Home Care Intake Form Template for England and Wales

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Home Care Intake Form Template

I need a Home Care Intake Form Template for our new private care agency opening in March 2025, focusing on elderly clients with complex medical needs and ensuring full CQC compliance for operations in Greater London.

Document background

The Home Care Intake Form Template is a crucial document used when initiating home care services in England and Wales. It serves as the foundation for establishing a care relationship between service providers and clients, ensuring compliance with the Care Act 2014, CQC regulations, and UK GDPR requirements. This document captures comprehensive information about the client's needs, medical history, preferences, and consent, enabling care providers to deliver appropriate and person-centered care while maintaining required regulatory standards.

Suggested Sections

1. Personal Information: Basic client details including name, address, date of birth, NHS number, and contact information

2. Emergency Contacts: Details of primary and secondary emergency contacts, including relationship to client

3. Medical Information: Current medical conditions, medications, allergies, and healthcare providers' details

4. Care Needs Assessment: Detailed assessment of client's care requirements, including daily living activities and support needed

5. Risk Assessment: Evaluation of potential risks and required mitigation measures

6. Consent and Agreements: Client/representative consent for care services and information sharing

Optional Sections

1. Mental Capacity Assessment: Required when there are concerns about client's decision-making capacity - use when client shows signs of cognitive impairment or inability to make decisions

2. Financial Assessment: Details of funding arrangements and financial responsibilities - use when public funding or complex payment arrangements are involved

3. Cultural and Religious Requirements: Specific cultural or religious needs affecting care delivery - use when client has specific cultural or religious requirements

4. End of Life Care Preferences: Advanced care planning and end of life wishes - use when client requires palliative care or wishes to record end of life preferences

Suggested Schedules

1. Care Plan: Detailed schedule of care tasks, timing, and specific requirements

2. Medication Schedule: Comprehensive list of medications, dosages, and administration times

3. Risk Management Plan: Detailed procedures for managing identified risks

4. Contact List: Complete list of all relevant healthcare professionals and service providers

5. Equipment Requirements: List of necessary equipment and maintenance requirements

Authors

Alex Denne

Head of Growth (Open Source Law) @ Genie AI | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

alex.den.21@genieai.co

Relevant legal definitions

Clauses

Relevant Industries

Healthcare
Social Care
Residential Care
Private Healthcare

Relevant Teams

Care Operations
Quality Assurance
Administration
Clinical Governance
Client Services

Relevant Roles

Care Manager
Care Coordinator
Social Worker
Healthcare Assistant
Quality Assurance Manager
Registered Manager
Care Quality Lead

Industries

Care Act 2014: Primary legislation that sets out local authorities' duties in assessing people's care and support needs, including personal budgets and direct payments

Mental Capacity Act 2005: Legislation protecting and empowering people who may lack the mental capacity to make certain decisions about their care and treatment

Health and Social Care Act 2008: Framework for the regulation of health and social care providers, including registration requirements and quality standards

Equality Act 2010: Legislation protecting individuals from discrimination and promoting equality in care provision

Data Protection Act 2018 and UK GDPR: Laws governing how personal information must be collected, stored, processed and shared in care settings

Human Rights Act 1998: Fundamental rights that must be respected in care provision, including right to privacy and dignity

Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Detailed requirements for providers of health and social care, including fundamental standards of care

Care Quality Commission (Registration) Regulations 2009: Requirements for registration of care providers with the CQC and ongoing compliance obligations

Care and Support (Assessment) Regulations 2014: Specific requirements for how care needs assessments should be conducted and recorded

CQC Fundamental Standards: Regulatory standards setting out the minimum quality and safety requirements for care providers

NICE Guidelines: Best practice guidelines for various aspects of health and social care provision

Personal Information Requirements: Standards for collecting, managing, and protecting service users' personal information, including consent and confidentiality

Assessment Protocols: Requirements for conducting and documenting care needs, risk assessments, and mental capacity assessments

Client Rights Framework: Service users' rights regarding care choices, dignity, privacy, and decision-making autonomy

Safeguarding Requirements: Procedures and protocols for protecting vulnerable adults, including risk assessment and emergency procedures

Healthcare Management Standards: Requirements for managing medical history, medications, and coordination with healthcare professionals

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Let's create your Home Care Intake Form

Authors

Alex Denne

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