Controlled Drugs in Care Homes: Storage, Registers, Administration and Disposal
A practical guide for registered managers and senior carers, built on CQC’s own controlled drugs guidance: what to store, record, witness, dispose of and report.
Controlled drugs are medicines controlled under the Misuse of Drugs Act 1971 and sorted into five schedules. In a care home, Schedule 2 controlled drugs must be stored in a controlled drugs cupboard and every movement recorded in a controlled drugs register. CQC says care homes without nursing must not hold stocks of controlled drugs and can only hold those prescribed and dispensed for an individual person. Care homes with nursing can hold stocks of Schedule 3, 4 and 5 drugs without a Home Office licence, and may need a licence for Schedule 2 stock.
Controlled drugs (CDs) are where medicines management and the law meet. Errors are rarely malicious, but a missing tablet or a register that does not balance can trigger a safeguarding concern, a police liaison conversation and a CQC finding. Clear rules and a routine that never slips are the defence.
This guide follows CQC’s page on controlled drugs in care homes (last updated 7 January 2025) and points to NICE’s guidance on controlled drugs (NG46). It is specific to care homes. If you run a home care agency, the person’s medicines remain theirs and are recorded on their MAR; apply the record-keeping principles below through your medicines policy and take advice from the supplying pharmacy.
Key takeaways
- Schedule 2 drugs (for example morphine, oxycodone, fentanyl) go in the controlled drugs cupboard and in the controlled drugs register.
- Care homes without nursing cannot hold stock. Care homes with nursing can hold stock of Schedule 3, 4 and 5 drugs without a Home Office licence.
- The register is a bound book with numbered pages (or a compliant electronic register), written up the same day, never altered, with a running balance.
- Two trained, competent staff witnessing receipt, balance checks, administration and disposal is CQC-described good practice.
- You need a written policy that says what to do about a discrepancy and who to tell, including your controlled drugs accountable officer.
In this guide
- What Are Controlled Drugs, and What Are the Schedules?
- How Should the Controlled Drugs Register Be Kept?
- How Should Controlled Drugs Be Stored?
- Care Homes With Nursing and Without: Who Can Hold Stock?
- How Should Controlled Drugs Be Administered and Ordered?
- What Should You Do If Controlled Drugs Go Missing or the Register Does Not Balance?
- How Can CQC Logic Help?
- Frequently asked questions
What Are Controlled Drugs, and What Are the Schedules?
CQC explains that the Misuse of Drugs Act 1971 places controls on certain medicines and the Misuse of Drugs Regulations 2001 sort them into five schedules by therapeutic usefulness and potential for harm, with lower schedules carrying higher risk. What you must do depends on the schedule:
| Schedule | Examples CQC lists | Storage | Controlled drugs register |
|---|---|---|---|
| 2 | Morphine, diamorphine, methadone, fentanyl, oxycodone, methylphenidate, ketamine, tapentadol | Controlled drugs cupboard (unless the person is looking after their own medicines) | Yes: record every movement |
| 3 | Buprenorphine and temazepam (cupboard); midazolam, pregabalin, gabapentin, tramadol, phenobarbitone (cupboard not required) | Certain Schedule 3 drugs must be in the cupboard | Not required |
| 4 and 5 | Oramorph 10mg/5mL, zopiclone, codeine, diazepam, lorazepam, clonazepam | Not required to be in the cupboard, but must be stored securely | Not required, but keep accurate records of receipt, administration and disposal |
CQC adds that a service may choose to keep other schedules in the cupboard and register as well. Follow your service’s medicines policy.
How Should the Controlled Drugs Register Be Kept?
CQC’s requirements for the register are specific:
- It should be a bound book with numbered pages, or a permitted electronic register.
- Entries must be made as soon as possible on the same day, in chronological order.
- Entries must be legible and not cancelled, altered or crossed out. Sign and date any correction in the margin or a footnote.
- The person making the entry signs and dates it. Whenever possible, a suitably trained second member of staff should witness and sign.
- It records receipt, administration, disposal and transfer, and must not be used for anything else.
- Where a drug is prescribed for an individual, put the person’s name, the drug, form and strength at the top of the page and use a separate page for each form and strength.
- Keep a running balance for each controlled drug preparation, which makes discrepancies easy to spot.
Electronic registers must make entries attributable to the person who created them, secure, auditable (including corrections), compliant with best practice, and accessible from the home and printable. Administration is also recorded on the person’s MAR with the dose and time (see what is a MAR chart).
How Should Controlled Drugs Be Stored?
- The cupboard must meet the Misuse of Drugs (Safe Custody) Regulations 1973. Your supplier can confirm that it does.
- You do not need to put it inside another cupboard. Do not use it for other items such as jewellery or money.
