An autism-friendly care plan records the person's sensory profile, the routines that keep them steady, and how they communicate, in enough detail that a worker who has never met them can support them without causing distress. It is written from the person's point of view, it ends every section with an instruction, and it is short enough to be read before a shift. Everything else in an autistic person's support flows from those three things.
The short answer
Autism-friendly practice in a care home means three things written into the person-centred care plan and used every day: a sensory profile that says, sense by sense, what the person seeks, what they avoid, what overload looks like and what staff should do; predictable routines that are recorded in enough detail to be kept by a stranger, with a plan for when they have to change; and a communication passport that explains, in the first person, how the person communicates, how they understand, what their behaviour means and what helps. Add environment adjustments, a positive behaviour support plan where one is needed, and daily notes that record what worked, and you have a plan that any worker can follow. This article explains how to write each part, with a table, a checklist, a review procedure and what inspectors look for under Right support, right care, right culture.
What autism-friendly practice means in a care home
Autism-friendly practice is not a set of adjustments bolted on to a standard care plan. It is a different way of writing the plan. A standard plan starts from tasks: personal care, meals, medication, activities. An autism-friendly plan starts from how the person experiences the world: what their senses do, what predictability means to them, and how they communicate. The tasks are then written in a way that fits.
The reason this matters is that most distress in autistic people in care settings is caused by the environment and the approach, not by the person. A worker who talks too much, a corridor that is too bright, a change of shift pattern that nobody explained, a meal at a different time: each of these is a cause, and each is avoidable if the plan says so. The plan is the tool that turns one worker's knowledge into everyone's practice, and it is the evidence that the home understands the person. It is also what CQC's Right support, right care, right culture guidance is looking for: support that is built around the person, care that is compassionate and specific, and a culture that enables rather than manages.
Who writes the plan, and with whom
The plan is written with the person, in whatever way they can take part, and with the people who know them best: family, previous support staff, a speech and language therapist if there is one, a psychologist or PBS practitioner where involved. The keyworker holds the pen. Start with what the person can tell you or show you. Then ask the people who have supported them for years, because they hold the detail: that she cannot bear the sound of the hand dryer, that he needs to know the day's plan before breakfast or nothing else works, that the word 'later' means never to him.
Write it in the first person where the person agrees, so that 'I' is doing the explaining. Use their words for their own experiences. If the person uses pictures or symbols, make an easy-read version that they can hold, with the same content in their format, and keep the two in step. A plan the person recognises and, ideally, helped make is both better practice and better evidence.
The sensory profile
The sensory profile is the heart of the plan. Go through each sense in turn, and for each record four things: what the person seeks, what they avoid, what overload looks like, and what staff should do. The senses to cover are sight, sound, touch, taste and smell, plus movement (vestibular), body awareness (proprioception) and internal sensations such as pain, hunger and the need for the toilet (interoception). The last three are the ones most plans miss, and they explain a great deal.
A worked example: sound
Seeks: the same three songs on repeat through headphones; the hum of the tumble dryer. Avoids: sudden noises, the hand dryer in the downstairs toilet, two people talking at once, the television and radio on together. Overload looks like: hands over ears, humming louder, pacing the hallway; if it continues, hitting the wall. What to do: turn off one source of sound immediately, do not talk, offer the headphones, walk with him to the garden if he goes towards the door. Use the upstairs toilet. Never run the hand dryer while he is downstairs.
Every row ends with an instruction. A profile that only describes the person is a report; one that tells staff what to do changes practice. Include the person's own words where they have them: 'the lights make my eyes hurt' belongs in the record. Review the profile after every incident, because overload is often the first link in the chain.
At a glance: the parts of an autism-friendly care plan
| Part | What it contains | Who needs it most | Review |
|---|---|---|---|
| One-page profile | What people like about me, what is important to me, how best to support me | Every worker, before the first shift | Six-monthly |
| Sensory profile | Each sense: seeks, avoids, overload, what to do | All staff, agency, hospital | After every incident and six-monthly |
| Routines | Day, week, transitions, what happens when things change | New and agency staff | Monthly or when routines change |
| Communication passport | How I communicate, how I understand, what my behaviour means, what helps | Everyone, including hospital and respite | Six-monthly |
| Environment plan | Room, lighting, noise, shared spaces, personal items | Managers, maintenance, new staff | Annually and on any change |
| PBS plan (if needed) | Setting events, triggers, early signs, primary and secondary strategies, reactive plan | All staff supporting the person | Monthly with data |
| Health and capacity | Physical health, medication, pain signs, capacity decisions, consent | Nurses, GP, hospital | Annually and on change |
| Easy-read version | The same plan in the person’s format | The person | In step with the main plan |
Predictable routines
For many autistic people, predictability is not a preference; it is what makes the day bearable. The plan should record the person's routines in enough detail that a stranger could keep them: the order of the morning, meal times and what is eaten, the route to the day service, the evening pattern, the bedtime sequence. Write it as a sequence with times where times matter and order where order matters. 'Breakfast about 8' is not a routine; 'toast, cut in four, on the blue plate, at the table by the window, after the shower and before getting dressed' is.
