Medicines management in care homes: what CQC expects to see

The standard you are being measured against

Regulation 12(2)(g) requires the proper and safe management of medicines. NICE guideline SC1 and the NICE quality standard on medicines management in care homes describe how that is achieved: clear policy, competent staff, accurate records, and systems that pick up errors before they repeat.

Assessors will follow individual people rather than audit your folder. Expect them to pick two or three residents and trace every medicine they take through the records.

Ordering, receipt and storage

• A named person responsible for ordering, with a check that what arrived matches what was ordered and prescribed.
• Records of medicines received, carried forward and returned, so a stock count can be reconciled at any time.
• Storage secure and within temperature range, with daily fridge minimum and maximum readings and room temperature monitoring, plus a recorded action when a reading is out of range.
• Controlled drugs stored and recorded in line with the Misuse of Drugs Regulations 2001, with a bound register and balance checks.
• Separate, safe handling of medicines awaiting return to the pharmacy, with disposal recorded.

Administration and records

• MAR charts with no unexplained gaps — every omission coded and explained, including refusals and hospital admissions.
• Photograph, allergies and known sensitivities on the chart, kept current.
• Time-critical medicines identified — for example Parkinson's medicines — with administration times respected and evidenced.
• Topical creams and patches recorded on body maps, with application sites rotated where required.
• Thickeners, oxygen, insulin and warfarin handled under specific written instructions, not general practice.
• Covert administration and crushing or dispersing only with documented capacity assessment, best interests decision and pharmacist or prescriber advice.
• Self-administration supported where the person wishes, with a risk assessment, secure storage and review.

PRN, homely remedies and antipsychotics

• A written protocol for every PRN medicine, with the reason and the outcome recorded on each administration.
• A homely remedies list agreed with the GP or pharmacist, with limits on duration and clear escalation.
• Antipsychotics and other psychotropics reviewed with the prescriber, with rationale, non-medicine approaches tried first and STOMP principles evidenced for people with a learning disability or autistic people.
• Regular medicines reviews with the GP or practice pharmacist, recorded with any changes actioned on the MAR the same day.

Errors, near misses and learning

A service with no recorded medicines errors is not a safe service; it is an under-reporting one. What assessors look for is what you did with the errors you found.

• An open error and near-miss log, with immediate clinical advice sought and recorded.
• Harm assessed, with duty of candour applied where the incident meets the notifiable safety incident threshold, and a CQC notification where it meets that threshold.
• Competency reassessment and supervision for the staff member involved, handled as learning rather than discipline unless conduct requires otherwise.
• Monthly analysis by type, time of day, medicine and staff member, with the change you made and whether it worked.

A medicines audit that survives inspection

• Weekly stock and MAR spot check on a sample of residents, initialled and dated.
• Monthly full audit covering storage, temperatures, controlled drugs, PRN protocols, topical records and disposal.
• Quarterly review of trends and of staff competency status.
• An action log where each finding has an owner, a date and evidence of completion.
• Governance minutes showing medicines are discussed as a theme, with escalation to the provider where the trend is not improving.

Common questions

Official sources

• NICE SC1 — Managing medicines in care homes
• Regulation 12: Safe care and treatment — CQC guidance
• NICE QS85 — Medicines management in care homes
• Misuse of Drugs Regulations 2001

More guides

• Care home regulations in England
• Duty of candour in adult social care
• Care home compliance
• CQC inspection questions