Beyond Limits (Plymouth)

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question Outstanding. At this assessment the rating has remained Outstanding. This meant services were tailored to meet the needs of individuals and delivered to ensure flexibility, choice and continuity of care.

This service scored 93 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider was exceptional at ensuring people remained at the centre of all decisions about their care, support and treatment. Staff worked in genuine partnership with people, taking the time to understand their views, preferences, aspirations and changing needs. Care was highly individualised and focused on what mattered most to each person, which ensured they were supported to live the life they chose.

Through highly personalised support and active involvement in its design and review, people were empowered to take control of their lives and pursue opportunities that mattered to them. This enabled them to achieve outcomes that had previously seemed unattainable, including making significant progress towards long-held dreams and aspirations. Staff worked alongside people to break goals down into achievable steps, providing encouragement, practical support and creative approaches to overcome barriers. As a result, people experienced improved confidence, independence and quality of life, demonstrating the provider's strong commitment to enabling people to live fulfilling, self-directed lives without being limited by traditional expectations of what they could achieve.

One person, who was autistic and had historically preferred familiar environments, often became distressed when faced with new places or experiences. Through highly personalised support, they were gradually supported to build their confidence and resilience. Working closely with their support team and progressing at a pace that suited them, they were able to achieve something that had previously been considered highly unlikely. The person successfully rode the Big Wheel in a nearby city and enjoyed the experience. This demonstrated how staff focused on people's strengths and aspirations rather than perceived limitations, supporting them to overcome barriers and achieve outcomes that were meaningful to them.

Another person, after spending many years in hospital settings, was now living independently within their community with support from their team. They were making decisions about their own life and enjoying opportunities important to them, including going on holidays, attending church and taking part in pamper sessions.

A further person, who had previously required 24-hour support, had developed greater independence and was now supported for around 10 hours each day. They were in a committed relationship and enjoyed cooking, spending time with their partner and going on holidays together.

These achievements demonstrated the provider's commitment to person-centred support and positive risk-taking. By focusing on people's strengths, aspirations and potential, staff enabled individuals to overcome barriers, expand their experiences and achieve meaningful outcomes that significantly enhanced their independence, wellbeing and quality of life.

The provider demonstrated an exceptional understanding of the diverse health, care and wellbeing needs of people using the service, enabling support to be highly personalised, coordinated and responsive. Staff and leaders were committed to ensuring people received the right support at the right time and consistently advocated on behalf of individuals to overcome barriers to accessing services, funding and community opportunities.

There was a strong culture of advocacy across the organisation. Staff worked tirelessly to ensure people were not disadvantaged by limitations within local systems and challenged obstacles that could impact people's independence, wellbeing or quality of life. Leaders and staff demonstrated a determination to secure the best possible outcomes for people, even when support was difficult to access.

Staff worked proactively and collaboratively with healthcare professionals, local authorities, funding bodies and other external partners to ensure support was effectively coordinated around people's needs and aspirations. Feedback from professionals demonstrated the high regard in which the service was held and reflected the positive impact staff had on people's lives.

A local authority professional told us, "Although our relationship is contractual, Beyond Limits deliver support akin to personal budgets. Not in financial terms, but by keeping the person at the heart of the support and approaches they take. The level of risk they confidently manage is exceptional compared to other market providers." Other feedback described the provider as "an experienced and skilled provider to manage a high level of risk" and commented, "They go above and beyond, never giving up on the person. The commitment they demonstrate to the person receiving support is outstanding."

The provider demonstrated an exceptional commitment to developing and presenting information in formats tailored to each person's individual communication needs, preferences and level of understanding.

People's communication needs were clearly assessed, documented and regularly reviewed, with information provided in a range of accessible formats including easy-read documents, photographs, symbols, colour-coded systems and digital tools. Everyone was offered an accessible version of their Service Design, although the provider recognised and respected some people either did not require one or found personal documentation distressing. Where accessible information was used, it was designed around the individual's preferences. For example, some people chose photographs alongside brief written information, while others used photographs alone to create personalised stories with staff.

The provider consistently adopted creative and innovative approaches to communication. Bespoke tools were developed to meet individual needs. For example, one person used a QR-code system linked to their smartphone, allowing them to decide when and where staff met them at the start of their shift, giving them greater choice, control and independence. Another person used a newspaper-style communication format that enabled them to receive information in a way they found engaging and meaningful. Staff told us, “We do a newspaper for them around issues they are having or will make a fun little article about why some things are better for you than others.”

Accessible information and surveys were adapted according to individual preferences, recognising that a one-size-fits-all approach was not appropriate and that some people preferred less visual methods of communication.

The service was further strengthening this area of practice through work with an Accessible Information Champion to develop accessible information about the Fundamental Standards, helping people better understand their rights and the quality of care they should expect. Staff also received training in the use of clear, accessible and non-clinical language. Feedback and observations demonstrated that personalised communication was embedded throughout the service, promoting inclusion, involvement and meaningful participation in decision-making. This approach ensured people could access information in ways that made sense to them, supporting their autonomy and enabling them to play an active role in their care and support.

The provider made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff involved people in decisions about their care and told them what had changed as a result.

The provider demonstrated a strong commitment to partnership working, placing people and their families at the centre of decision-making and ensuring they were actively involved in shaping support. Guided by the principles of the Family Charter, which emphasised listening, valuing people, working together, learning from mistakes, providing support and never giving up, the provider fostered trusting and collaborative relationships. Families were involved in developing the charter, reflecting the organisation's commitment to co-production.