Then record what happens when routine has to change, because it will. How is the person told, how far in advance, in what format? A visual timetable, a written note, a conversation the night before? Who tells them? What helps them cope with the change? What does it look like when a change has gone badly, and what should staff do then? A plan that only records the routine and not the change plan sets the person up to fail on the first bank holiday.
Transitions
Transitions between activities and places are where most difficult moments happen. Record how the person moves from one thing to the next: warnings at ten minutes and two minutes, a timer, a 'first, then' card, a particular phrase. Record what makes transitions harder, such as being rushed or being asked questions during them.
The communication passport
The communication passport is a short document, usually two pages, written in the first person, that goes everywhere the person goes: hospital, respite, day service, the dentist. It covers how I communicate (speech, signs, symbols, a device, behaviour, pointing), how I understand (short sentences, one instruction at a time, pictures, extra processing time, no idioms), what my behaviour means (if I rock I am happy; if I bite my hand I am in pain or overwhelmed), what helps (wait ten seconds after asking, show me rather than tell me, do not touch me without warning), and what makes things worse.
The passport is the first thing a new worker reads and the thing agency staff are handed at induction. It also belongs at the front of the hospital passport, because an A&E department that knows the person needs ten seconds to process a question and hates being touched on the shoulder will get a very different afternoon from one that does not.
Write it with the person and the people who know them. Test it by giving it to someone who has never met the person and asking them to explain how they would say good morning. If they cannot, it is not finished.
Communication in practice: what the plan should tell staff to do
Good communication in health and social care is usually taught as a general skill. For autistic people it has to be specific. The plan should tell staff: how many words to use, whether to use the person's name first, how long to wait for a response, whether to repeat or rephrase, whether questions or statements work better, what tone and volume, whether to stand or sit, how close, and what not to say. It should say how the person says yes and no, how they say they are in pain, how they ask for a break, and how they say they have had enough.
It should also tell staff what to do with their own body: no sudden movements, no touching without warning, no standing over the person, no crowding at a door. Two workers arriving together to ask something is a common trigger and a common mistake. And it should say how the person likes to be greeted and left, because both are transitions.
Positive behaviour support: when the plan needs one
Where a person's behaviour puts them or others at risk, the care plan needs a positive behaviour support plan alongside it. A PBS plan is built from a functional assessment: what the behaviour achieves for the person, in what settings and after what triggers. It sets out setting events, triggers, early signs, primary strategies that make the behaviour unnecessary, secondary strategies for when early signs appear, and a reactive plan for when it happens, including any agreed physical intervention and who is trained to use it.
The sensory profile, routines and communication passport are the primary strategies for most autistic people. Most PBS plans that work in autism services are mostly about the environment and the approach, with the reactive part short. Data drives the review: ABC charts recorded in the moment and looked at monthly for patterns of time, place, people and antecedent. Our positive behaviour support plan example and guide to ABC charts show the format. In the care record, the PBS plan should sit next to the sensory profile, not in a separate folder, because they are two views of the same person.
Environment and the plan
The plan should say what the person's room and the shared spaces need to be like. Lighting: dimmable, no fluorescent, blackout blinds. Sound: a quiet room available, no radio in the kitchen at breakfast, soft-close doors. Smell: unscented cleaning products, laundry not done during the evening. Touch: particular bedding, clothing labels removed, a weighted blanket if the person uses one. Space: a route out of the lounge that does not pass the television, a chair that is theirs. Personal items: what must never be moved.
Some of these are for the person's room and some are for the whole home, which means the plan has consequences for other people. Record how the home has balanced them, because an inspector will ask why the radio is off at breakfast and the answer should be in a care plan, not a house rule. Where a home cannot meet a person's environmental needs, that is a placement question and should be recorded honestly.
