Medication Management & Administration Policy and Procedure

1. Governance

1.1. This is the Medication Management & Administration Policy and Procedure for The Good Place Home Care Services Limited.

1.2. The Good Place Home Care Services Limited will be referred to in this document as "The Good Place Home Care Services Limited","The Good Place","We","Us", or "Our".

1.3. Our registered address is: 186 Wetmore Road, Burton-on-Trent, Staffordshire, DE14 1QZ.

1.4. We can be contacted by:-

• a. Telephone: 01283 296 337
• b. Email: [protected:ahello][protected:athegoodplace.care]
• c. Post: The Good Place, 186 Wetmore Road, Burton-on-Trent, Staffordshire, DE14 1QZ

1.5. Words importing one gender include all genders, and words in the singular include the plural and vice versa, unless the context requires otherwise.

1.6. Document control sheet:-

2. Purpose

2.1. To ensure that the people we support receive their medications safely and correctly, and that staff have clear procedures to follow.

2.2. To prevent medication errors, misuse, or harm.

2.3. To ensure medication safety for the people we support at all times, maintaining their health and well-being.

2.4. To comply with all legal requirements and CQC expectations for managing medicines in domiciliary care.

2.5. To support service users' independence and preferences regarding medication (for example, enabling self-administration where possible) while providing the necessary help when they cannot manage alone.

2.6. To provide staff with guidance and training so they feel competent and confident in managing and administering medications.

2.7. To support us to meet, and be able to evidence compliance with, the following CQC Single Assessment Framework quality statements:-

3. Scope

3.1. This policy applies to all staff members of The Good Place who are involved in any aspect of medication handling or support. It covers care & support workers providing direct support in service users’ homes, supervisory staff overseeing medication practices, and any other employees who coordinate, administer, or record medications as part of a service users’s care plan. Everyone from care & support workers to the registered manager must understand and follow this policy to ensure consistency and safety in medication management.

4. Policy Statement

4.1. The Good Place is committed to the safe management and administration of medications for all service users we support. We recognise that proper medication handling is critical to our service users’ health, safety, and well-being. This policy outlines our commitment to high standards of medication safety, and it provides staff with clear guidelines to prevent errors and ensure service users receive the right medication at the right time in the right way.

4.2. This policy is grounded in the legal and regulatory framework for social care in England. We adhere to the Care Act 2014, which emphasises meeting service users’ care needs (including support with medication) and safeguarding their well-being.

4.3. We also comply with relevant Care Quality Commission (CQC) regulations and Fundamental Standards, including Regulation 9 (person-centred care), Regulation 10 (dignity and respect), Regulation 11 (need for consent), Regulation 12 (safe care and treatment), Regulation 13 (safeguarding service users from abuse and improper treatment), Regulation 17 (good governance), Regulation 18 (staffing) and Regulation 20 (duty of candour), all of which apply to the safe handling of medicines and robust record-keeping.

4.4. In addition, our practices follow NICE guidance (such as NICE guideline NG67 on managing medicines for adults receiving social care in the community) to ensure we implement nationally recognised best practices.

4.5. By following these laws, regulations, and guidelines, The Good Place aims to promote the health, dignity, and rights of the people we support in all aspects of medication support.

4.6. This policy sets out the practical systems The Good Place uses to deliver medicines support safely in people’s homes and to prevent avoidable harm. In line with Regulation 12: Safe care and treatment, we will assess risks, prevent and control risks, and ensure staff are competent and supported to deliver safe medicines support. We do this by:

• a. Assessing and managing medicines risks for each service user (including allergies, swallowing difficulties, cognition, capacity, high-risk medicines and time-critical medicines) and recording controls in the care plan and MAR.
• b. Ensuring consent/capacity decisions are lawful and recorded (Mental Capacity Act 2005; best-interests decisions where required).
• c. Using the agreed level of support (self-administration, prompting, supervised self-administration, administration) so that medicines support is proportionate and service person-centred.
• d. Following safe administration procedures (the ‘rights’ of administration, correct documentation, and escalation where there are discrepancies).
• e. Maintaining safe storage and handling in the service user’s home through a documented home storage agreement and risk assessment.
• f. Preventing, responding to and learning from errors/ near misses through immediate escalation, Duty of Candour where applicable, incident reporting, and root cause review.
• g. Governance and continuous improvement, including MAR audits, spot checks, competency sign-off, action plans and monitoring trends.

4.7. In line with Regulation 13: Safeguarding service users from abuse and improper treatment, we treat medicines misuse as a safeguarding risk. This includes deliberate withholding, coercion, over-sedation, inappropriate PRN use, falsifying MAR records, theft, or using medicines as punishment or control. Any suspicion of medicines-related abuse or neglect is escalated immediately under our safeguarding procedures and reported externally where required.

4.8. We do not permit any use of medicines as a form of control or punishment. Any restrictive use of medicines (for example, psychotropic medicines used to manage behaviour) must be exceptional, lawful, the least restrictive option, clearly documented and regularly reviewed. Any misuse of medicines is treated as a Regulation 13 safeguarding concern and escalated under our Safeguarding Adults Policy and Procedure and local authority safeguarding arrangements.

We do not permit any use of medicines as a form of control or punishment. Any restrictive use is exceptional, lawful, proportionate and recorded; misuse is treated as a Regulation 13 safeguarding concern and escalated under our Safeguarding Adults Policy and Procedure.

5. Assessing medication needs and planning safe medicines support

5.1. Before providing any medicines support, The Good Place completes an assessment to determine the person’s medicines needs and the safest, least restrictive level of support, in line with Regulation 9 (person-centred care). This assessment is completed by the Registered Manager (or a delegated competent senior staff member) and is reviewed at care plan reviews and whenever needs change.

5.2. The assessment will include:-

• a. A current medicines list (name, strength, dose, route, timing) and confirmation of the supplying pharmacy/ GP;
• b. The service user’s consent and any communication needs (Accessible Information Standard);
• c. Mental capacity for medicines decisions (decision-specific) and whether advocacy/ IMCA is required;
• d. Risks such as high-risk/ time-critical medicines (e.g., anticoagulants, epilepsy medicines, Parkinson’s medicines), swallowing difficulties, allergies, side effects, cognition/memory, and risks of misuse;
• e. Agreement on the level of medicines support (self-admin, prompting, supervised self-admin, administration) and any boundaries;
• f. How consent to medicines support will be obtained and recorded, or where the person lacks capacity, how best-interests decisions and any agreed covert medicines plans will be documented and reviewed;
• g. Home environment risks (safe storage location, access by children/ visitors, fridge storage where required, sharps arrangements); and
• h. How we will escalate concerns, including who to contact for medicines queries and urgent clinical advice.

5.3. Outcomes are documented in the care plan and reflected on the MAR. Where information is unclear or incomplete (for example, label/ MAR discrepancies), staff will not proceed until clarified with the prescriber/ pharmacy/ manager.

6. Types of Medication Support Provided

6.1. The Good Place delivers a range of medication support services tailored to each service user’s needs, as identified in their care plan. The types of medication support we provide are detailed below.

6.2. Prompting/ Reminding

6.2.1. Care staff remind the service user to take their medication at the appropriate times. This involves verbally prompting or gently reminding the service user to take their medicine. The service user retains responsibility for self-administering the dose; the staff’s role is only to remind and ensure the service user hasn’t forgotten. (Example: saying, “It’s time to take your blood pressure tablets now,” to a service user who then takes the medication themselves.)

6.3. Administering Medication

6.3.1. Trained care staff take full responsibility for administering medication directly to the service user. This means the staff prepares the dose (e.g. taking pills out of a blister pack or measuring a liquid) and gives it to the service user by the correct route (such as orally, via a feeding tube, etc.), in accordance with the prescription. The staff member then documents the dose on the MAR chart (Medication Administration Record).

6.3.2. Administering medication requires the care & support worker to follow the exact instructions on the pharmacy label or prescription and adhere to the “7 rights” (right service user, right medication, right dose, right time, right route, right to refuse, and right documentation) to ensure accuracy and safety.

6.4. Assisting with Controlled Drugs

6.4.1. In cases where a service user is prescribed a controlled drug (medications subject to special legal control, e.g. certain strong painkillers or sedatives), our staff can assist or administer these only if they have been trained and authorised to do so. Additional precautions are taken with controlled drugs: they should be kept in secure storage (as agreed in the care plan, possibly a locked box in the service user’s home) and handled with extra care.

6.4.2. Whenever possible, doses of controlled drugs will be double-checked for accuracy. For example, if two staff are present (or a family member is available to witness), both should verify the medication and dose before administration to reduce the risk of error.

6.4.3. All controlled drug administrations are meticulously recorded on the MAR chart and, if required, in a dedicated controlled drugs log, including running stock counts. Staff follow relevant laws (Misuse of Drugs Act and regulations) and company procedures to ensure controlled medications are not misused or mishandled.

6.5. Anticoagulants

6.5.1. Anticoagulants, such as warfarin, apixaban, rivaroxaban, and others, are high-risk medications that require precise handling due to their potential to cause serious harm if mismanaged.

