Surrey Children's Homes Procedures Manual

First Aid, Home Remedies and Medication

Regulations and Standards

Related guidance

Amendment

In January 2026, Section 3, Home Remedies was amended to include the increasing advisory role pharmacists play re over the counter medication.

January 26, 2026

1. First Aid

The Home must have a qualified First Aider on duty at all times. Each home also has access to the Crisis Mental Health Helpline (0800 915 4644) where advice can be sought from trained mental health practitioners.

First Aid boxes should have a white cross with a green background. They must be held in the home and should be carried in each of the vehicles used for the transportation of children or young people.

Each box has an inventory that must include the full quantity of each item stipulated in the box. When an item has been used, then it should be replaced as soon as possible. The contents of the boxes are checked on a weekly basis.

Recording: Each child or young person should have permission for staff to administer first aid and non-prescription medication from a person with Parental Responsibility for them recorded in the relevant plan. Permission should be sought and arranged by the child or young person's social worker.

The administration of First Aid must be recorded in the individual child or young person's Daily Record and any other relevant record such as Oshens (online accident recording), significant incident form or Medication Administration Record (MAR).

2. Allergies

A specialist allergy nurse/consultant will help develop a Health Care plan which should be shared with all agencies working with the child or young person.

The Care and Placement Plan and Health Care Plan should contain the following:

All known allergies and associated risks including spotting the signs and symptoms of an allergic reaction and anaphylaxis for the child oryoung person;
Preventative measures should be detailed in the Plan - for example taking daily antihistamines for hay fever, making sure cleaning products and gloves are hypoallergenic, and washing powder is suitable for skin conditions;
Actions to take when a child or young person has an allergic reaction. The plan should describe exactly what to do and who needs to be contacted in the event of an emergency. For example, when to use an EpiPen and calling for an ambulance;
All staff should be aware of the Plan and should have been trained to administer an EpiPen by a suitable qualified health professional;
The child or young person should be educated around their allergies and what to do in an emergency - a young person may be able to self-administer their own EpiPen or take antihistamines. If this is the case this should be recorded;
Medication should be easily accessible so staff and/or the child or young person can access their medication in an emergency situation;
A record should be kept of each episode and any medication given should be recorded on Medication Administration Record (MAR) sheet.

For further information please contact the child or young person’s health professional who deals with their allergies and check the NHS website or see Allergy UK Website.

3. Home Remedies

Home Remedies are medicines that can be bought over the counter, including Paracetamol*, homeopathic, herbal, aromatherapy, vitamin supplements or alternative therapies.

If a young person has capacity and there are no safeguarding issues, they may be permitted to 'self-administer' Home Remedies. This would need to be approved by their social worker, with the agreement recorded in the Placement Plan.

Home Remedies can only be used by the child or young people in the home with the approval of relevant social workers (as set out in children or young people's Placement Plans) and the person/s with PR, or as prescribed by a General Practitioner (GP) or from guidance from the pharmacy.

Home Remedies must be purchased from the pharmacy. Advice should be sought from the pharmacist when purchasing an unprescribed Home Remedy.

Unprescribed Home Remedies can only be used once authorisation has been sought from the Home's Manager.

Home Remedies should be purchased for a named individual child or young person and booked in using a Medication Administration Record (MAR) sheet. If the Home Remedy is unprescribed, this must be booked in by the Home's Manager or by a senior staff member following the authorisation of the Manager.

When a Home Remedy container is opened, staff should record the date of opening to ensure it is not kept beyond its expiry date.

Each time an unprescribed Home Remedy is administered, the first dose must be reported to the manager. This is to support the monitoring and reviewing of continued use without advice from the General Practitioner (GP).

Consideration should be given as to how long a child continues to use Home Remedies before they arrange to see their General Practitioner (GP).