Health, pain and interoception
Many autistic people do not recognise or report pain, hunger, thirst, fatigue or the need for the toilet in the way staff expect, and physical health problems are missed for that reason. The plan should record what pain looks like for this person, what illness looks like, what a change in behaviour has meant in the past, and what to check first. It should record how the person tolerates examinations and appointments and what adjustments the GP, dentist and hospital need to make. Annual health checks, medication reviews and any reasonable adjustments agreed with the GP should be in the plan with dates. When a person's behaviour changes with no obvious cause, the first question is always physical health, and the plan should say so.
Consent, capacity and restrictions
An autism-friendly plan records how the person makes decisions and how they are supported to do so: the format information needs to be in, the time they need, the people they trust to help. Where capacity for a specific decision is in doubt, record the assessment, the reasons and the outcome, and any best interests decision with who was consulted. Any restriction, from a locked cupboard to a two-to-one plan, needs a recorded reason for this person, the less restrictive options considered, and a review date. Blanket rules are the thing CQC challenges most often in learning disability and autism services, and the answer is always an individual record. Our care records keep capacity decisions and restrictions against the person with review prompts, which makes the audit trail visible rather than reconstructed.
Bringing it together: the one-page profile
A plan with all of the above runs to many pages. Nobody reads many pages before a shift. So the front page is a one-page profile: what people like and admire about me, what is important to me, and how best to support me, in that order, with a photograph the person chose. The ten most important instructions from the sensory profile, routines and passport go on that page. Everything else is behind it. The one-page profile is what agency staff read at 7.30am, what the hospital gets, and what the person holds. If the ten instructions on it are right, most shifts go well. Print it, laminate it if the person likes that, and put a copy where the person wants it, not only in the office.
Daily notes that support the plan
The plan only stays alive if the notes talk to it. A note that says 'good day, no issues' tells the review nothing. A note that says 'kept the morning routine; went to the garden at 11 when the cleaner started the hoover; used the headphones; ate lunch at the table by the window; upset at 3 when the taxi was late, calmed with the timer' tells the review that the sensory profile worked and that the change plan for late taxis needs work.
Prompt for it. If the sensory profile says sound is the main issue, the daily log should ask about sound and what helped. If the routine has six steps, the note should say whether they happened. If there is a PBS plan, the ABC chart should be a tap away from the note. Three-tap logging that is quick enough to do in the moment is what makes this happen in practice; a note written at 9pm from memory will not record that the hoover started at 11.
Agency and new staff: making the plan usable in ten minutes
The plan is tested every time a stranger works a shift. Make sure the one-page profile, the sensory profile and the communication passport are the first three things any new or agency worker sees, on their device, before they meet the person. Pair them with someone who knows the person for the first hours. Tell them the three things most likely to go wrong and what to do. And record that they read the plan, because an inspector will ask an agency worker how they know what this person needs, and 'I read the profile and the passport at 7.30' is the answer you want. Keep induction and training against each worker in the training matrix, including autism training such as the Oliver McGowan mandatory training and any PBS or physical intervention training the person's plan requires.
Reviewing the plan
Review is where most plans die: a signature a month, nothing changed. Use this procedure instead.
- Read the last month of daily notes and ABC charts against the plan. List every point where the plan was followed and worked, followed and did not work, or not followed.
- Ask the person, in their format, what has been good and what has been hard. Record their words.
- Ask the staff who know them best the same two questions.
- Check physical health first for any change in behaviour or mood.
- Update the sensory profile, routines and passport with anything learned. Date each change.
- Update the easy-read version so it matches.
- Update the one-page profile if any of the ten instructions changed.
- Record who took part, what changed and why, and set the next date.
- Tell every shift what changed, at handover and in the record, not in an email.
Six-monthly is the usual full review; monthly for the PBS plan and the routines while they are settling; immediately after any significant incident, change in health or change in living situation. Keep every version of the plan, because the trail of dated changes is itself evidence that the home learns.
Checklist for an autism-friendly care plan
- Written with the person and the people who know them, in the first person where agreed.
- One-page profile at the front with the ten most important instructions and a photograph the person chose.
- Sensory profile covering all eight senses, each row ending with an instruction.
- Routines recorded in enough detail for a stranger, with a change plan and a transitions plan.
- Communication passport that a stranger can use to say good morning.
- Environment plan for the room and the shared spaces, with the balance against other people recorded.
- PBS plan where needed, next to the sensory profile, with ABC data reviewed monthly.
- Health section covering what pain and illness look like for this person and the adjustments agreed.