6.5.2. The Good Place recognises the critical importance of accurate administration, monitoring, and documentation of anticoagulant therapy. All staff involved in supporting service users prescribed anticoagulants will receive specific training to understand the medication’s effects, signs of bleeding, and interactions with other drugs and foods.

6.5.3. MAR charts must clearly indicate dosage and timing, and any dose adjustments provided by healthcare professionals (e.g., after INR testing) must be confirmed in writing and recorded immediately. Staff must never guess or alter doses and must escalate any concerns—such as signs of bruising, nosebleeds, or unusual fatigue—to a manager or healthcare professional without delay. Close liaison with prescribers and pharmacists is maintained to ensure safe management and ongoing review of anticoagulant use.

6.6. Time-Sensitive Medications

6.6.1. Some medications must be administered at specific times to maintain therapeutic effectiveness or to avoid harm—these include medications for Parkinson’s disease, epilepsy, diabetes (e.g., oral hypoglycemics), and pain relief regimens.

6.6.2. At The Good Place, we identify all time-sensitive medications during the initial assessment and care planning process. These medications are clearly marked on the MAR chart and highlighted in the service user’s care plan.

6.6.3. Staff are trained to prioritise punctual administration and understand the clinical importance of timing.

6.6.4. Missed or delayed doses of time-sensitive medication must be reported to a manager immediately and recorded as a medication error, triggering an internal review.

6.6.5. If a visit is running late due to unforeseen circumstances, staff must contact the office for guidance before administering the medication outside the scheduled window.

6.6.6. Our scheduling system aims to ensure that visits align with critical medication timings, and this is monitored through regular audits.

6.7. Flammable Medication Storage

6.7.1. Some medications used in domiciliary care (such as alcohol-based topical preparations, aerosol sprays, or inhalants) contain flammable substances that pose fire and safety risks if not stored appropriately.

6.7.2. The Good Place ensures that all flammable medications are identified during the care planning and risk assessment process. These items must be stored away from heat sources, direct sunlight, and electrical appliances, and should never be kept near cooking areas or radiators.

6.7.3. Where practical, flammable medications should be kept in a designated, well-ventilated, and cool location as agreed with the service user we support and their family or representative.

6.7.4. Staff are trained to recognise flammable products and to follow manufacturer instructions regarding storage and handling.

6.7.5. Additionally, care & support workers must not smoke or use open flames near these medications and should report any safety concerns immediately. Any significant fire risk identified will be documented in the person’s risk assessment and escalated in line with our Health and Safety Policy and Procedure and fire safety procedures.

6.7.6. If there is any uncertainty about how a product should be stored, staff must seek guidance from a manager or pharmacist before proceeding.

6.8. PRN ("As Needed") Medication

6.8.1. PRN medications are those taken only when required, rather than on a fixed schedule.

6.8.2. Our staff will administer PRN medication when the service user needs it, based on the prescriber’s instructions and the care plan.

6.8.3. Clear criteria should be documented for when to give a PRN medicine (for example, a painkiller for reported pain, or a laxative if no bowel movement for a certain number of days).

6.8.4. Before giving a PRN medicine, staff must confirm that it is needed at that time – for instance, by asking the service user if they are in pain or by observing symptoms – and check the timing of the last dose to ensure it’s safe to give another (respecting the minimum interval between doses and the maximum doses per day).

6.8.5. PRN doses are recorded on the MAR chart with the exact time given, and the reason for giving the medication is noted (e.g. "given for headache").

6.8.6. Staff also later monitor the effect, and if the PRN medication is not effective or if the service user’s need for it is increasing, they will report this to a supervisor or the service user’s GP for review.

6.9. Applying Creams, Ointments, or Patches

6.9.1. care & support workers apply topical medications (such as creams, ointments, or transdermal patches) as prescribed. This might include applying a prescribed cream to a skin area or placing a patch (like a pain-relief or nicotine patch) on the body.

6.9.2. Staff will ensure they understand the instructions – for example, "apply to clean, dry skin on the upper arm daily" or "apply cream to rash on legs twice a day".

6.9.3. They will use gloves and appropriate infection control practices when applying creams to protect both the service user and themselves.

6.9.4. After application, the staff member documents it on the MAR chart or a topical medication administration record, including what was applied and where (if relevant), especially for patches which may need rotation of application sites.

6.9.5. Used patches or any residual cream on gloves will be disposed of safely.

6.10. Administering via PEG (Percutaneous Endoscopic Gastrostomy) Tube

6.10.1. For service users who receive medication through a PEG tube (a tube directly into the stomach), trained staff can administer medications using this route. This is a specialised task – only staff who have received specific training in PEG feeding/ medication administration will perform it.

6.10.2. The procedure involves preparing the medication in the appropriate form (liquid or finely dissolved tablets, as per pharmacy instructions), flushing the PEG tube with water before and after giving the medicine to ensure it is clear, and positioning the service user properly (usually upright) to prevent complications.

6.10.3. Staff must follow infection control procedures (e.g. hand hygiene, wearing gloves) and ensure the PEG tube is handled gently and correctly.

6.10.4. After administering, they will confirm the medication has been given and record it on the MAR chart.

6.10.5. Any issues with the PEG (such as blockages or site inflammation) are reported immediately.

6.10.6. We do not administer enteral feeds or medication via PEG unless specifically trained and the task is in the care plan, and we always coordinate with healthcare professionals for guidance on PEG care.

6.11. Specialist Tasks Not Provided

6.11.1. Certain medical tasks fall outside the scope of routine duties for The Good Place care staff. Insulin administration (insulin injections) for diabetic service users will only be undertaken as a Level 3 specialist task where there is explicit commissioning, a written delegation and training plan from the community nursing team, and documented competency assessment for named staff. In the absence of such arrangements, insulin injections will be carried out by district nurses or other qualified healthcare professionals.

6.11.2. Likewise, any injections (such as intra-muscular or sub-cutaneous injections), controlled oxygen therapy initiated or adjusted on clinical judgement, or invasive procedures are not undertaken by our care & support workers unless a specific Level 3 agreement, written delegation and training are in place.

6.11.3. If a service user requires such interventions, arrangements will be made with community nursing services.

6.11.4. Our staff’s role may be to observe and report concerns in these cases, but not to perform the injection or specialised task itself.

6.11.5. This limitation is in place to protect service users and staff, ensuring that only competent healthcare professionals handle certain high-risk medications.

7. Levels of Medicines Assistance – Definitions and Procedures

7.1. This section explains exactly what support The Good Place provides at each level, when the level is appropriate, what staff must do, and what sits outside our remit. The agreed level is always recorded in the care plan and on the MAR (Medication Administration Record), with any limits or special instructions. Levels are chosen to maximise the person’s independence and choice while keeping them safe, in line with NICE NG67 and CQC Single Assessment Framework expectations.

7.2. Level 0 - Self-Administration (Independent)

7.2.1. Most people prefer to remain in control of their medicines. Where a service user can store, select, and take their own medicines safely, staff do not handle medicines.

7.2.2. Staff may still:-

• a. Check the environment is safe (lighting, water available),
• b. Observe from a respectful distance if requested,
• c. Record “Self-administered” on the MAR if the commissioner requires an audit trail.

7.2.3. This level is to be used when a service user has capacity (or best-interests decision supports independence), can identify their medicines, understands timing/ dose, and risks are low.

7.2.4. Staff must not set up pill organisers, decant/ blister-pack medicines, or alter dosage forms. Where a monitored dosage system (MDS) or compliance aid is required, this should be requested from the supplying pharmacy or prescriber and not assembled by care staff.

7.3. Level 1 - Prompts and Reminders (Verbal/ Environmental Support)

7.3.1. Staff give timely prompts (in service user or agreed tele-prompt), read labels aloud, and provide simple practical help without selecting the medicine or presenting it to the service user. Staff may open outer packaging or a difficult bottle if the service user then takes the dose themselves.

7.3.2. This level is to be used when a service user knows what to take but benefits from cueing due to memory, vision, language, or dexterity barriers.

7.3.3. Documentation to be made on MAR as “Prompted/ Reminded”; note any refusal or delay.

7.3.4. Staff must not pour liquids, place tablets into a pot for the service user, or decide which medicine is due.

7.4. Level 1+ - Supervised Self-Administration

7.4.1. The service user selects and takes their medicine; staff witness to confirm the correct medicine and dose were taken at the correct time. This is used where proof of adherence is required or risks are slightly higher.

7.4.2. This level is to be used with new high-risk medicine (e.g., anticoagulant), early post-discharge, or safeguarding concerns about adherence.

7.4.3. Documentation: MAR signed as “Supervised self-admin”; record variances.

7.5. Level 2 - Administration by Trained Staff

7.5.1. Staff select the correct medicine for the correct service user, prepare it, and administer it (e.g., present tablets in a pot, administer liquids via oral syringe, give eye/ ear/ nasal drops, apply topical creams, fit transdermal patches, support inhaler technique, or give oxygen as prescribed). Staff confirm the dose has been taken/ absorbed and record it immediately.

7.5.2. This level is to be use with documented consent (or best-interests decision), risk assessment, and a current MAR produced by the supplying pharmacy/ GP. Staff must be trained, observed as competent, and listed on the medicines competency matrix.
 