Recording: The administration of any Home Remedies must be recorded in individual child or young person's Medication Administration Record (MAR). The Home Remedy advice sheet must be followed. Particular attention must be paid to the dosage and administration guidance, including how long the child oryoung person can continue taking the Home Remedy before a General Practitioner (GP) appointment should be made. This will differ depending on the Home Remedy.

*Paracetamol must not be given for more than three consecutive days without the advice and guidance being sought from a General Practitioner (GP)/Medical Practitioner/Pharmacist.

For further advice on what a pharmacist can support with please see: How pharmacies can help (NHS).

4. Key First Aid and Medication Records held in the Home

Each home should keep the following records:

Caption: Each home should keep the following records
Record	Purpose
Significant Incident Form	To record any administration of First Aid that has required subsequent hospital admission, or to record a medical error.
Oshens Forms	To record any accidents or incident including assaults.
Medical Record	Individual record for each child, details of health-related issues, medication used, name of General Practitioner (GP).
Medication Administration Record (MAR)	Individual record for each child or young person to record any medication (or Home Remedies) administered etc.

For detailed information about controlled drugs (such as morphine, pethidine, methadone and Ritalin) see Care Quality Commission CQC information on Controlled Drugs.

4.1 Ordering Ongoing Medication

Some children and young people will have prescribed medication, which is ongoing. This should be ordered on a regular basis where possible, such as a repeat prescription. Responsibility for ordering these medicines is that of the individual child or young person's keyworker with the home's manager having overall responsibility. This may be delegated to a specific/member of staff.

When ordering a repeat prescription staff should check stock levels. To minimise wastage and reduce risks of errors, stock levels should be kept to a minimum (No more than six weeks stock to be held at any time).

4.2 Collecting Prescriptions

Depending on the purpose of the home and its location, local arrangements may be in place for electronic ordering or collection of repeat prescriptions, including the provision of medication in blister packs as necessary. Where staff collect prescriptions from the General Practitioners (GP)/surgery they should make sure that they have received all the prescriptions they have ordered and the quantities are correct before taking to the Pharmacy. If a medicine has directions of 'as directed' or 'as before' then the surgery should be asked to amend the prescription. Staff should check with the Pharmacy as to when the prescriptions will be ready for collection.

As part of preparation for adulthood some young people may be encouraged to collect their own prescriptions. This should be written into their independence plan.

4.3 Receiving/Collecting Medicines

Staff in homes providing short breaks will be receiving supplies of medication from parents or carers, but these procedures apply.

Staff must take their ID when collecting medicines or controlled drugs from the Pharmacy.

When the medicines are collected or received from parents/carers, staff should check that the details of the medication are correct. The medication should be properly labelled with a dispensing label. This should include the name of the young person, the details of the medication and how the medication should be taken. Any discrepancies should be brought to the attention of the Pharmacy and rectified as soon as possible.

No prescribed medication should be administered if a dispensing label is not on the medication. It may be that a child or young person arrives at the home in an emergency and medication is not in its original packaging. Medical advice should be sought via the Crisis Mental Health Helpline, the G.P. or NHS 111 before administering the unlabelled medication. A new supply of labelled medication should then be ordered. Medicine prescribed to one child or young person must never be administered to a different child or young person.

Medication records must provide clarity on when certain medication should not be taken in conjunction with other types of medication.

The Pharmacy will be able to give, and advice should be sought upon:

Potential side effects;
Advice on how the medicine should be taken;
Advice on whether the medicine may be affected by any other medicines;
Advice on any impact of a child or young person's illicit substance or alcohol use;
Whether the medicine should be stored in the fridge;
If the medicine is a controlled drug.

If advice is needed between the hours of 11pm and 8am, this will be sought from NHS 111 or the Crisis Mental Health Helpline, who will be able to make contact with the on-call consultant.

Staff should also make sure that they have received a Patient Information Leaflet from the Pharmacy, this is usually in with the medication.

The receipt of medication should be recorded on the individual child or young person's Medication Administration Record (MAR). If a Controlled Drug has been prescribed, 2 staff are required to record/sign the child or young person's record and the Home's medication log. This will be checked by a member of the management team.