- Capacity decisions and any restrictions recorded individually with reasons and review dates.
- Easy-read version in step with the main plan and held by the person.
- Daily notes prompted by the plan and read at review.
- Review dates set and kept, with changes dated and passed to every shift.
Common mistakes
- A sensory profile that describes the person and never tells staff what to do.
- Routines recorded as approximate times rather than sequences, with no plan for change.
- A communication passport written in the third person by staff, never shown to the person.
- The PBS plan in a separate folder from the care plan.
- Blanket house rules where the plan should record an individual reason.
- Daily notes that say 'no issues' and give the review nothing.
- Agency staff meeting the person before reading the profile.
- Behaviour change treated as behaviour when it is pain.
What good looks like on inspection day
The inspector, applying Right support, right care, right culture, picks an autistic person and reads the plan. The one-page profile has a photograph the person chose and ten instructions. The sensory profile covers eight senses and every row ends with what to do. The routines are sequences, with a change plan that was used last week when the day service closed, and the note records how it went. The communication passport is in the first person and the agency worker on shift can explain how the person says no because she read it at 7.30 this morning on her phone. The PBS plan sits next to the sensory profile and the ABC data for last month shows fewer incidents after the kitchen radio was moved, a change the manager can date. The easy-read plan is in the person's room and they show it to the inspector. The last review has the person's words in it and three dated changes. Nothing about the person is in a house rule; everything is in their plan. That is what a system such as Kiwi, with easy-read plans, ABC charts and PBS plans in the same record as the daily log, is built to hold. If you want to see how the sensory profile and the passport look on a worker's phone, book a demo.
Final conclusion
An autism-friendly care plan is a person-centred care plan written from the inside out: how the person's senses work, what predictability means to them, and how they communicate, each turned into instructions a stranger can follow. Put a one-page profile at the front, keep an easy-read version in step, add a PBS plan where one is needed and put it next to the sensory profile, prompt the daily notes from the plan, and review with the person's words in the record. Do that and the plan stops being a document about the person and becomes the reason each shift goes well.
Frequently asked
What should a sensory profile in a care plan include?
Each sense in turn, including movement, body awareness and internal sensations such as pain and hunger: what the person seeks, what they avoid, what overload looks like, and what staff should do. Every row should end with an instruction so the profile changes practice rather than just describing the person.
What is a communication passport?
A short first-person document, usually two pages, that explains how the person communicates and understands, what their behaviour means, what helps and what makes things worse. It goes everywhere the person goes, including hospital, respite and day services, and it is the first thing a new or agency worker reads.
How often should an autism-friendly care plan be reviewed?
A full review every six months, the PBS plan and routines monthly while they are settling, and immediately after any significant incident, change in health or change in living situation. A review means reading the notes against the plan, asking the person and changing what needs changing, not a signature.
What is the difference between a care plan and a positive behaviour support plan?
The care plan covers the whole of the person’s support: sensory needs, routines, communication, health, environment and capacity. A PBS plan is a specific plan, built from a functional assessment, for behaviour that puts the person or others at risk. In autism services the sensory profile, routines and passport are usually the main primary strategies in the PBS plan, so the two should sit together.
What should be included in a person-centred care plan for an autistic adult?
A one-page profile, a sensory profile, routines with a change plan, a communication passport, an environment plan, physical health including how pain and illness show, capacity decisions and any restrictions with reasons, a PBS plan where needed, an easy-read version, and daily notes prompted by the plan.
How do you write a care plan that agency staff can use?
Put the one-page profile, the sensory profile and the communication passport first, on their device, before they meet the person. Keep the ten most important instructions on the front page. Pair them with someone who knows the person for the first hours, and record that they read the plan.
How does CQC assess care for autistic people in care homes?
Through the single assessment framework alongside the Right support, right care, right culture guidance, which asks whether support is built around the person, whether care is specific and compassionate, and whether the culture enables rather than manages. Inspectors look for individual plans rather than house rules, restrictions that are justified and reviewed, and evidence that people’s lives are getting better.
Sources
- National Autistic Society: guidance for care settings
- NICE: CG142 autism spectrum disorder in adults, diagnosis and management
- CQC: Right support, right care, right culture
- Skills for Care and Health Education England: Core Capabilities Framework for Supporting Autistic People
- Oliver McGowan Mandatory Training on Learning Disability and Autism
- Restraint Reduction Network: Training Standards
- Mental Capacity Act 2005 Code of Practice
- GOV.UK: national strategy for autistic children, young people and adults