7.5.3. Time-critical medicines (e.g., Parkinson’s, anticonvulsants, insulin if in scope):-

• a. Visits are scheduled to meet the clinically safe window noted on the MAR/ care plan.
• b. Insulin administration where explicitly commissioned and delegated in writing by the community nursing team

7.5.4. Transdermal patches:-

• a. Use a body map, rotate sites, date/ time on patch backing if manufacturer permits, and document removal/ application.

7.5.5. Topicals/ creams:-

• a. Use a body map and apply only to specified sites.

7.5.6. Inhalers/ nebulisers:-

• a. Check device technique, spacer use, and cleaning per manufacturer instructions.

7.5.7. Oxygen (if prescribed in care plan):-

• a. Follow the prescribed flow-rate, fire-safety rules, and supplier guidance, and do not adjust flow-rates unless this has been specifically delegated in writing by a healthcare professional.

7.5.8. Not permitted at Level 2:-

• a. Crushing tablets or opening capsules, altering dosage forms, or any covert administration unless authorised (see Level 3).

7.6. Level 2C - Controlled Drugs (CDs) in the service user’s Home

7.6.1. Where a CD is administered by staff, a second check is undertaken whenever possible (two staff), or a single-worker double-check using a defined checklist and photo-MAR where lone working is unavoidable. Running balances are reconciled on the MAR each visit if required by the commissioner/ care plan.

7.6.2. CDs must remain in the service user’s home; staff should encourage safe storage but do not remove service useral medicines.

7.7. Level 2PRN - "When Required" Medicines

7.7.1. PRN medicines are used only in line with a written PRN protocol, developed with and/ or authorised by the prescriber or pharmacist, that states the indication, maximum dose/ 24h, minimum interval, non-drug alternatives, when to escalate to 111/ 999/ GP, and what to record, including how to record and monitor the effect of the medicine.

7.8. Level 3 - Specialist/ Complex Tasks (Only If Specifically Commissioned)

7.8.1. Certain tasks are outside routine practice and are undertaken only where the care plan explicitly commissions them and staff have role-specific training, assessment, and ongoing competency sign-off. Examples may include:-

• a. PEG/ enteral administration of medicines (with pharmacy compatibility guidance and flush protocols)
• b. Dose adjustment under a written delegation from the community nursing team
• c. Buccal midazolam for seizures under an emergency plan.

7.8.2. If we do not offer a specific task, the care plan must name the responsible clinician/ service (e.g., community nursing).

7.9. Covert Administration (Exception Process)

7.9.1. Medicines must not be hidden in food/ drink without a service users' knowledge unless a lawful covert pathway is followed:-

• a. Capacity assessment for the decision;
• b. Best-interests meeting with a pharmacist/ GP;
• c. Product-specific advice on crushing/ sprinkling;
• d. Clear documentation on the MAR/ care plan; 
• e. Frequent review to seek less-restrictive alternatives.

7.9.2. See Covert Medication, Capacity, and Consent for the full covert medication procedure below.

7.10. Changes in Level/ Escalation

7.10.1. If staff believe the current level is no longer safe or proportionate (missed doses, repeated refusals, swallowing difficulties, delirium, safeguarding concerns), they pause non-urgent administration, keep the service user safe, record the issue, and notify the co-ordinator/ Registered Manager. The care plan, risk assessment, and visit schedule are reviewed the same day, and prescriber/ pharmacy are contacted where needed.

7.11. Refusals, Omissions, and Errors

7.11.1. Refusal: respect the decision, explore reasons, re-offer once if appropriate, record precisely (“refused – stated nauseous”), and inform as per care plan.

7.11.2. Omission: document reason (e.g., “medicine unavailable”), arrange urgent supply if needed, and escalate for time-critical medicines.

7.11.3. Error/ near miss: treat as an incident; inform the service user/representative, prescriber/pharmacy if clinically indicated, and follow the incident and duty-of-candour procedure.

7.12. Training, Competency, and Supervision

7.12.1. Only staff who have completed medicines training (including time-critical, CDs, PRN protocols, body-maps, and error reporting), been observed in practice, and are recorded as competent may work at Level 2/ 2C/ 2PRN/ 3. Competency is re-assessed at least annually, or sooner after an incident, with spot checks and MAR audits by the senior team.

7.13. Reasonable Adjustments and Communication

7.13.1. The Good Place is fully committed to meeting the requirements of the Accessible Information Standard (AIS), as set out by NHS England. This means we will ensure that people with a disability, impairment, or sensory loss receive information and communication support that they can understand and use effectively. Adjustments may include large-print/ easy-read MARs, pictograms, translation/ interpreter support, and longer visits for safe administration. See our Accessible Information Standard (AIS) Policy and Procedure for further details.

7.14. Tasks We Do Not Undertake (Unless Explicitly Commissioned and Competent)

7.14.1. Re-dispensing/ decanting medicines; transcribing directions; altering dosage forms without prescriber/ pharmacist approval; using another service user’s medicines; administering out-of-date or unlabelled medicines; making clinical dosing decisions; or any invasive/ specialist procedures not named in the care plan.

8. Staff Responsibilities and Training

8.1. Safe medication management is a key responsibility for our staff. The Good Place ensures that any staff member involved in medication tasks is properly trained, assessed as competent, and fully aware of their duties. The following are the expectations and requirements for staff regarding medication responsibilities and training. This supports compliance with Regulation 18 (staffing) and NICE NG67, which require that staff have the skills, knowledge and support to safely provide medicines support.

8.2. Training Before Administration

8.2.1. Only staff who have completed appropriate medication training and have been deemed competent are allowed to administer or assist with medications.

8.2.2. New care staff must undergo medication management training as part of their induction (or provide evidence of equivalent training) and be observed by a competent senior staff member when they first administer medication.

8.2.3. They must demonstrate understanding of correct procedures (including the 7 Rights of medication administration) before they can work unsupervised with medications.

8.3. Annual Refreshers and Competency Checks

8.3.1. All care staff must renew their medication training at least once a year and have their competency re-assessed regularly. The Good Place provides annual refresher training that updates staff on any changes in best practices, company policy, or guidelines.

8.3.2. In addition, a manager or qualified trainer will conduct periodic competency evaluations, which include direct observation of the staff administering medicines and a review of their knowledge (for example, checking they know how to read a MAR chart correctly, what to do if a dose is missed, etc.).

8.3.3. If a staff member’s competency has lapsed or if an error has occurred, they will not be allowed to administer medication until they receive re-training and are re-assessed as competent.

8.3.4. Keeping knowledge and skills up-to-date on an ongoing basis is essential for maintaining safety.

8.4. Following the Policy and Procedures

8.4.1. Staff members are expected to follow this Medication Management Policy and all related procedures precisely.

8.4.2. They must always adhere to the “Seven Rights” (Right service user, Right medication, Right dose, Right time, Right route, Right to refuse, Right Documentation). 

8.4.3. Before giving any medicine, the care & support worker should verify these details:-

• a. Confirm the service user’s identity,
• b. Double-check the medication name and strength against the MAR chart and prescription label,
• c. Measure the correct dose,
• d. Give it at the correct time, and
• e. Use the correct method (e.g., by mouth, via PEG, applied to skin, etc.),
• f. Respect the service users' right to refuse.

8.4.4. After administering, the care & support worker must immediately record it.

8.4.5. If at any point something doesn’t match (for example, the MAR chart doesn’t match the pharmacy label, or the service user says they already took the dose), the care & support worker must not proceed until the discrepancy is resolved.

8.4.6. Staff should also check expiry dates on medicines and never give a medication that looks compromised (such as tablets that are discoloured or a cream that has separated) – instead, they should consult a supervisor or pharmacist for advice.

8.5. Communication and Consent

8.5.1. Staff should obtain consent from the service user we support before administering medication whenever the service user is able to give it.

8.5.2. This might be as simple as asking "Shall we take your morning pills now?" and ensuring the service user is willing.

8.5.3. If a service user we support refuses a medication, the staff must respect that decision (provided the service user has capacity to make that choice) and follow procedures for refusal (e.g., try again a short while later, and if still refused, record the refusal and inform the supervisor/ office).

8.5.4. Under no circumstances should staff force or trick someone into taking medication. If a service user lacks capacity to consent and medication is given in their best interest (in line with the Mental Capacity Act), this will be detailed in their care plan and might involve covert administration only under proper authorisation and guidance.

8.5.5. In all cases, respectful communication and the service user’s dignity are paramount.

8.6. Accountability and Reporting

8.6.1. Staff have a duty to report any concerns or issues related to medication immediately. This includes reporting any errors, near-misses, or if they notice any changes in a service user's condition that might be related to medication (for example, side effects or if the service user appears to be over-medicated or not taking their meds off-schedule).

8.6.2. Staff should also inform their supervisor if they feel unsure about administering a certain medicine or if they haven’t been trained for a specific task (e.g., a new type of inhaler or eyedrops technique).

8.6.3. No staff member should perform a medication task they are uncomfortable with or untrained for – asking for guidance is always encouraged over risking a mistake.

8.6.4. Management will support staff in clarifying instructions (by liaising with pharmacists or doctors as needed) and will provide additional training or mentoring if a staff member needs more confidence with medications.

