Managing medicines in supported living

Supported living offers personalised support to help people live as independently as possible in their own homes.

Some people in supported living will receive the regulated activity of Personal care, but not everyone will receive this. In supported living there are separate contractual arrangements to provide personal care and the housing aspects.

A provider that is registered with us to deliver personal care may also administer a person’s medicines as part of this. This is because medicines support is considered ‘ancillary to’ the personal care they are receiving.

A service might support people to take their medicines themselves but not provide personal care. In this scenario, the medicines support is not an ‘ancillary activity’. It does not fall into the scope of registration by CQC and the provider of the service therefore does not need to register for that regulated activity.

Guidance

NICE guideline NG67 Managing Medicines for People Receiving Social Care in the Community includes the following population and settings:

• adults (aged 18 years and over) who take or use medicines and who are receiving social care in the community (and their families and carers).
• supported living

Medicines support

Where possible, people should make decisions about their own care and manage it themselves. This includes their medicines. Sometimes people need support when taking their medicines. Providers of care for people in supported living should therefore think about:

• how to support the person to manage their own medicines, and whether this meets their wishes and abilities
• whether the person understands why they are taking their medicines and whether information about their medicines could be provided in a different way
• what support the person needs, for example helping them to read the labels on medicines, use inhalers or apply creams
• whether the person has any problems when taking their medicines, particularly if taking several different medicines
• any related social, cultural, emotional, religious and spiritual needs
• whether they have any specific nutritional and hydration needs, including the need for nutritional supplements or other support.

If a person does not or may not have mental capacity to make decisions about their medicines (permanently or fluctuating), supported living services must follow the Mental Capacity Act Code of Practice when making assessments and decisions. This includes giving medicines covertly.

Joint working and information sharing

Providers of care for people in supported living should work with health professionals and social care practitioners. This enables people to receive integrated, person-centred support.

Health and social care professionals should consider people’s communication needs and should meet the Accessible Information Standard. People’s views, wishes and aspirations should be included in medicine reviews. If the person's care transfers to another service, for example on admission to hospital, health and social care professionals should share information about how people take their medicines.

Records and administration

People should be supported to take their own medicines when they want to if it is safe to do so. Providers should work with people to develop a self-management plan for medicines. This plan must consider the risks, values and benefits.

Care staff may administer or support a person to take their medicines. They must keep records in line with NICE guideline NG67. This includes details of all support for prescribed and over the counter medicines, such as:

• reminding a person to take their medicine
• giving the person their medicine
• recording whether the person has taken or declined their medicine.

Providers should have robust processes to make sure care staff keep accurate, up-to-date medicines administration records. They should have assurance that people are taking their medicines as prescribed and in a person-centred way. People have the right to refuse to take a medicine if they have the mental capacity to make that decision.

Ordering and supply

Providers should be confident that people will get the medicines they need. People must have reliable access to both prescribed and over the counter medicines. Care providers should work with pharmacies or dispensing doctors as needed so that they make reasonable adjustments to help people manage their medicines. For example, large print dispensing labels, easy to read leaflets, and accessible administration charts.

NICE NG67 says providers should consider using a monitored dosage system only when:

• a health professional (for example, a pharmacist) has carried out an assessment in line with the Equality Act 2010 and
• a specific need has been identified to support a person to keep taking their medicines as prescribed.

This also involves taking account of the person's needs and preferences and involving them or their family members or carers and the social care provider when making decisions.

Transporting, storing and disposal

Where the supported living provider is responsible for transporting or disposing of medicines, it should carry out a risk assessment and keep records. Unwanted or waste medicines can be returned to a community pharmacy for safe disposal.

Providers of care for people in supported living should have processes to make sure medicines are stored safely. Medicines should be stored in people’s homes, rather than in a central area. This includes medicines that might need to be stored in a fridge and controlled drugs. Supported living services do not need a separate medicines fridge or controlled drug cupboard. Providers should work with people to store medicines in a way that meets their individual needs and the manufacturer’s requirements.

Training and governance

Care staff should be trained and competent to support a person to manage their medicines safely and effectively. Supported living schemes must be confident that people receive their medicines safely and when needed. They should make sure that medicines errors are investigated and reported, and that they share learning to reduce the likelihood of future errors.