4.4 Administration

NOTE: all staff must be familiar with the following detailed guidance on the administration of medication:

Caption: Guidance Required
Guidance Required	Where to find it
For detailed guidance on the administration of medication.	Appendix 1: Administration of Medication Guidance
For guidance on specific issues, e.g. refusal to co-operate, if a child or young person is missing/absent, covert administration.	Appendix 2: Specific Issues re Administration
For the administration of medication away from the home e.g. if a child or young person is on holiday or having contact with their parents.	Appendix 3: Administration away from the home
Skilled Health Tasks, e.g. for children or young people with Diabetes.	Appendix 4: Skilled Health Tasks

Medication should be administered as set out on the label or instructed by the General Practitioner (GP)/Medical Practitioner.

No child or young person may be permitted to 'self-administer' unless approved by their social worker, with the arrangements outlined in the Individual Placement Plan. A self-administration risk assessment should be completed for each medication which should be reviewed regularly.

Administration should be recorded on the individual child or young person's Medication Administration Record (MAR), if a Controlled Drug has been administered, 2 staff are required to record/sign the record.

4.5 Storage and Expiry Dates

Medicines kept in the Home must be stored in a secure place so as to prevent any child or young person from having unsupervised access to them.

All medicines (including controlled drugs) must be kept in a safe/secure place, e.g. a locked cabinet that does not exceed 25 C. A key to this cabinet should be accessible by the responsible member of staff on duty.

Access to controlled drugs will be closely regulated and monitored by the team manager or assistant team manager. Receipt of medication to be recorded in the controlled drugs book.

Medicines that are taken internally should be stored separately to those used externally in the medicine cabinet, with liquids preferably on the bottom shelf.

*Medicines that require refrigerated storage should be kept in either a dedicated lockable fridge (in the staff office) or a locked box inside the food fridge, where children and young people will not have unsupervised access.

All medication for one child or young person should be stored together, physically separate from other children or young people's medication.

No more than 400ml of any flammable liquid such as surgical spirit should be stored in the medicine cabinet.

All medicines have expiry dates, usually clearly stated on the label, upon expiry, they should be disposed of, see below.

4.6 Disposal

Medication should be disposed of when:

The expiry date has been reached;
The course of treatment is completed;
The medication has been discontinued.

Unless instructed by a General Practitioners (GP)/Pharmacy, unused/expired medicines should be returned to the pharmacy, and a receipt obtained.

Return or disposal of medication should be recorded on the individual child or young person's Medication Administration Record (MAR), and the receipt attached, if a controlled drug has been disposed of, 2 staff are required to record/sign the record. Disposal of Controlled Drugs must be recorded in the Disposal of Medication record with the receipt firmly attached.

If a child or young person leaves the home any medication will be given to an appropriate adult i.e., social worker and they will be asked to sign for receipt of these.

5. Appendix 1: Administration of Medication Guidance

All staff are required to attend training on Handling and Administering of Medication bookable via MyLearning before handling or administering medication, this course must be refreshed every three years.

Medication prescribed for one child or young person must not be given to another.

All medicines must be administered strictly in accordance with the prescriber’s instructions (or as advised on the packet in relation to Homely Remedies). Only the prescriber (e.g. General Practitioners (GP)) can vary the dose. Medicines must be locked away in the locked storage areas when not in use. Before administration, staff should:

Wash their hands;
Make sure they have a pen and any required record sheets;
Enough glasses for each young person receiving medication;
A jug of water.