8.7. Ongoing Professional Development

8.7.1. Medication management is included in our ongoing staff development. Medicines practice, including any incidents or learning, is discussed in one-to-one supervision at least every 3 months or sooner if concerns are identified.

8.7.2. Team meetings and supervision sessions will regularly cover medication topics – such as discussing any incidents that occurred (in a blame-free, learning-focused manner), updates in policy, or sharing tips for safe practice.

8.7.3. Staff are encouraged to share feedback and suggestions for improvement. For instance, if a staff member finds a better way to document PRN reasons or a common challenge in the field, they should bring it up so the whole team can learn.

8.7.4. By fostering continuous learning, The Good Place ensures that our medication practices remain current and effective. We keep records of all training and competency assessments for each staff member as part of our compliance and quality assurance.

8.8. Delegated healthcare tasks

8.8.1. Where an NHS professional delegates a task related to medicines (for example, administering via PEG, inhaler spacer technique, or transdermal patch rotation), we will only accept delegation when:-

• a. Written task-specific instructions and risk assessment are in place;
• b. Named staff have been trained and assessed as competent by an appropriate clinician;
• c. Ongoing supervision/ reassessment is defined; and
• d. Escalation/ withholding criteria are documented in the care plan and MAR.

8.8.2. The Registered Manager retains oversight and may decline delegation if safe governance cannot be assured.

8.9. Medication concerns: who to contact (24/ 7)

8.9.1. Urgent clinical risk (e.g., overdose taken, chest pain, anaphylaxis, seizures, suspected sepsis): Call 999 immediately.

8.9.2. Time-critical doses missed (e.g., Parkinson’s/ anticonvulsants/ insulin if in scope) or serious side-effects: Contact the Registered Manager/ on-call on 01283 296 337 at once; we may also call the service user’s GP or NHS 111 for clinical advice.

8.9.3. Supply problems (no stock/ late delivery, label discrepancies): Inform the office/ Registered Manager on 01283 296 337; we will liaise with the GP/ pharmacy to prevent missed doses.

8.9.4. Safeguarding/ abuse concerns (e.g., deliberate withholding, over-medication): Escalate per Safeguarding Adults Policy and Procedure and inform the local authority; record and notify CQC where required.

8.9.5. All actions and advice received must be documented on the MAR and in daily notes (include names, times and instructions).

9. Medication Recording and Audits

9.1. Accurate documentation is a fundamental part of safe medication administration. Every interaction with a service user’s medication must be recorded properly. In addition, regular audits of these records are conducted to verify that our medication management is safe, effective, and compliant with standards. Below are our procedures for recording and auditing:

9.2. Use of MAR Charts

9.2.1. We use Medication Administration Record (MAR) charts for each service user who receives any level of medication support (prompting, assistance, or full administration). The MAR chart is the official log of all medications given.

9.2.2. Staff must complete an entry on the MAR chart every time they prompt or administer a medication. For electronic MAR (eMAR) systems, the date, time and staff details are automatically captured when the administration is recorded. For paper MAR charts, staff must write their initials and the exact time given in line with the MAR key.

9.2.3. If a medication was supposed to be given but was not (e.g., the service user refused, or the medication was temporarily not available), the staff should still document the occurrence by using the designated MAR codes on the MAR (and explaining in the appropriate section why it wasn’t taken).

9.2.4. It is vital that MAR charts have no blanks for scheduled doses – every scheduled dose must be accounted for with either a confirmation of administration or a reason why it was omitted.

9.2.5. For paper MAR charts, clear, legible handwriting is required, and entries should never be altered with correction fluid; if a mistake is made, it should be crossed through with a single line and initialled.

9.2.6. Remember: if it’s not documented, in the eyes of regulators it didn’t happen. Poor record-keeping can put both the service user and the care & worker at risk, leading to dosing errors or missed doses. Therefore, maintaining up-to-date and precise MAR records is a strict requirement.

9.2.7. Whether using paper MAR or eMAR, access is controlled, records are backed up and retained in line with our Record Keeping and Documentation Policy and Procedure, and staff are trained in the correct use of the system.

9.3. Additional Recording Tools

9.3.1. Besides MAR charts, staff may encounter other recording tools depending on the situation. For example, there might be a Controlled Drug register/ log kept in the service user’s home (if we are tracking quantities of controlled drugs), or a topical cream chart for recording applications of creams and patches separately.

9.3.2. Staff should ensure they understand and use all required documentation correctly. When in doubt, they should ask a supervisor.

9.3.3. All documents related to medication are considered part of the care record and must be treated with the same accuracy and confidentiality as other records.

9.3.4. We also record any advice or instructions given by healthcare professionals (like a GP or pharmacist) regarding medications in the daily communication notes or a medical visit form, and update the care plan/ MAR accordingly.

9.3.5. Keeping thorough records ensures continuity of care especially if multiple staff support the same service user – each staff can see what was done or given previously and when.

9.4. Monthly Medication Audits

9.4.1. The Good Place conducts monthly audits of medication administration records. Typically, at the end of each month (or at a set schedule), a designated senior staff member or manager will collect or review the MAR charts and related medication records for each service user.

9.4.2. During an audit, we check for completeness (no missing details, every dose accounted for), legibility, and correctness of entries.

9.4.3. We verify that any gaps or anomalies have appropriate explanations, and that PRN usage is recorded with reasons.

9.4.4. We also reconcile the number of doses administered with the remaining stock for certain medications when feasible – especially important for controlled drugs or for monitored dosage systems (like blister packs) to ensure no doses are unaccounted for.

9.4.5. These audits are documented, and any issues or errors identified are followed up immediately with the staff team. For instance, if an audit finds that a MAR chart has a missed administration code, we would investigate to find out if the dose was actually given and just not completed for (a documentation error) or if it was potentially missed (an administration error), and take appropriate action.

9.4.6. Regular auditing is part of our governance process to catch problems early and maintain high standards. It also helps us identify if additional training or support is needed for staff in certain areas of medication management. Audit findings contribute to the evidence we use to demonstrate compliance with the CQC Single Assessment Framework quality statements for Safe, Effective and Well-led.

9.5. Audit Feedback and Action

9.5.1. After each audit, the findings are shared with the care team and management. Positive findings (e.g., excellent documentation practices) are acknowledged, and any negative findings are addressed constructively.

9.5.2. If systemic issues are found (such as many staff forgetting to record the reason for PRN meds), we will update our training and reminders to all staff.

9.5.3. If service user issues are found, the manager will speak to the staff member concerned to provide guidance or additional training.

9.5.4. The audit process is also an opportunity to update our policies: for example, if audits reveal that the MAR chart format is confusing staff, we might redesign the form or provide clearer instructions.

9.6. Accountability

9.6.1. The Registered Manager (Dean Hill) is responsible for ensuring these audits happen and that action is taken on the results.

9.6.2. Audit records are kept as evidence of our ongoing quality monitoring, which can be provided to CQC inspectors or commissioners to demonstrate our compliance with medication management standards.

9.7. External Audits

9.7.1. In some cases, we may also engage with local pharmacists, consultancy companies or commissioners for additional audits or medication reviews.

9.7.2. Pharmacists might perform an annual medication review for service users (checking that all medications are still needed and being used correctly) or review our MAR charts and storage as part of a service improvement. We welcome such external input, as it provides an objective check and expert recommendations.

9.7.3. Any feedback from external audits or reviews is incorporated into our practice. We also ensure that the medication aspect of each service user’s care plan is reviewed regularly (at care plan reviews or if their health changes), to confirm that the level of support we provide is still appropriate (for example, someone initially needed administration but can now self-manage with prompting, or vice versa).

10. Storage and Disposal of Medication

10.1. Proper storage and disposal of medications are essential to prevent misuse, deterioration, or accidental ingestion. In domiciliary care, medications are kept in the service user’s home, so we work collaboratively with service users (and their families where appropriate) to manage this safely. This section details how staff should handle medication storage in service users’ homes and what to do with unused or expired medications, including specific guidance for controlled drugs.

10.2. Safe Storage in service users’ Homes

10.2.1. All medications should be stored in a safe and suitable place in the service user’s home.

10.2.2. On commencement of service or during assessment, staff will discuss and agree with the service user where their medicines will be kept. The storage spot should be clean, dry, and at an appropriate temperature as per medication requirements (for example, away from direct sunlight and heat sources).

10.2.3. If the medication needs refrigeration (such as certain liquid antibiotics, insulin (which our staff do not handle, but maybe insulin pens for service user self-injection storage), or eye drops), it should be kept in the fridge ideally in a clearly labelled container so that it’s not confused with household food.

10.2.4. Staff should check that the refrigerator is working – unlike care homes, a daily fridge temperature log is not required in a private home, but obvious fridge failure or inappropriate storage must be addressed.

10.2.5. For general medicines, a high cupboard or a locked medication box is recommended, especially if there are children or others in the home who might tamper with the medication.

10.2.6. Some service users will have a lockable medication safe or tin; if provided, staff should ensure it is used consistently and kept locked.

10.2.7. The keys to any medication box should be kept in a secure yet accessible manner as agreed (e.g., the service user might hold the key, or it might be stored in a key safe). Importantly, who has access to the medicines should be clear – usually only the service user and authorised care staff (and perhaps family caregivers) should handle them.

