I have just written a training course of sexuality and relationships in the lives of learning disabled which goes into depth about the rights of the learning disabled in this area.
One of the things I discovered whilst researching for the course was that consent must be obtained, whether that’s verbal or non verbal and that no one can make a best interest decision for the individual on this subject.
I would ask to see the care plan and any notes, there should be a record of what has taken place and by who as a minimum. If it has been written in the care plan, for medical reasons that the individual is shaved around their genitals, then with consent that should be obtained every time from the individual … think about when you’ve been in hospital, if in your own room, someone taps on the door, or pops their head around the corner and asks if they can come in, then says what they are there to do, whilst they don’t always get a verbal yes, or no answer, a nod of the head is considered gaining consent.
A reason to shave this area, could be because of sores, infections or medical apparatus such as a catheter etc. it may be a shock to realise that information sharing, i.e. telling you they’ve shaved your family member, may not be legally in their remit because information sharing must be compliant with the relevant legislation, the Mental Capacity Act 2005 is very clear on how decisions are made for adults who may lack capacity to consent to care or treatment, i.e. capacity must be assumed unless it is show someone lacks capacity through capacity assessments - which must be decision-specific. Any best interest decisions must be the least restrictive options. Under the Care Act 2014 there is requirement that care support promotes a person’s well-being, dignity and ensures that care and support respects their wishes and preferences. If intimate personal care is therefore provided, it must respect dignity, privacy and autonomy. There should be policies on intimate care within the care setting, and details of why the care is needed, what consent was obtained and who provided the care. (Health & Social Care Act 2008 and CQC Standards Regulation 10 & 11).
If you suspect shaving of private parts was done without valid consent or for non-medical/religious/cultural reasons or at least that the reason are unclear, then definitely ask to see your family members care plan and records, ask whether valid consent was obtained - every time they were shaved, even if made under best-interests - this must be documented.
If care was provided without consent or appropriate reason, then raise a concern/complaint with the health care setting, request a copy of their complaints procedure, you can escalate this under the Local Government and Social Care Ombudsman (LGSCO) if local authority or care provider fails to address issues properly.
If you suspect neglect, abuse, or breach of dignity/consent, it may constitute adult safeguarding under the Care Act and if decisions are made about care without the appropriate documentation and best-interest processes, then that may breach the Mental Capacity Act principles. You or an advocate can request full records, capacity assessment notes and the best interests decision rationale.
You can ask for an Independent Advocate if the individual does not have full capacity or involve other trusted family/carers/friends.
If after reviewing the records it is deemed that actually it was a best-interest decision and it was fully documented etc, then that care must be provided with dignity, privacy and respect for preferences.
Questions you can ask
Could I see the care plan, intimate care records and consent documentation for personal care provided to my sister?
What was the specific reason for shaving her, and was consent obtained each time (verbal or non-verbal)?
Has a capacity assessment been done (if needed) for consenting to intimate care?
Were my sister’s preferences respected — e.g. gender of staff, privacy measures, and her right to refuse?
Can you explain why this was recorded (or not) and how you ensure dignity, consent and best-interest for service users generally?
If unsatisfied with the responses, then
-
Use the provider’s complaints procedure, if it fails escalate to the local authority or LGSCO
-
Request a safeguarding adults review - especially if you suspect neglect or abuse, or repeated breaches of dignity/privacy
Hope this helps.