The procedure for administration is as follows:

Only one child or young person should be administered medication at a time, this reduces the risk of mistakes being made;
Check the child or young person's medical profile;
Check the medication on the individual medication records corresponds with that on the child or young person's medical profile;
Check the Individual medication record sheet to ensure that someone else has not already given the medication;
Check the expiry date and use by date (where appropriate) on the medication;
Check the amount to be given at that time;
If opening a new container, add the date;
Measure or count the dose without touching the medicine;
If the medicine is a solid (such as a tablet) then carefully place into an appropriate container and offer to the child or young person. They may wish to put it in their hand or swallow straight from the container;
If the medicine is a liquid, take care not to drip onto the label. If the amount to be measured is less than 5ml, then use a medicine syringe otherwise use a medicine spoon or measure as preferred by the child or young person;
If the medicine is a cream or ointment, then it should be squeezed directly onto the child or young person's finger for them to apply. If required to be applied by staff, then latex/pvc gloves must be worn;
When administering a controlled drug, a second member of staff, must check the dose prior to it being administered;
Watch the child or young person as they take their medicine to ensure administration is successful;
Offer the child or young person a drink of water (where appropriate);
Check that the medication is recorded in all the required records including Medication Administration Record (MAR) sheet and Daily Observations;
Print and sign your name against date and time of each medicine administered;
Record when medicine has been refused / not taken and the reasons why;
If a child or young person is absent when medication is due - this should be recorded;
Do not sign for any medicines that you have not administered or witnessed yourself;
If a child or young person refuses to take medication, under no circumstances should they be forced to do so;
Medication must be kept in the original labelled (by the Pharmacy) containers and not put into weekly/daily medical boxes;
After administration the medicines should be returned to the cabinet immediately and the cabinet locked;
Each time you give medication, remember that it is important to consider the time of administration. Care should be taken to ensure that if the medicine is required to be taken before food, that this is done. Similarly the administration of some medicines such as eye drops or inhalers may not be suitable to be given at meal times. Not all medicine administration times will fall in line with meal times.

6. Appendix 2: Specific Issues re Administration of Medication

Swallowing Problems

Staff may find that some children or young people may struggle with swallowing their medicines. The child or young person's G.P should be contacted for an alternative. Under no circumstances should staff take it on themselves to crush tablets without seeking advice from the G.Por Pharmacist. Any advice given should be recorded.

Medication Refusal

When a child or young person refuses to take their medicine, then the G.P. or Crisis Mental Health Helpline should be contacted for advice on the first occasion. It should be written into their placement plan what action should be taken in the event of refusal to take prescribed medication including the effects that staff should look out for and when medical advice must be sought. This information must be recorded and followed. Children and young people cannot be forced to take their medicines.

If a Child or Young Person is Absent when the Medicine is Due

When a child or young person is absent and their medication is due, this should be recorded. When the child or young person returns, then staff must consider the time delay and seek advice if required from the Pharmacist, the G.P or NHS website (as appropriate depending on the time of day). Any advice should be confirmed in writing. To miss taking a medicine completely can be dangerous depending on the medical condition.

Covert Administration

Covert administration is where a medicine is hidden in food and the person does not know that they are taking it. Staff must not hide any medicine in food or perform any other types of covert administration. If there is concern about the impact of persistent refusal of medication and the capacity of the child or young person to make this decision, consideration should be given to whether a Best Interests meeting should be held.

Lone Working

On occasions staff may be required to work on their own for a period of time. It may be the case that the administration of a medicine will have to happen during this period. Staff should ensure that they double check for themselves and make a record of any medical administration required during the period of time for when they were lone working.

This can be a problem when administering controlled drugs. It is important that the child or young person receives their medicine at the correct time therefore the member of staff administering the medicine, must also record that they were lone working in the register. It is not acceptable for another staff member to sign the register when they come in. You cannot be a witness to something you have not seen happen. The on call manager should be consulted for advice and may witness the process via video link.

Spilled Medicines

When a medicine has been dropped on the floor or spilled then this must be safely disposed of and a note must be made in the records. A second dose should be offered to the child or young person (where a medication has spilled, leaving the remainder short for the completion of the course of the prescription, advice should be sought from the NHS 111 or the G.P as to how to make-up for the lost dosage).