10.2.8. Each visit, staff should be mindful of medication storage – for example, not leaving the blister pack out on a table where it could be forgotten or taken by someone else after assisting the service user.

10.3. Home storage agreement (domiciliary care)

10.3.1. For people who self-administer or share storage space at home, we agree and document safe storage arrangements (for example, a lockable box, refrigerator segregation, and secure storage of controlled stationery). This is recorded in the care plan and reviewed at each visit block.

10.4. Controlled Drugs Security

10.4.1. If the service user we support is on controlled drugs (CDs), such as morphine, fentanyl patches, or other schedule 2 or 3 drugs, extra measures are taken in storage.

10.4.2. While the law requiring a special controlled drugs cabinet applies to care homes and care providers, in a service user’s own home it is best practice to still keep these medicines in a secure location (e.g., a locked cash box or cupboard) to prevent diversion or misuse.

10.4.3. We advise service users and families of this and can assist in arranging a lockable container if needed. Staff should remain vigilant about the quantity of controlled drugs in the home; at each administration, they should note if the remaining count tallies with what’s expected.

10.4.4. Any discrepancy or any sign of CDs missing must be reported immediately to the manager, as it could indicate a serious issue (like theft or accidental overuse).

10.4.5. Documentation for CDs may include a running log signed by staff each time a dose is given (if required by our procedures or care plan). This log, combined with the MAR, provides a clear audit trail. Additionally, controlled drugs should never be left out in the open or in an obvious place; after administration, they should be promptly returned to their secure storage.

10.5. Medication Disposal (Expired or Discontinued Medication)

10.5.1. Medications that are no longer needed, have expired, or have been discontinued by the prescriber must be disposed of safely.

10.5.2. It is dangerous to keep old or unused medications in the home because they could be taken by mistake or misused.

10.5.3. Our procedure is that unused medications should be returned to a pharmacy for safe disposal (pharmacies will destroy medications in accordance with regulations).

10.5.4. Typically, the service user or their family is responsible for disposal of their medicines; however, care staff may assist in facilitating this if the service user cannot do it themselves and has given consent. For example, with the service user’s permission (recorded in the care notes or care plan), a care & support worker may take the expired medication to the service user’s regular community pharmacy in a sealed, labelled container. When doing so, staff must document what was removed (name of drug, strength, quantity, date of return) and get a receipt or signature from the pharmacy if possible. This information (date of disposal, what and how much was disposed, and which pharmacy or method) should be recorded in the care notes or on a medication disposal form.

10.5.5. If family members handle the disposal, staff should note in the records which family member took responsibility and when.

10.5.6. Important: Staff must never dispose of medications by throwing them in the bin, sink, or toilet. Flushing medications or tossing them in household trash can create safety hazards (risk of someone else finding and ingesting them, or environmental contamination).

10.5.7. Always follow proper return-to-pharmacy procedures or local authority guidelines for medication disposal.

10.6. Disposal of Controlled Drugs

10.6.1. Controlled drugs require witnessed disposal. If a controlled drug is discontinued or expired, two authorised people should ideally witness and document the removal of the drug for disposal.

10.6.2. In a home care scenario, this could be the care & support worker and a pharmacist (when returned to pharmacy) or the care & support worker and a family member who’s an adult.

10.6.3. We prefer returning controlled drugs to a pharmacist, who will then destroy it (often requiring a witness pharmacist).

10.6.4. Staff must record the handover (e.g., “Returned 5 tablets of morphine 10mg to Pharmacy Name on Date, received by Pharmacist Name”). If a controlled drug needs to be destroyed on site (rare in domiciliary care), a pharmacist or authorised service user should come to do it – care staff should not themselves destroy controlled drugs by e.g. crushing and disposing, except under professional guidance.

10.6.5. Until disposal, controlled drugs that are no longer in use should remain securely stored.

10.6.6. Any used patches (for example, fentanyl patches after use) should be folded so the adhesive sides stick together (to prevent drug leakage) and disposed of in a safe manner (ideally returned to pharmacy or placed in a sharps bin if one is used for that patient).

10.7. Sharps Disposal

10.7.1. Although our staff do not administer insulin or other injections, there may be scenarios where sharps (needles, lancets, syringes) are used in the service user’s home – for example, the service user might self-inject insulin or a district nurse might administer an injection during a visit, leaving used sharps.

10.7.2. We ensure there is a proper sharps container in the home if needed. Care staff should never handle used sharps with bare hands.

10.7.3. If assisting with something like an insulin pen needle (only in a prompting role, since we don’t inject), staff must ensure the needle goes straight into a sharps box after use. Do not recap needles.

10.7.4. Sharps bins should be collected/ replaced by the district nursing service or local council’s clinical waste service when full or when the treatment is completed.

10.7.5. Staff should inform the manager if they notice a sharps bin is nearly full or if one is needed and not present.

10.8. Refusals and safe disposal

10.8.1. If a service user refuses medication, staff will not force or repeat dosing. The refusal and reason are recorded on the MAR and care plan, and advice sought per the escalation pathway.

10.8.2. Unwanted or expired medicines are not disposed of in domestic waste; we arrange return to the supplying pharmacy (or the service user’s agreed disposal service) and keep a disposal record countersigned by a witness.

10.8.3. In summary, the storage and disposal procedures aim to ensure that medications remain effective (through proper storage conditions), are kept out of reach of those who might be harmed by them, and are disposed of in a manner that is safe, traceable, and environmentally responsible. By following these guidelines, we protect our service users and others from the risks associated with improper handling of medications when not in use.

11. Reporting Medication Errors

11.1. The Good Place fosters an open culture where staff are encouraged to report errors or near-misses immediately. A medication error is any deviation from the prescribed medication regimen or the proper procedures – for example, giving the wrong medicine or dose, missing a dose, giving it at the wrong time, or giving it to the wrong service user, as well as documentation mistakes that could lead to error.

11.2. We recognise that even with careful practices, errors can occur, and it is our responsibility to handle them transparently and learn from them. This section describes what staff must do if a medication error or near-miss happens, and how we manage such incidents:

11.3. Medication concern - who to contact:-

• a. Registered Manager/ On-call: 01283 296 337  (immediately)
• b. NHS 111 for urgent advice; 999 in an emergency
• c. Prescriber/ GP (or specialist team named on MAR) for clinical advice
• d. Pharmacist (supplying pharmacy) for interactions/formulation queries

11.4. Record actions and advice on the MAR and incident form, and inform family/ advocate as appropriate.

11.5. In depth procedure

11.5.1. If a medication error or near-miss occurs, staff should take the following steps immediately.

11.5.2. Step 1 - Ensure the service user’s Safety First

11.5.2.1. The first priority is the wellbeing of the service user we support. As soon as an error is realised, the care & support worker should assess the service user we support for any adverse effects.

11.5.2.2. If the wrong medication or dose was given, or a dose was missed, monitor the service user for any signs of distress or reactions.

11.5.2.3. Depending on the situation, the staff may need to seek medical advice right away – for instance, by calling the GP, NHS 111, or in severe cases 999 for emergency help. Examples: If a double dose was accidentally given, call a healthcare professional for advice on any symptoms to watch and whether the service user needs urgent treatment. If a critical medication (e.g., an anticonvulsant) was missed, the GP might need to advise on whether to take it late or skip it.

11.5.2.4. Staff should not leave the service user alone if there are any immediate health concerns; stay until it’s clear how the situation will be managed medically.

11.5.3. Step 2 - Report Immediately to Management

11.5.3.1. As soon as the immediate safety steps are underway, the staff member must inform a supervisor or manager about the error. This should be done immediately (within minutes) once the situation with the service user is stabilised.

11.5.3.2. During office hours, the care & support worker should call the Registered Manager (Dean Hill) on 01283 296 337.

11.5.3.3. If the error happens out of hours, the on-call manager/ supervisor must be contacted by phone: 01283 296 337.

11.5.3.4. All staff have been provided with the on-call contact number – use the emergency on-call system as per our protocol. Even if it the same company number the on call service user will answer the call.

11.5.3.5. It is important to use these established reporting lines so that management is alerted and can assist in managing the aftermath. We use an internal incident reporting system; the staff member should communicate the facts of what happened to the manager (e.g. “I gave Mrs. X the wrong medication at 9am” or “I found that I forgot to give Mr. Y his 8am dose”).

11.5.3.6. Prompt reporting allows the management to give immediate guidance, help decide on contacting medical services (if not already done), and start the documentation process.

11.5.3.7. Note: Staff should use any provided shortcodes or reference codes when documenting or communicating the incident internally if our system requires (for example, using a service user ID instead of full name in text messages to maintain confidentiality).

11.5.4. Step 3 - Do Not Attempt to Hide the Error – Duty of Candour

11.5.4.1. Honesty is imperative. The staff member should not try to cover up or rectify the error secretly (for instance, never give a double dose later to make up for a missed dose – this can be extremely dangerous).

11.5.4.2. The Good Place follows the NHS and CQC’s Duty of Candour, which is a legal obligation to be open and transparent when things go wrong. This means we will inform the service user (and/ or their next-of-kin/representative, if appropriate) about the error as soon as possible, explain what happened in a straightforward way, describe what will be done to address it, and apologise for the mistake.