People and their families were encouraged to share their views through annual surveys, bespoke planning days and ongoing conversations with staff and leaders. The provider recognised the importance of accessible engagement and was exploring new ways to increase participation, including digital and accessible survey formats. Clear information about rights, expectations and complaints processes was provided through support agreements.

There was a strong culture of openness, transparency and responsiveness throughout the organisation. Leaders maintained a visible presence in people's lives, operated an open-door approach and encouraged feedback, concerns and constructive challenge. Relatives described managers and directors as approachable, accessible and willing to listen. Concerns and complaints were welcomed as opportunities to learn and improve, with robust oversight by the Registered Manager ensuring issues were investigated appropriately, Duty of Candour requirements were met, and learning was embedded into practice.

Relatives were generally positive about communication and responsiveness, describing leaders as accessible and willing to listen. One relative told us, “I can pick up the phone, and they will get back to me. Even if it’s right at the end of the working day. They are very accessible.” Another relative described how they had challenged the cost of work phones for staff after identifying a better value option and felt their views had been listened to. During the assessment, where some relatives expressed concerns regarding a change in company ownership, the registered manager acted immediately to address these concerns and provide reassurance.

The provider also actively sought feedback from staff through engagement surveys and other forums, using this information to drive continuous improvement. Overall, the organisation demonstrated a culture of accountability, collaboration and continuous learning, where people, families and staff were valued partners in shaping and improving services.

The provider was exceptional at ensuring people could access the care, support and opportunities they needed, recognising and actively addressing barriers that could prevent people from achieving positive outcomes. Staff demonstrated strong advocacy, working persistently with healthcare services, local authorities and other agencies to challenge inequalities and secure access to specialist support, housing and community opportunities.

The provider recognised the difficulties some people faced when accessing mental health services, specialist interventions and suitable housing. Staff worked proactively to ensure people's needs were understood and responded to. For example, one team collaborated closely with a Private Case Worker (PCW) to secure access for a person to mental health and psychology services that were not available from their local authority. The PCW also developed a detailed report that helped professionals better understand the person's needs and experiences, promoting a more coordinated and person-centred approach.

Leaders described the significant challenges involved in securing appropriate social housing and worked alongside partner agencies to navigate complex systems and advocate on people's behalf. Once accommodation was secured, people were supported to gradually personalise their homes and create environments that reflected their preferences and promoted a sense of ownership and belonging.

People were also supported to access employment, education, volunteering and meaningful community opportunities. One staff member described supporting a young person who had become socially isolated following the COVID-19 pandemic. After expressing a wish to have a job, the person was supported to take on a role as a health and safety inspector within the provider's office. Staff described the significant positive impact this had on the person's confidence and wellbeing, with the person telling them, “This gives me happiness inside.”

These examples demonstrated the provider's commitment to removing barriers, promoting inclusion and ensuring people had access not only to essential care and treatment, but also to the opportunities that enhanced independence, confidence and quality of life.

The provider demonstrated an exceptional commitment to understanding and responding to the diverse needs, experiences and aspirations of people, particularly those at risk of inequality, exclusion or poorer outcomes. Staff took time to understand each person's history, strengths, communication needs, preferences and experiences of trauma, using this information to provide highly individualised support that promoted positive outcomes and maximised opportunities.

People experienced significant and sustained improvements in their quality of life, wellbeing and independence. Many had successfully transitioned from long-term institutional settings into fulfilling lives within their local communities. Relatives spoke positively about these outcomes, with one describing their family member as “much more independent” and another saying they had “come a long way… making their own choices.”

Staff promoted choice, autonomy and positive risk-taking through shared decision-making, accessible communication and tailored support. This enabled people to develop confidence, build new skills and achieve outcomes that were meaningful to them, including employment, education, relationships, hobbies and community participation. Flexible funding arrangements and creative approaches to support helped ensure opportunities were based on people's aspirations rather than service limitations.

The provider actively promoted inclusion and belonging. People contributed to a social committee that planned events and activities for both people using the service and staff. They were encouraged to take leading roles, including running arts and crafts workshops, creating artwork and promotional materials, and helping to organise community events. Activities such as Christmas celebrations, and planned events including a magic show, brought people, families and staff together, strengthening relationships and community connections.

Staff and leaders consistently challenged discrimination, inequality and barriers to opportunity, advocating for people within healthcare and wider systems to ensure they received fair access to services and support. Feedback, observations and outcomes demonstrated people were empowered, confident and achieving personal goals that mattered to them. This reflected a culture of sustained and embedded outstanding practice, where people were supported to live meaningful, self-directed lives and achieve outcomes that exceeded traditional expectations.

The provider supported people to plan for significant life changes and make informed decisions about their future. Planning was personalised, with staff using creative, accessible approaches to help people understand complex information, express their wishes and remain at the centre of decision-making. Through structured planning days, regular reviews and ongoing conversations, people were supported to reflect on their achievements, identify goals and plan for important milestones such as employment, relationships, holidays and greater independence.

Staff approached future planning with compassion, recognising that discussions about major life events and end-of-life wishes could be sensitive and emotional. An End of Life Lead was in post, with plans to further strengthen this area through additional leadership capacity. Staff understood the importance of having these conversations at the person's own pace, allowing time for reflection and ensuring choices were genuinely informed rather than rushed. They also recognised the impact such discussions could have on families and worked sensitively with everyone involved to ensure people and those important to them felt supported, listened to and respected throughout the process.

This person-centred approach ensured people were empowered to make decisions about their future and supported to achieve outcomes that reflected their individual wishes, values and aspirations.