The Care Quality Commission (CQC) published new guidance on 21st February 2019 for inspection teams and registered adult social care providers that sets out how care providers should consider the relationship and sexuality needs of people using adult social care services. The guidance deals with a variety of issues relating to relationships and diversity and was developed with a number of different providers and public representative bodies.
What does the CQC guidance say?
The term ‘sexuality’ is broadly defined within the guidance and incorporates a range of factors including gender identity; body image and sexual expression; and sexual orientation and experiences. It also includes clear definitions for sexual orientation and gender identity, as well as LGBT+.
The guidance stresses the importance of enabling people to manage their sexuality needs, which includes providing access to education and information to help them develop and maintain relationships and express their sexuality. There is also emphasis on the need for providers to understand and appropriately manage the risks associated with people’s sexuality needs. It sets out that an assessment of a person’s needs should include their sexual needs and that may include consideration of their previous and current relationships; sexual orientation; their understanding of sexual health; personal dress preferences; and gender identity. Whilst the CQC make clear that such information should be gathered by competent staff, it acknowledges that candid conversations may only take place once people have developed close working relationships with staff.
It also sets out further guidance on how providers can support people living with a physical disability and how they can support people with accessing dating services. For example, providers may need to assist people with arranging to meet new people or with seeking advice about how they might optimise their sex life despite their physical disability.
With regards to incidents which may occur in a service, such as unwanted sexual behaviour, the CQC makes it clear that there should be relevant policies and procedures in place to direct staff as to the appropriate action in response, such as reporting the incident to the police or safeguarding, and it emphasises the requirement for providers to investigate and report on any incident in a timely and appropriate way.
Overall, this guidance covers very sensitive topics that are often quite complex and require a substantial degree of sensitivity and understanding. This guidance will hopefully assist adult social care providers in supporting people with their relationships and to appropriately manage and understand the associated risks moving forwards.
What does this mean for adult social care providers?
This is the first time that the CQC has published guidance on meeting people’s sexual needs and it is therefore likely to receive a lot of focus during inspections moving forwards. A failure to suitably assess; support; and manage a person’s sexual needs could impact on an inspector’s findings during an inspection and the resulting ratings, which in the most serious of cases, could lead to enforcement action.
Providers should ensure that they have considered this guidance carefully to ensure that they understand their requirements in respect of assessing people’s sexuality needs. In particular, it may be helpful for providers to review Appendix 1 to the guidance, which sets out how people’s sexuality needs fit into the Key Lines of Enquiry (KLOEs) and the evidence which may be sought to assess whether a service is meeting their needs. For example, inspectors may look at care plans; feedback from people and relatives; and staff knowledge when determining whether people’s care plans reflect their holistic needs, and whether they are encouraged and supported to make and maintain relationships.
Inspectors are likely to direct specific questions to providers, managers and staff about how a service meets people’s equality and diversity needs and supports them in meeting their sexuality needs. The CQC sets out 11 example questions at section 16 of the guidance, which providers should give particular consideration to prior to any inspection.
Staff training is also an important consideration and providers should ensure that staff receive ongoing training on sexuality and relationships. In addition, providers should ensure that such training is covered in detail within a new member of staff’s induction to a service. Training on equality and diversity is also essential to support staff’s understanding of this area and should be regularly updated, as well as training on identifying the risk of exploitation and abuse and how to report such incidents.
At Stephensons, we have a team of specialist CQC lawyers who provide advice and representation to providers and managers in the adult social care sector in relation to compliance; inspections; and enforcement action. If you require any advice or assistance, you can call us now on 01616 966 229.