requirements
This report raised 11 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.3
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Action
Introduce dining registers and quick-reference guides for managing specialist diets, with formal review and update governance.
Stated by Hc-One Limited -
Action
Implement daily ‘Resident of the day’ care-plan reviews and report changing needs through the clinical risk register.
Stated by Hc-One Limited -
Action
Develop a long-term diet-notification review process and incorporate it into HC-One’s choking-risk governance strategy.
Stated by Hc-One Limited
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Concerns raised1
Failure to define required levels of resident supervision in care plans and guidance
This report raised 1 other concern. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.2
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Action
Revise care documentation, supporting guidance and resident-care policies to specify individualised supervision requirements and responsible staff for daily activities.
Stated by Bupa Care Services -
Action
Allocate resources for further investigation of the supervision, commode suitability and investigation deficiencies identified by the coroner, then discuss findings and agree actions and learning.
Stated by Bupa Care Services
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Concerns raised1
Failure to incorporate tissue viability advice into care plans
This report raised 11 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
No linked response statementsNo respondent-stated action or position is linked to these concerns in the published data.
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Concerns raised1
Failure of care plans to specify dates for meetings and task completion
This report raised 5 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
No linked response statementsNo respondent-stated action or position is linked to these concerns in the published data.
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Concerns raised1
Failure to revise the mobility care plan in response to documented deterioration in mobility
This report raised 2 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.3
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Action
Overhaul and rewrite residents’ care plans.
Stated by SCOSA LIMITED T/A ROSEWOOD LODGE RETIREMENT HOME -
Action
Review care plans monthly or sooner after changes and update associated risk assessments.
Stated by SCOSA LIMITED T/A ROSEWOOD LODGE RETIREMENT HOME -
Action
Implement computerised person-centred care-plan software for live updates and incident, accident, mobility and other needs reporting.
Stated by SCOSA LIMITED T/A ROSEWOOD LODGE RETIREMENT HOME
Data last updated 7 September 2026