The Royal Commission into Institutional Responses to Child Sexual Abuse has uncovered evidence that organisations sometimes provide opportunity for the sexual abuse of children. How do organisations go about preventing this? The authors of this paper consider the case of an out-of-home care (OOHC) agency which failed to protect children. By identifying gaps in practice and culture in this case, the authors suggest that protecting children in OOHC requires a “weave” of organisational structures, staff development and cultural competence. In this case, the Chief Executive Officer (CEO) of the organisation was able to create an opportunity for access to vulnerable young people by using strategies we can now identify as grooming behaviours. He did this by using his positional power. He ignored standards, isolated protective adults and therefore children and young people, rewarded compliance, discouraged reflective practice, used his culture to avoid scrutiny from funding and oversighting agencies, and created an organisational culture of fear and secrecy. In effect, he used culture to trump safety. Even in the stressful conditions of managing an OOHC service, good practice is important, not only because it meets the standards and legislation, but because this is how services maintain the safety of children and young people in care.