Beyond Limits (Plymouth)

Beyond Limits (Plymouth) provides a supported living service to people living in their own homes. The service specialises in providing 'bespoke' packages of care for adults with learning disabilities, autistic spectrum disorders, mental illness, or physical disabilities. At the time of this inspection the service was supporting 19, eight of whom required support with personal care. Everyone supported by the service lived individually in their own home. Where people required support 24 hours a day, facilities were available for staff, such as a bedroom for those who slept-in overnight.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service and what we found

Beyond Limits (Plymouth) was a truly person-centred service. Empowerment, respect and protecting people’s rights as citizens were the driving force behind the service’s ethos of how people should be supported. People were involved from the first time they met with the provider and registered manager to develop the support network they needed to live successfully in the community.

Beyond Limits (Plymouth) provided a dedicated team of staff for each person, supported by professionals, to ensure people could live their best life. The service was determined to overcome the barriers and discrimination people had faced to living an ordinary life in the community. One professional told us, “I think they are an excellent provider, their particular strengths are including people and their families in their support, they are creative and very individualised” and another said, “They are able to see the potential in people that others would not.”

People received a service that was exceptionally personalised. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensured that people who used the service could live as full a life as possible and achieve the best possible outcomes that included control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent. Consistent care and support from well-trained staff, who had been individually chosen by people, was seen as important to develop trusting relationships between people and their staff team. People knew they could trust how staff would respond to them and they could rely on them for safe support. The service recognised this as being essential to people’s success. People told us how positively their lives had improved since being supported by the service. For example, some people no longer required medicines to help them cope with their anxieties, other people who had previously experienced physical interventions to manage their behaviour no longer required this, and others were able to undertake educational courses and/or find employment.

The service placed a strong emphasis on assessing and managing risk to support people’s positive risk taking to increase their confidence and independence. The service used innovative ideas to support people’s development including the use of technology through developing interactive websites. One professional told us, “The focus is always on enhancing quality of life and community links, but they are still mindful of safety, but this does not deter them from working with the person to achieve important goals”

The service continued to work closely with other professional and national organisations to promote and demonstrate how successful individualised, person-centred support can be, especially for people who in the past had been considered the most ‘challenging’. The service encouraged people to share their success with other professionals to influence how services could be developed for people with complex support needs. For example, one person went to national conferences for professionals to describe their support and how successful it had been.

The service saw itself as a learning organisation with a willingness to reflect on what went well for people and where the service needed to adapt and improve. A member of staff told us, “If there is a challenge everyone comes together to figure out how we can adapt to make something work and ensure that everyone that wants to participate can be included.”

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was outstanding (published 14 August 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Beyond Limits (Plymouth) provides a supported living service to people living in their own homes. The service specialises in providing ‘bespoke’ packages of care for adults with learning disabilities, autistic spectrum disorders, mental illness, or physical disabilities. At the time of this inspection they provided a service to nine people. This was the first inspection of this service at the present address. Beyond Limits (Plymouth) moved to the current premises in 2016, when the location was re-registered.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People who used the service, relatives, professionals and staff praised the providers and management team for their ethos, and their determination to make a positive difference to people’s lives. There was a very strong emphasis on providing a service that was person-centred and tailored to the person’s individual needs and wishes. We heard stories of how people’s lives had been transformed since they began using the service. The provider told us they aimed to ‘wrap the service around people’. They carefully assessed people’s needs before the service began. They worked with people, their families and professionals to help them draw up and agree a plan setting out how the person’s needs would be met.

People were involved in choosing and recruiting their staff team and the provider and management team constantly monitored the person’s satisfaction with the service to ensure the staff team continued to match their needs. A relative told us “She is thriving with them.” Another relative told us “There has been progress. From what he was like before he came here to what he is now there has been progress. Small steps.” They also said “We are very pleased with the staff he has.” They told us the staff were well trained and understood the person’s needs fully, saying “Staff can ‘read’ him”

People received a service that was safe. Staff were carefully checked to ensure they were suitable for the post. Staff knew how to keep people safe and protect them from the risk of harm or abuse. There were sufficient staff employed to meet people’s complex needs and to care for them safely.

People received highly personalised and effective support from the service to enable them to gain independence and remain in good health. Staff received training and support to enable them to provide an effective service to the people they supported. Staff told us they felt well-supported. Staff morale was high and staff turnover was lower than other similar services we compared them with. Comments from staff included “I admire and am proud to be a part of a company who are extremely person-centred, with a great ethos. A company that really makes an effort to support their staff, as well as they support their clients” and “I’ve felt well supported by them from an employee point of view and I feel they provide a very good service for the person I support.”

The service supported people to take positive risks. Support plans contained detailed assessments of each known risk to individuals, and there were clear instructions to staff on the procedures they must follow to reduce the risks where possible. Support plans included documents entitled “What service does the person need in order to be safe and live a fulfilling life?” These set out the wide range of activities each person had chosen to participate in, including some which may have been potentially risky. Activities such as swimming, climbing and trampolining were assessed, and measures put in place to ensure the person enjoyed the activity while at the same time being as safe as possible.

People received support with their medications that was carefully assessed and planned to ensure the person had as much control over the process as possible. Staff had received training on safe administration of medicines and understood the procedures they must follow. Medicine administration records were in place for each person that set out the name, dosage and times of administration of each medicine. There were safe procedures in place for obtaining new medicines, recording medicines on administration, and returning unwanted medicines to the pharmacy. Audits were carried out weekly to check stock levels and administration records.

People received a service that was very caring. There was an ethos of caring not only for the individual receiving the service, but also for their family, friends and staff team. The emphasis was on working with the person to carefully design a service that met their individual needs. A relative told us “We are all on the same page. (Person’s name) has her goals – what she wants to do. Staff don’t tell her what to do but work with her.” A member of staff told us “For the first time I feel that I am a valued member of a team and that my opinions and concerns will always be listened to. I look forward to coming to work as I really think we are helping the person we support to have as independent and fulfilling life as possible.”

People received a service that was highly responsive to their individual needs. When the provider received a referral for a new person they spent time and care getting to know the person, finding out how they wanted to be supported, and to help them build a ‘bespoke’ package of care. The process usually took many months to complete and often also involved supporting the person to find suitable accommodation. At the time of this inspection each person who used the service lived in their own individual accommodation they either owned, part owned, or rented. This gave people a sense of community and belonging. The provider, management team and staff worked with each person and their families and supporters to draw up and regularly review a plan (known as a working policy) setting out how they wanted to be supported. The documents provided detailed information to staff on all areas of the person’s daily routines, health and personal care needs.

The provider ran value-based training throughout the year that focussed on human rights, choice, control and inclusion. They had launched a Family Charter in the last year outlining their promises to involve families and the people they supported in all areas of the service. They told us their aim was to listen, understand and continuously improve. They had been identified as ‘leaders of best practice’ by national bodies such as NHS England and Learning Disability England. They were members of organisations such as the Citizens’ Network, Learning Disabilities England, and The Challenging Behaviour Foundation. They have set up a small group of local, like-minded organisations to share best practice

The service was well-led. The provider had systems in place to monitor and assess the service to ensure the service continued to meet people’s needs. Quality service reports were completed quarterly on the support given to each person. The reports looked at all aspects of the person’s support over the previous three months including service review meetings and planning meetings. Where the provider identified areas that could be improved they put in place plans to ensure the improvements were carried out. There was an ethos of listening to people, family friends, and other professionals, and of learning from any mistakes.