- Restrict access according to need and store spare keys securely.
- CQC says there are no rules about which staff may hold the keys. Carry out a risk assessment and include the decision in your policy.
- A drug that needs refrigeration can go in a standard locked medicines fridge, ideally in a lockable box inside it with access restricted.
- A person who self-administers can keep their own controlled drugs, provided they are kept safely and a risk assessment has considered storage.
Care Homes With Nursing and Without: Who Can Hold Stock?
| Care home without nursing | Care home with nursing | |
|---|---|---|
| Stock of controlled drugs | Must not hold stock. Can only hold controlled drugs prescribed and dispensed for an individual person | Can hold stock. The register needs a separate section for each drug and a separate page for each form and strength |
| Home Office licence | Not applicable to stock | Not needed for Schedule 3, 4 and 5 stock; may be needed for Schedule 2 stock (see the Home Office) |
| Disposal of unwanted drugs | Store in the cupboard, record in the register and return to the community pharmacy for destruction; no T28 waste exemption needed | Denature before the waste company takes them; apply for a free T28 waste exemption; Schedule 2 stock destroyed in front of an authorised witness |
If you are unsure which category you fall into, see who needs to register with CQC and what a care home with nursing is.
How Should Controlled Drugs Be Administered and Ordered?
- CQC describes it as good practice for two staff to witness and sign when a home receives stock, checks balances, administers or disposes of a controlled drug. Both should be trained and competent.
- For topical controlled drugs such as transdermal patches, record the site of application and how the site is rotated.
- Prescriptions for controlled drugs are valid for 28 days from the prescription date, and the Department of Health and Social Care strongly recommends the maximum quantity prescribed should not exceed 30 days.
- You need a valid controlled drugs prescription to obtain supplies, and robust ordering so people do not run out.
What Should You Do If Controlled Drugs Go Missing or the Register Does Not Balance?
CQC says you must have a policy or standard operating procedure covering ordering, storing, administering, recording and disposal, including what to do if there is a discrepancy and who to inform. Check you hold current contact details for:
- your controlled drugs accountable officer (CDAO), from CQC’s online register of CDAOs
- your regional NHS England CDAO
- your nearest police controlled drugs liaison officer
Report incidents involving controlled drugs to your local CDAO through the controlled drugs reporting website, and tell CQC if the incident meets a statutory notification criterion (see the notifiable events list). Then record the error, check the person is safe, review the cause and share the learning. See what to do after a medication error.
How Can CQC Logic Help?
CQC Logic does not replace the bound controlled drugs register or your MAR. It supports the governance around them: a medication audit and a controlled drugs check you can add as a custom audit in the audit schedule tracker, a medication error log, a notification tracker for events you must report, and a training and supervision record so staff competency is evidenced. See plans.
Sources: CQC: Controlled drugs in care homes · NICE NG46: Controlled drugs: safe use and management
Show that controlled drugs checks happen
CQC Logic lets you schedule controlled drugs audits, log errors and track actions to closure, so you can show an inspector the checks were done and acted on. See a sample improvement plan, view pricing or get started free.
Frequently Asked Questions
What are examples of controlled drugs in care homes?
CQC lists Schedule 2 examples such as morphine, diamorphine, methadone, fentanyl, oxycodone, methylphenidate and ketamine, Schedule 3 examples such as buprenorphine and temazepam, and Schedule 4 and 5 examples such as zopiclone, codeine, diazepam, lorazepam and clonazepam.
Can a care home without nursing hold controlled drugs?
Only those prescribed and dispensed for an individual person. CQC says care homes without nursing must not hold stocks of controlled drugs.
Do all controlled drugs go in the controlled drugs register?
No. CQC says Schedule 2 movements must be recorded in the register. Schedule 3 drugs do not need to be, and Schedule 4 and 5 drugs need accurate records of receipt, administration and disposal but not a register entry, although a service may choose to register them.
How should controlled drugs be disposed of in a care home?
In a care home without nursing, store unwanted drugs in the controlled drugs cupboard, record them in the register with a witness, and return them to the community pharmacy. In a care home with nursing, stock and people’s own drugs in Schedules 2, 3 and 4 (Part I) must be denatured, a T28 waste exemption is needed, and Schedule 2 stock is destroyed in front of an authorised witness.
Does a controlled drugs entry need two signatures?
CQC says the person making the entry signs and dates it, and that whenever possible a suitably trained second member of staff should witness and sign. It also describes two-person witnessing of receipt, balance checks, administration and disposal as good practice.
Who do you tell if controlled drugs are missing?
Follow your policy. CQC says it should name who to inform, including your controlled drugs accountable officer or the police depending on the circumstances, and you report incidents to your local CDAO. Tell CQC too if the incident meets a statutory notification criterion.