11.5.4.3. Typically, the Registered Manager or senior staff will take responsibility for this communication, but the care & support worker may be involved or asked to be present during the explanation and apology.

11.5.4.4. We understand that admitting an error can be difficult, but it is essential for maintaining trust and ethical standards.

11.5.4.5. The Duty of Candour applies to all levels of harm – even if no obvious harm occurred, we still acknowledge the error to the service user.

11.5.4.6. Management will ensure the conversation with the service user/ family is documented (and if it meets the threshold of a formal notifiable safety incident under Regulation 20, we will follow those specific steps, such as providing a written follow-up of the apology and investigation outcome).

11.5.5. Step 4 - Document the Incident

11.5.5.1. The error must be documented in detail, both in the service user’s records and in the company’s incident log.

11.5.5.2. On the MAR chart, the staff should make a note about what happened. For example, if a dose was given at the wrong time, record the time it was actually given with a note “given at 10am in error, reported to manager” or if a dose was missed, write “omitted in error” or similar.

11.5.5.3. The staff member (with manager’s help if needed) must also complete an Incident Report Form as soon as possible, ideally immediately after ensuring the service user is safe.

11.5.5.4. The incident report should include: date and time of the error, the names of those involved (service user and staff), exactly what the error was, how it happened (if known at that point), what actions were taken (who was notified, what medical advice was sought, service user’s status), and any immediate outcome.

11.5.5.5. This report should be factual and clear – it’s fine to note any early thoughts on causes (e.g. “noticed two similar bottles next to each other, may have grabbed the wrong one”) but avoid speculation. This documentation is crucial for later investigation and for regulatory compliance.

11.5.6. Step 5 - Management Investigation and Follow-Up

11.5.6.1. Management will investigate every medication error or near-miss to understand why it happened and how to prevent it in the future.

11.5.6.2. The Registered Manager or a designated investigator will speak to the staff involved and any witnesses service userly, review the MAR charts and incident form, and look at the circumstances (for example, were they rushed due to low staffing, was the MAR chart confusing, was the label hard to read, etc.).

11.5.6.3. The goal is to perform a root cause analysis – identifying whether the error was due to human mistake, system issues, communication problems, or other factors. The Good Place promotes a “fair blame” or “no blame” culture, meaning the purpose of the investigation is not to punish staff for mistakes made in good faith, but to learn and improve.

11.5.6.4. However, if an investigation were to find wilful negligence, misconduct, or repeated violations of procedure, then disciplinary action could be considered in line with our HR policies.

11.5.6.5. In all cases, the findings of the investigation are documented. We then create an action plan to address any issues found: this could include measures like refresher training for the staff member or entire team, changes to the medication procedures, additional supervision for a period, or adjustments in the care plan (for example, if a service user has a very complex regimen, maybe arranging for pharmacy to provide a blister pack).

11.5.6.6. The emphasis is on learning from the error so it does not happen again. Lessons learned might be shared in anonymised form with the care team (e.g., “We had an incident where a medication was given at the wrong time because the MAR times were unclear; as a result, we have updated how we write MAR charts.”).

11.5.7. Step 6 - Reporting to External Authorities

11.5.7.1. Certain medication errors may need to be reported to external bodies. We follow CQC and local authority guidelines on this. CQC must be notified of any medication error that results in, or may have resulted in, death, serious harm, or where it forms part of a safeguarding concern, in line with Regulation 18 notifications and Regulation 20 (duty of candour). If a medication error causes a death or serious injury, we will inform CQC via the statutory notification process and the local Safeguarding Adults team, as well as RIDDOR if applicable.

• a. Local Authority: Staffordshire County Council
  • aa. Email: [protected:aSSASPB.admin][protected:astaffordshire.gov.uk]
  • ab. Online: Staffordshire & Stoke-on-Trent Adults Safeguarding Partnership Board
  • ac. Telephone (working hours): 0345 604 2719
  • ad. Telephone (out of hours): 0345 604 2886

11.5.7.2. If we suspect the error amounts to abuse (for example, a staff member intentionally withholding medication or giving an overdose on purpose), it will be treated as a safeguarding matter and reported to the safeguarding authorities immediately.

11.5.7.3. We also inform the service user’s GP (and other health professionals involved) about the error, especially if medical follow-up might be needed. In the case of certain drug errors, we might need to advise the service user’s GP so they can monitor or alter treatment as necessary.

11.5.7.4. All external communications and notifications are coordinated by the Registered Manager or quality manager. Additionally, under Duty of Candour requirements, if the incident meets the definition of a “notifiable safety incident” (which usually means it resulted in moderate or severe harm, or death), we will provide a written notification to the service user we support or their representative documenting the error, its effect, and giving an apology, and we will keep a copy of this correspondence.

11.5.8. Step 7 - Learning and Continuous Improvement

11.5.8.1. After the immediate incident has been dealt with and investigated, The Good Place reviews what happened to improve our systems.

11.5.8.2. We look at whether our current policies were followed and if not, why. Perhaps the procedure needs clarification, or maybe everything was done right but an unpredictable error occurred – either way, we consider what preventative measures can be taken.

11.5.8.3. This could result in updating this Medication Policy, providing targeted training sessions (for example, a workshop on administering eye drops properly if that was a problematic area), or investing in tools to help (maybe using color-coded medicine administration times on MAR charts to avoid time errors or implementing electronic systems).

11.5.8.4. We also track medication errors over time as part of our quality monitoring. The frequency and type of errors are analysed: if we notice a pattern (e.g., multiple errors with the same service user or same medication), we will take proactive steps such as a case review or additional support for that service user or staff.

11.5.8.5. Conversely, identifying that we have very few errors and a lot of reports of “near-misses” might indicate a healthy reporting culture where staff catch issues before they affect the service user – which we encourage.

11.5.8.6. Our aim is to create an environment where staff feel comfortable reporting mistakes or near-misses without fear, understanding that this honesty helps everyone receive safer care.

11.5.8.7. As guided by NICE and CQC, we maintain robust processes for identifying, reporting, reviewing, and learning from medicines-related incidents.

11.5.8.8. Regular summaries of incidents and lessons learned are shared with the care team (for learning) and with senior management and trustees (for oversight). In supervision meetings, medication management is a standing agenda item, allowing any service user issues to be addressed.

11.5.8.9. Overall, every error or near-miss is an opportunity to improve our service, and we are committed to continually refining our practices to minimise the risk of future errors.

12. Handling and Administering PRN ("As Needed") Medication

12.1. PRN medications (from the Latin "pro re nata" meaning "as the situation arises") are those that are not scheduled at regular times but are given in response to specific symptoms or situations. Examples include pain relievers, laxatives, or anxiety medications that a service user only takes when they feel they need it. Proper management of PRN medication is vital to ensure that service users get relief when they need it while preventing overuse or omission. Our approach to PRN medication includes clear guidelines on when to give it, how to decide, and how to record it:

12.2. Clear Protocols for When to Give PRN

12.2.1. Each service user who has PRN medication will have details in their care plan or MAR chart specifying under what conditions that medicine should be used.

12.2.2. The prescribing doctor or pharmacist usually provides directions that should be on the medication label and/or the MAR chart. For example: “Take 1 tablet as needed for pain (moderate to severe headache), with a minimum interval of 4 hours between doses, not to exceed 4 tablets in 24 hours.”

12.2.3. Staff must familiarise themselves with these instructions so they know the purpose of the drug, the allowed dosage range, and the minimum time gap between doses.

12.2.4. If this information ever seems unclear or is missing, the staff should ask a supervisor or contact the pharmacy for clarification before administering the PRN medication. We avoid any guesswork with PRNs – instructions must be unambiguous.

12.3. Assessing the Need

12.3.1. The decision to give a PRN medication should ideally involve the service user. If the service user is able to communicate, staff should ask them about their symptoms. Example: “Are you feeling pain right now? Do you think you need your pain relief tablet?”

12.3.2. The service user’s request or consent is important; some service users will proactively ask for their PRN medication when they feel they need it, while others may need to be asked. If the service user cannot clearly communicate (due to dementia or other issues), the care & support worker must use their observation skills and knowledge of the service user.

12.3.3. Look for signs of the problem that the PRN treats (e.g., signs of pain like grimacing, holding a body part, increased heart rate, or signs of anxiety like pacing, agitation). Also, refer to any PRN protocols in the care plan – often, nurses or doctors will have written guidance like “If John appears to be in pain (e.g., facial expression, vocalisation), it is appropriate to offer PRN pain medication.”

12.3.4. When in doubt about the need, the care & support worker should consult a senior or a healthcare professional. It’s better to check than to either give a PRN unnecessarily or hold back when it’s needed.

12.4. Checking Timing and Previous Doses

12.4.1. Before administering a PRN dose, staff must check the time of the last dose of that same medication. This includes checking the current day’s MAR chart and, if relevant, asking the service user if they took any dose earlier (in case another care & support worker or a family member might have given a dose before staff arrived).

12.4.2. This is critical to avoid giving doses too close together or exceeding the maximum allowed. For instance, if a service user has a PRN sedative that can be given “up to twice a day,” the care & support worker should ensure it hasn’t already been given twice.