When medicine has been spat out then this medication must be cleared away following the correct procedures and a note made in the records. However, a second dose must not be offered, as staff will not know how much has been absorbed. If this persists the G.P should be contacted.

Detached or Illegible labels

If a label becomes detached from a container or is illegible, then staff must seek advice from the Pharmacist. Until this advice is received then the container should not be used.

Secondary Dispensing

Staff must ensure that medicines stay in the containers supplied and labelled by the Pharmacist. Medicines must not be placed in daily or weekly medicine trays.

Medication Errors

In the event of an error being made in the administration of any medication, advice must be sought from the Crisis Mental Health Helpline, the child or young person's G.P. or another medical practitioner/ help line (e.g. NHS website) immediately or as soon as the error has been discovered. Staff must record the advice that they have been given which should be confirmed in writing. A medication error must be recorded on a significant incident form and a copy sent to the social worker and a copy kept on the child or young person's file in the home.

Verbal Alterations

There may be times when it is necessary to stop or change the dose of a child or young person's medication without receiving a new prescription. Verbal requests to change medication by the G.P must be confirmed in writing before any changes are permitted. These changes must be recorded on all relevant medication records including the Individual Medication Record in the child or young person's file. Staff must note the change, the name of the Doctor, the time the confirmation of alteration was received and the date. Staff must not alter the dispensing labels. A note may be added saying 'Refer to record for new instructions'. Staff should check the next prescription to make sure these new changes have been implemented.

Adverse Drug Reaction

Any adverse drug reaction or suspected adverse drug reaction should be reported to the G.P before further administration is considered. Advice should be sought on whether the medicine should be stopped, or the treatment carries on. Staff must record the advice that they have been given indicating the date and time and authorising Practitioner.

Drug Recalls

When a Drug Recall Notification is received then staff should check the medication to see if the Home is holding any stock. If there is none in stock then the notification should be signed, dated and filed for reference.

When stock if found that is listed on the drug recall, then staff must follow the directions given after isolating the stock.

7. Appendix 3: Administration Away from the Home

8. Appendix 4: Skilled Health Tasks

This applies to specialist or skilled healthcare tasks, for example:

For diabetic children or young people;
Physiotherapy programme;
For the use of Buccal Midazolam;
For the use of Rectal Diazepam.

If a child or young person requires a skilled health task to be undertaken, this will only be carried out by staff, and as set out in a Placement Plan or other written Health Care Plan.

Appropriate training will be provided, together with written guidance, as to how the skilled tasks will be performed and recorded.

9. Appendix 5: Guidance: Intentional Overdose

If an overdose is suspected, hospital treatment should be sought without delay. Staff should try to find out what the child or young person has taken and if possible take a sample to give to a medical practitioner. Staff should give any empty packets, boxes or containers to medical professionals.

Possible signs of an overdose:

Mild nausea/vomiting;
Paler skin;
Blue lips or fingernails;
Not waking up or reacting to a loud noise;
Shallow or disrupted breathing;
Gurgling, snorting or snoring /choking sounds;
Slow or very faint pulse.

It can take a long time between taking the substance and the first signs of an overdose; children or young people may verbally 'boast' about having taken an overdose: even when there are no signs, but staff must consider that there is a chance an overdose has been taken and they must act in caution and seek medical attention.

What to do if someone is reacting to an overdose:

Lie them on the floor;
Put them in the recovery position;
Call the ambulance - 999 - inform the operator of the overdose;
Do not leave the child or young person alone, make sure they don't roll onto their back;
Inform the ambulance team what the child or young person has taken; try to gather all the packaging you can find;
Get some help, keep other children and young people away (but don't dismiss any valuable information that they may be trying to pass on to you).

DON'T

Walk the child or young person around;
Put the child or young person in a cold bath/layer them up to heavily to generate warmth;
Give them a drink.

Recording and Review

Please refer to the Self-Harming and Suicidal Behaviour Procedure.

10. Further Information

Last Updated: January 26, 2026

v96