What is a recording?

A recording in adult social care is any recording made, or information held by the local authority about a person with care and support needs and/or a carer with support needs. Examples include but are not limited to:

• Correspondence (letters, emails, telephone transcripts).
• Formal documents (assessment of needs, care and support plans, reviews, safeguarding enquiries, mental capacity assessments).
• Data necessary for management of performance (type of referral, time taken to action, next steps, safeguarding, risk).
• Common data sets (personal details, identify, residency, accommodation, communication, capacity, disability, health, relationships).

What is an assessment of needs recording?

In the context of an assessment, this factsheet will focus on the formal document prepared following an assessment of needs. An assessment of needs begins as soon as it has been identified that there is an appearance of need for care and support. This often means that at the first point of contact with an adult, the assessment is underway, and the recordings may contribute towards the final assessment of needs document.

Assessment of needs recording is an integral and important part of an assessment intervention. It is not simply an administrative process to go through as quickly as possible, but is central to good, person-centred support and a vital component of professional practice. Recording is not only important due to the legal requirement to record but it also provides:

• A framework for good care and support.
• Continuity of care and communication with other agencies.
• A tool to help identify themes and challenges in the adult’s life.
• Accountability – to the adult, managers, inspections, and audits.
• Evidence – for court, complaints, and investigations.

Context

• The local authority (authority) must give a written record of a needs assessment to the adult to whom the assessment relates and any other person to whom the adult asks the authority to give a copy, for example any carer that the adult has (Section 12). With this in mind, it is necessary that any recordings reflect that a strengths-based and person-centred approach has been taken and a key consideration of recording is “what would I think if I read this about myself?”.

An assessment of needs recording should include:

• Assessment details (e.g. referral, date case is allocated and to whom, when the assessment meeting took place).
• Communication preferences of the adult and support that may be required (e.g. Independent Advocacy).
• Health conditions (e.g. section 117 status, Autism, deaf and/or blind).
• Assessed needs and personal outcomes and impact on individual wellbeing. (e.g. significant life events, personal/desired outcomes, priorities, strengths).
• Information and advice that has been provided in context while discussing personal outcomes and needs.
• Preventative pathways that have been considered (e.g. the assessment conversation was paused to enable reablement to take place).
• Risks (e.g. risk assessments and risk enablement plans).
• Other (e.g. advanced decision making, registered Lasting Powers of Attorneys).
• Next steps (e.g. outcome of the assessment, financial assessment, agreed next steps).

Legislation and further resources

SCIE, Care Act: assessment and eligibility (SCIE, 2024)

SCIE, Care Act: Legal duties and impact on individuals (SCIE, 2024)

Gov UK, Care and support statutory guidance (Gov.UK, 2023)

Legislation UK, Care Act 2014: Section 12 (Legislation.GOV.UK, 2024)