12.4.3. If the maximum dose for 24 hours has been reached, do not give any more, even if the service user is requesting it – instead, explain the situation and possibly contact a healthcare professional to see if an alternative can be arranged for relief. Likewise, if not enough time has passed since the last dose (e.g., only 2 hours since a pain tablet that needs 4-hour gaps), the care & support worker should gently inform the service user it’s too early and perhaps offer a non-medication comfort measure in the meantime (like a warm compress for pain, etc., per care plan).

12.4.4. Adhering to these rules prevents overdosing and adverse effects.

12.5. Administering the PRN Medication

12.5.1. If it is determined that the PRN medicine is needed and safe to give (criteria met, appropriate timing), the care & support worker will administer it following the usual safe procedures (check the 7 Rights, prepare the medication correctly).

12.5.2. Only one dose should be given at a time according to the instructions – never give more on the assumption “they might need it later.” PRN meds are strictly on an as-needed basis.

12.5.3. While administering, it’s good practice for the care & support worker to mention to the service user what the medication is for (“Here is your inhaler for shortness of breath, since you’re feeling wheezy”) so the service user is informed and can confirm if that’s what they want. If the service user at that moment says they don’t actually want or need it, then don’t force it – maybe their condition changed.

12.5.4. PRN stands for giving when needed, not automatically.

12.5.5. After giving the medication, make sure the service user is comfortable and monitor for any immediate reaction if it’s something that might act quickly (for instance, some pain meds might cause dizziness – be aware to assist the service user if they stand up, etc.).

12.6. Documentation of PRN Use

12.6.1. Every administration of a PRN medication must be recorded clearly on the MAR chart at the time of administration. Because PRNs are not given at regular times, the exact time of administration should be detailed in the MAR. Additionally, staff should record the reason it was given.

12.6.2. Documentation creates a trail that can be reviewed by supervisors or medical professionals to assess how often PRN meds are being used and whether the care plan needs any adjustment (e.g., if a PRN painkiller is used every single day, the GP might decide to put the service user on a regular pain medication instead). Staff must also record, where practicable, whether the PRN medicine was effective (for example, pain score before and after) in line with the person’s PRN protocol.

12.7. Decision Authority and Support

12.7.1. Generally, the trained care staff will make the judgment call to administer PRN medication in line with the care plan guidelines and the service user’s immediate needs. However, they are not alone in this decision – they have support. If ever unsure, they should call a supervisor or the on-call nurse (if we have nursing support) for advice.

12.7.2. The care plan might also specify if any PRN decisions need to be authorised by a nurse or if the service user’s family wants to be informed. For instance, some protocols say “Contact district nurse if more than 2 doses of PRN glyceryl trinitrate spray are needed in 24 hours for chest pain.” Staff should be aware of such instructions.

12.7.3. In normal circumstances, if everything is clear (service user is in pain, has order for PRN paracetamol, hasn’t exceeded dose, etc.), the care & support worker gives it and then informs the team via documentation. If the PRN medication is of a critical nature (like emergency medication for seizures or an EpiPen for allergic reaction), there should be explicit training and instructions for those scenarios, and staff must follow those emergency protocols, including calling emergency services when such medications are used.

12.8. Monitoring and Review of PRN Usage

12.8.1. The use of PRN medications is reviewed during care reviews and also monitored in our monthly audits. We watch out for patterns: if a service user never uses a PRN that’s prescribed, during the care plan review we might ask the GP if it’s still needed on the prescription.

12.8.2. If a service user is using a PRN very frequently or in increasing amounts, that triggers a review as well – staff should flag this to the manager, who may communicate with the GP. Our aim is to ensure the service user’s health is managed optimally; frequent PRN use might mean their condition has changed and the regular prescription needs updating.

12.8.3. All these considerations ensure PRN medicines are used appropriately – enough to address needs but not so much that they cause other issues.

13. Monitoring and Reviewing Medication Practices

13.1. Medication management is not a “set and forget” aspect of our service – it requires ongoing monitoring, review, and quality improvement. The Good Place is committed to continuously reviewing how we handle medications to maintain compliance with regulations and to seek ways to improve safety and effectiveness. This section describes how we monitor our own practices (in addition to the monthly MAR audits mentioned earlier) and how we keep our policy and procedures up-to-date.

13.2. Regular Oversight and Spot-Checks

13.2.1. In addition to formal monthly audits of MAR charts, supervisors or the management team conduct random spot-checks and observations.

13.2.2. Spot-checks might include unannounced visits or phone calls during medication rounds to ensure staff are following procedures (for example, checking that a care & support worker is correctly checking MAR entries, or verifying that a controlled drugs count in a service user’s home matches the record).

13.2.3. We may also occasionally shadow a care & support worker during a visit (with consent) to observe their medication administration technique and adherence to the policy. These spot-checks are done in a supportive way, not to “catch out” staff, but to identify any lapses in practice that can be corrected and to reinforce good practice.

13.2.4. Findings from spot-checks (good or bad) are fed back to the staff member and recorded by management. Patterns of issues (if any) found on spot-checks will influence our training and supervision priorities.

13.3. Management Review and Quality Assurance

13.3.1. The Registered Manager reviews overall medication management performance at least quarterly. This includes looking at audit results, incident reports (errors/near misses), and any feedback from service users or families about medication handling.

13.3.2. We use a Medication Management Audit Tool aligned with CQC guidance to systematically evaluate compliance (covering storage, records, training, etc.). This higher-level review helps ensure that our policies are being implemented properly and identifies broader areas for improvement. For example, if the quarterly review finds that documentation is consistently good but storage practices could be better (maybe some homes don’t have ideal storage), the manager will initiate an improvement plan (like ensuring all service users are offered a lockable meds box).

13.3.3. Conversely, if everything is running well, that gets noted and will be reported in management reports or CQC self-assessments as evidence of good practice.

13.4. Staff Feedback and Engagement

13.4.1. We consider our care staff as crucial partners in monitoring medication practices. Staff are encouraged to give feedback on the medication systems during team meetings or directly to managers. They are the ones handling medications daily and often have practical insights – for example, they might notice that a particular MAR chart layout is confusing or that timing of medication visits needs adjustment for effectiveness.

13.4.2. We hold periodic staff meetings or training refreshers where medication management is on the agenda. In these sessions, we invite care & support workers to discuss challenges or suggestions.

13.4.3. If a staff member has identified a safer way or a concern (“I think we should double-check insulin fridge temperatures weekly, just in case”), management will consider and, if appropriate, implement that suggestion.

13.4.4. We aim for a culture of continuous improvement, where even small ideas (like adding a column for cream application on the MAR) can make a difference and are valued.

13.5. Keeping Policies and Procedures Up-to-Date

13.5.1. The healthcare landscape and regulatory guidance can change, so we ensure that this Medication Management Policy is reviewed at least annually and whenever there is a significant change in relevant guidelines or regulations. For example, if NICE issues new guidance on managing medications in home care or if CQC updates its inspection criteria or if there’s a change in legislation (like controlled drug regulations), we will update our policy and inform/ train our staff on the changes.

13.5.2. The review will consider any new NICE guidelines, CQC bulletins, pharmacy advice, or sector best practices. We also incorporate lessons learned from our own operations; for instance, if an investigation into an incident reveals a gap in the policy, we will revise it. The updated policy is then redistributed to all staff (usually with a briefing on what’s changed) and old versions are archived.

13.5.3. By keeping our policies current, we maintain compliance with the latest standards and improve the quality of care.

13.6. Compliance and External Inspections

13.6.1. We regularly self-audit our medicines management against the CQC Single Assessment Framework quality statements, particularly those under Safe, Effective and Well-led, to ensure we meet all expectations.

13.6.2. This means checking that we have evidence for things like: people’s medication needs are assessed and met, staff are trained and competent, records are complete and accurate, medicines-related incidents are learned from, and governance arrangements are effective.

13.6.3. When the CQC or local commissioners inspect or review our service, we are prepared to demonstrate our medication management performance through our audit reports, training records, incident logs and feedback from people and their representatives. Any feedback from such external inspections is taken very seriously.

13.6.4. If CQC were to highlight a required improvement (for example, “improve documentation of PRN effectiveness”), we would act on it immediately and document the completed action. We strive not just to meet minimum standards, but to exceed them by proactively monitoring our service.

13.7. Continuous Improvement Examples

13.7.1. Over time, the monitoring and reviewing process has led (and will continue to lead) to improvements in how we operate. Some hypothetical examples include: introducing electronic MAR (eMAR) if it’s found to reduce transcription errors, scheduling twice-yearly refresher workshops (instead of only annual) because we found knowledge dips in the second half of the year, or partnering with a pharmacist to do medicine use reviews for our service users for optimisation. We remain open to innovation in medication safety.

13.7.2. Ultimately, the constant monitoring and review cycle ensures that medication management at The Good Place remains safe, effective, and aligned with best practice – it’s an ongoing commitment rather than a one-time effort.

14. Covert Medication, Capacity, and Consent

14.1. Covert medication refers to the practice of hiding medication in food or drink without the service user’s knowledge to ensure they take it. This may only be considered when a service user lacks the mental capacity to make an informed decision about taking their medication and is refusing it in a way that places them at significant risk. It must be a last resort, in the service user's best interests, and must follow a lawful process.

