Nicholas has made such significant progress that the only physical intervention technique that remains in his PBSP will be removed.

Nicholas is unable to use verbal language or augmented communication tools, however, he uses the five Makaton signs for food and can respond to some familiar verbal language. Nicholas lacks insight into his need for care, treatment, and supervision and is fully reliant on staff support and supervision to maintain good personal hygiene and wellbeing. Without the level of support and supervision he has he would be at risk of self-neglect of declining physical and mental health. Nicholas has no sense of danger and would be at risk of walking in the road and potentially into oncoming traffic without the provision of 2:1 staffing. It is recognised that without the current care arrangements, including a deprivation of liberty, Nicholas would be at immediate and significant risk in several areas including:

• Death, injury or deterioration in his physical health through non-engagement in life sustaining care and treatment.
• Deterioration in his health through non-engagement in specialist treatment and support.
• Death or injury through misadventure and poor risk assessment skills.
• A significant vulnerability to exploitation, neglect and self-injury.
• A lack of capacity to agree or disagree with his current care arrangements.

Due to the previous landlord issuing two months’ notice of eviction, Brighter Living identified a new property that provided Nicholas with a more conducive environment for progression. Nicholas’s advocate, family, social worker and support team all believed this was a home that would meet Nicholas’s interests. Brighter Living undertook transition work with Nicholas so that he could move smoothly into the new environment in September 2020.

Nicholas historically has presented with relatively frequent physical aggressive behaviour that has includes biting and hair pulling. In the last 12 months, Nicholas has made such significant progress that the only physical intervention technique that remains in his PBSP will be removed in September 2021. Nicholas’s PBSP focus’s primarily on proactive interventions to avoid challenging behaviours occurring, through the use of positive praise.

There has been absence for the need of physical restraint and the team will only be lawfully permitted to use self-protection techniques as taught as mandatory level 1 NAPPI UK Ltd training. This is a significant development in Nicholas’s life. Not only has the physical intervention need reduced but the need for chemical restraint in the form of PRN medication has also significantly reduced. He still experiences periods where it is required for periods of unmanageable anxiety (especially if unwell) but these periods are very isolated and infrequent as opposed to the more common need in the previous years. The Positive behaviour support model used has impacted on Nicholas’ ability to self-regulate and soothe.

All of these combined strategies, along with the partnership working with health services, successfully allow Nicholas to be supported to receive health care including having both Covid-19 vaccinations in 2021. This consistency has allowed for not only working with his complex care needs to be maintained but making real steps in improving his quality of life and future prospects.