Issue 11: Promoting sexual safety

People who use health and social care services should be protected from sexual incidents and kept safe.

Sexual incidents happen in all types of health and social care services and are mostly carried out by people who use services.

Sexual incidents experienced by people can include:

• verbal abuse
• sexual harassment
• sexual assault.

It is vital that health and social care services have adequate systems and processes to protect people from any kind of harm or abuse as everyone has the right to be kept safe while receiving care. If providers do not do this or ensure that staff are adequately trained, people may be put at risk and sexual incidents can happen.

Providers should also work closely with people, their relatives and staff to create a culture where sexuality and sexual safety are openly discussed. Where poor and closed cultures exist in services, people are not appropriately supported.

Prosecution by CQC

We have the power to pursue criminal action, including prosecution, and hold registered providers and staff to account where people using a service are harmed or exposed to a significant risk of harm. We use these powers several times each year.

We recently prosecuted a care home provider and a registered manager for failing to protect a resident from avoidable harm.

A man had been a resident at the care home since January 2018. In April, a social worker spoke to the registered manager and told her that the man was on the sex offenders register and had committed a sexual offence as well as other offences.

Two months later, the man sexually assaulted a resident in her 70s with dementia. Police were called and the man was arrested and later convicted.

At prosecution, both the provider and the registered manager were found to have failed to take all reasonable steps to protect people. This included failure:

• to have effective policies and processes, regarding admissions and risk assessment, as well as decision-making processes
• to adequately carry out risk assessments with other health and care organisations to protect people from harm or abuse
• to manage any risks posed.

The court ordered the registered provider to pay:

• a £128,000 fine
• costs of £10,645
• a victim surcharge of £120

The court order the registered manager to pay:

• a £1,000 fine
• costs of £15,067.05
• a victim surcharge of £100

What happened next?

Soon after the incident in 2018, we carried out a comprehensive inspection of the care home and found the service required improvement against almost all key questions:

• The service was not safe because people were not always protected from harm because risks around relationships were inappropriately assessed and managed. There had been a high level of incidents in which people were harmed or at risk of harm.
• The service was not always effective because on admission the assessment process was not always completed thoroughly and so vital information had been missed.
• The service was not always responsive, because people's care needs were inaccurately recorded in their care plans. This put them at risk of receiving inappropriate or unsafe care.
• The service was not well-led because there was no registered manager in post at the time of the inspection. The provider's governance and quality assurance systems were ineffective. These did not support achieving the best possible outcomes for people that used the service.

We also identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) relating to person-centred care (Regulation 9), safe care and treatment (Regulation 12), and good governance (Regulation 17). We asked the provider to send us a report to say what action they were going to take. They told us they would ensure a new team was put in place who were dedicated to leading on improvements needed within the service. A senior manager was also assigned to the service to oversee and monitor improvements. The quality of the actions taken were monitored regularly through an improved governance system operated by the provider.

On our following inspection, we found improvements had been made, and the provider was no longer in breach of regulations.

The new management team had been put in place and this meant the service was well managed. The issues we identified previously had all been addressed and improvements were embedded. Staff told us they felt better supported and people using the service and their relatives told us they felt listened to.

What can you do to avoid this happening?

In 2020 we published a report, Promoting sexual safety through empowerment because people who use services and their families told us of their shocking experiences of sexual abuse in adult social care. The report also aims to encourage a conversation about sexual safety, sexuality and respectful relationships so that all people, including staff, feel empowered to talk about sexuality and raise concerns around safety where necessary.

Our 2019 guidance, Relationships and sexuality in adult social care services, covers a range of issues, like diversity, supporting people to form and maintain relationships, and helping them to understand risks.

Skills for Care have produced Supporting personal relationships guidance and further resources to help employers think about what staff need to know and understand about personal relationships, and how they can create a workforce development programme for their organisation. This is also discussed on our accompanying podcast.

The Royal College of Nursing's Older people in care homes guidance has been developed to help nurses and care staff work effectively with issues of sexuality, intimate relationships, sexual expression and sex, particularly for people living in care homes.

Hourglass provides a confidential helpline to support an older person, or anyone concerned about an older person who is at risk of, experiencing or recovering from any form of abuse or neglect.