There has been recent media attention in relation to sexual safety of service users in care homes following the case of CQC v Hillgreen Care Limited , where the provider was fined £300,000 for failing in its duty to protect service users in its care, exposing them to the risk of sexual abuse. District Judge Susan Williams also awarded CQC £141,000 in costs.
This Ridout Report considers what the regulations say about protecting service users from risks and CQC’s position on sexual safety in care settings and practical steps providers can take to reduce risks.
CQC v Hillgreen Care Limited 
In the case of CQC v Hillgreen Care Limited, the provider delivered supported housing for young adults with learning disabilities. CQC brought the case against Hillgreen Care Limited for not providing the constant, one-to-one supervision required for a service user who the prosecution said was an ‘opportunist sexual predator’ and that this was obvious from ‘all the information provided to the Defendant, including a current care plan and risk assessments.’ The consequence of this failure was that the service user had sexual intercourse with two service users in the Home with neither of them having the capacity to consent to such intercourse.
The provider was found to be in breach of Regulation 12 and 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was on the basis that it failed to provide care and treatment in a safe way for service users under Regulation 12. Contrary to Regulation 13, the provider failed to put in place and effectively operate systems and processes to protect service users from harm, including sexual harm, which resulted in avoidable harm to service users.
CQC’s position on sexual safety
Commenting on the judgement, CQC’s Chief Inspector of Adult Social Care, Andrea Sutcliffe said: “As the judge has made clear, Hillgreen Care Limited utterly failed in their duty of care for the people they were responsible for supporting… It has taken a long time to bring this prosecution to a conclusion but the outcome proves that it has been worth the effort and dedication of CQC’s inspection and legal teams. Providers should be clear that if people are exposed to harm through their failure of care we will take every step we can to hold them to account.”
CQC is clearly focused on improving sexual safety for service users in care homes and other care settings including hospitals. In September 2018, CQC published a report titled, ‘Sexual Safety on Mental Health Wards’ following concerns raised during an inspection of a mental health trust which had reports of sexual safety incidents. The report stated that, “People need to be kept safe and their privacy and dignity should be maintained at a time that, for many, is the most vulnerable point in their lives. We encourage providers, commissioners and improvement organisations to work together and take…. actions to improve the sexual safety of people who use services”.
Practical steps providers can take to reduce risks
Under Regulation 12 and 13, providers need to ensure they have efficient systems and processes in place which are operated effectively to prevent abuse taking place. If providers can show that they have taken all reasonable steps and exercised all due diligence to prevent a breach of regulations, this will be a defence to a charge where criminal liability arises.
Reasonable steps may include but are not limited to the following:
- Carrying out a comprehensive and detailed risk assessment of a service user with a history of committing sexual offences, considering and assessing the risks they might pose to staff and service users, prior to being admitted to a care home.
- Deploying enough qualified, competent and experienced staff to enable them to meet all service users’ needs and keep them safe. Staffing levels need to be sufficient to provide the required level of support to service users 24 hours a day, seven days a week.
- Staff need to receive appropriate support, training, professional development, supervision and appraisal as is necessary to enable them to carry out their duties and manage sexual safety issues.
- Care plans should be detailed – for example, specifying that a service user needs to be on one to one support 24 hours a day and the levels of monitoring and supervision required (i.e not leaving the service user unsupervised around other service users and/ or in the community).
- Have specific instructions about how to manage their behaviour and how to monitor their behaviour such as the importance of knowing their whereabouts in the Home at all times.
- Care plans should provide specific instructions about how staff should support the service user around their sexuality, how to manage their behaviour and what measures are needed to safeguard against risk (i.e the importance of knowing the service user’s whereabouts at all times).
The case of CQC v Hillgreen Care Limited, draws attention to a very important issue that all providers should take seriously, particularly if there are service users in their homes who have a history of committing sexual offences.
Providers should always carry out a proper risk assessment in advance of a placement to ensure that their staff have the competence to look after the service user in question and a provider should not feel pressurised to accept a person who presents with needs and challenging behaviour which is beyond the skill set of the home.