This inspection was announced and took place on 24 May 2017 and 7 June 2017. The provider was given 48 hours’ notice because the location provides a personal care service for younger adults who are often out during the day. We needed to make sure the registered manager and their staff team were available to meet with us. We also wanted to meet with people who used the service, their families and members of their staff team to hear their views about the service. 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.