14.2. At The Good Place, covert medication will only be used when all of the following are in place:

• a. A full Mental Capacity Assessment confirms the service user lacks capacity to decide about their medication.
• b. A Best Interest Meeting is held with the involvement of relevant professionals (e.g., GP, pharmacist), family members, and/or an Independent Mental Capacity Advocate (IMCA) if appropriate.
• c. The decision and the rationale for covert medication are clearly documented in the service user’s care plan.
• d. Pharmacist advice is sought to determine the safest method for administering the medication covertly (some medications must not be crushed or mixed).
• e. A covert medication care plan is created, regularly reviewed, and includes monitoring for side effects or efficacy.
• f. Staff administering medication covertly are trained, competent, and fully understand the care plan instructions.

14.3. Staff administering medication covertly are trained, competent, and fully understand the care plan instructions. Where the overall care arrangements (including covert medication) may amount to a deprivation of liberty, advice will be sought from the local authority or the Court of Protection so that any such deprivation is lawfully authorised.

14.4. Covert medication should be regularly reviewed and withdrawn as soon as it is no longer necessary. It is not permitted without proper authorisation and documentation.

14.5. Capacity and Consent

14.5.1. Before any medication is administered, staff must consider whether the person has the capacity to consent. The Mental Capacity Act 2005 applies. If a person has capacity, their decision to take or refuse medication must be respected - even if that decision might seem unwise. This supports compliance with Regulation 11 (need for consent) and should be read alongside our Consent to Care and Support Policy and Procedure.

14.5.2. Where a service user has capacity:-

• a. Staff must always seek consent before administering medication.
• b. Consent may be implied (e.g., the service user agrees when offered their medicine) or explicit (e.g., verbally agrees).
• c. If the service user refuses, staff must record this and report to the manager, unless the refusal puts the service user at immediate risk, in which case advice must be sought urgently.

14.5.3. Where a service user lacks capacity:-

• a. Any decision to administer medication must be in their best interests.
• b. Staff must follow the principles of the Mental Capacity Act and use the least restrictive option.
• c. If regular medication is required, a clear best interests decision must be documented in the care plan, and where appropriate, involve the family or IMCA.

14.6. Medication Audits

14.6.1. Medication audits are conducted regularly to ensure safe practices, compliance with policy, and accurate records. This includes:-

• a. Monthly audits of MAR charts and controlled drug records.
• b. Spot checks and direct observations by supervisors.
• c. Auditing documentation related to consent, capacity assessments, and covert administration where applicable.
• d. Ensuring that any best interest decisions and covert medication plans are reviewed and updated.
• e. Recording and reviewing any medication refusals, errors, or patterns that may suggest capacity concerns.

14.6.2. Findings from audits are used to improve practices, update training, and ensure the ongoing safety and rights of the people we support.

15. Ensuring Service Users Maintain a Safe Supply of Medication

15.1. At The Good Place, we recognise that maintaining a continuous supply of medication is vital for the health, safety, and well-being of people using our domiciliary care service. Our responsibility extends beyond administration to supporting service users so that they never run out of prescribed medicines. This is particularly important as, in a home care setting, service users and their families may not always be able to manage prescription requests and repeat ordering independently.

15.2. Assessment and Care Planning

15.2.1. During the initial assessment and when developing each service user’s care plan, we identify the level of support required to manage medication supplies. Some service users and/or their families will be able to order and collect their medicines independently; others may need our help to monitor supplies, request repeats, or collect prescriptions.

15.2.2. By following these procedures, The Good Place ensures that all people we support are safeguarded from the risks associated with missed or interrupted medication due to supply issues.

15.3. Monitoring Medication Supplies

15.3.1. Care staff are required to check the supply of each medication during their regular visits. This involves visually checking packaging (e.g. counting remaining tablets in a blister pack or bottle) and checking for upcoming expiry dates. If staff notice that a supply is running low (for example, less than a week’s supply remaining), they will notify the office or person responsible as set out in the care plan. We do not alter prescriptions or quantities prescribed; any concerns about the adequacy of prescribed quantities are raised with the GP or prescriber.

15.4. Supporting Prescription Requests and Repeat Ordering

15.4.1. Where a service user cannot manage reordering, or has asked us to help, staff will support them by:-

• a. Reminding the service user or their family when repeat prescriptions are due.
• b. Assisting in requesting repeat prescriptions from the GP (for example, by phone, online, or in service user at the surgery), in accordance with the service user’s consent and care plan.
• c. Liaising with pharmacies to arrange for timely dispensing and, where agreed, supporting collection or delivery of medication.
• d. Documenting all actions related to medication ordering in the care records.

15.5. Arranging Collection or Delivery

15.5.1. If required and agreed in the care plan, care staff can collect medication from the pharmacy on the service user’s behalf, or arrange for a pharmacy delivery. All collections/deliveries are recorded, and medication is checked on receipt against the prescription and MAR chart for accuracy.

15.6. Contingency Planning

15.6.1. If there is a risk of running out of medication (for example, due to delays in GP approval or pharmacy supply issues), staff will escalate the concern promptly to the manager. The manager will then contact the GP, pharmacy, or out-of-hours service as needed to ensure continuity of supply.

15.7. Service User Involvement and Independence

15.7.1. Where possible, we encourage and support service users to manage their own medication supplies, in line with their abilities and preferences. For those who wish to remain independent but need reminders, staff can prompt them to order repeats and check if the order has been placed.

15.8. Record Keeping

15.8.1. All actions relating to checking supplies, ordering, collecting, or arranging delivery of medication are documented in the daily care notes, ensuring there is a clear audit trail.

16. Links to Other Policies

16.1. Medication management does not stand in isolation; it is interconnected with several other areas of our care service. Staff should be aware of the following related policies, as situations involving medications might invoke these policies too.

16.2. Safeguarding Policy

16.2.1. Safe medication practices are a part of safeguarding our service users from harm. Medication errors, especially if frequent or deliberate, can amount to neglect or abuse. If a staff member or anyone deliberately withholds medication, gives too much, or otherwise uses medication inappropriately to harm or control a service user, this is a safeguarding issue.

16.2.2. Our Safeguarding Adults Policy and Procedure provides guidance on recognizing and reporting abuse or neglect, including medication-related concerns. For example, a pattern of missed medications could be a form of neglect that must be escalated under safeguarding procedures.

16.2.3. Staff must refer to the Safeguarding Adults Policy and Procedure if they suspect a service user’s health is being placed at risk due to medication mismanagement.

16.3. Whistleblowing Policy

16.3.1. We encourage an open culture, but if staff feel unable to report medication concerns through normal lines (perhaps because the issue involves their direct supervisor or they feel it’s being ignored), the Raising Concerns, Freedom to Speak Up and Whistleblowing Policy and Procedure offers a way to raise concerns confidentially and without fear of reprisal.

16.3.2. This could include concerns about unsafe medication practices, such as witnessing a colleague falsifying MAR charts or stealing medication. The Raising Concerns, Freedom to Speak Up and Whistleblowing Policy and Procedure outlines how to raise such concerns with senior management or external authorities if necessary, and protects whistleblowers under UK law.

16.3.3. Staff should remember they have this avenue if needed – it’s better to speak up about a potential medication danger than stay silent.

16.4. Complaints Procedure

16.4.1. service users we support and their families have the right to complain if they are dissatisfied with any aspect of our service, including medication management. For instance, a service user might complain that they did not receive their pain medication on time, or a family member might raise a concern that medications are not being logged correctly in the MAR chart.

16.4.2. Our Complaints Policy and Procedure explains how service users or representatives can make a complaint, how we will investigate it, and the timeframes for response.

16.4.3. Any complaint related to medication is taken very seriously and will typically trigger a review of the medication records and practices for that service user. Findings from complaints investigations might reveal areas for improvement. We treat complaints as an opportunity to remedy any wrongdoing and improve our service.

16.4.4. Staff are expected to be cooperative and honest during any medication-related complaint investigation and to learn from the outcome.

16.5. Other Related Policies

16.5.1. In addition to the three key policies above, staff should also be mindful of connections to:-

• a. The Health and Safety Policy and Procedure (for example, safe storage of medicines is a health and safety matter, as is dealing with sharps)
• b. The Infection Control Policy and Procedure (relevant when handling medications like creams, injections, or PEG tube care – use of gloves, etc.)
• c. The Consent to Care and Support Policy and Procedure (applicable when administering medication to someone who may lack capacity to consent, ensuring best interest decisions and proper authorisation for covert administration if ever needed).

16.5.2. While these may not be explicitly listed in every context, good medication management will often require understanding those policy areas too.

16.5.3. Regulation 13 (Safeguarding service users from abuse and improper treatment) - which requires The Good Place to prevent and respond to any medication-related abuse or improper treatment (e.g., over-sedation, coercive or inappropriate PRN use, or withholding medicines)

16.5.4. By understanding and following this Medication Management and Administration Policy in conjunction with related policies, The Good Place staff will ensure a holistic, safe, and service user-centered approach to supporting service users with their medications. This ultimately helps the service users we support maintain their health and quality of life, and ensures we meet our regulatory responsibilities as a domiciliary care provider in England.