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About Us

Nature of the business:
Specialist Domiciliary Care and Residential Service for Adults with Complex Mental Disorders

Treherne Care and Consultancy Ltd was founded by the late owner Mrs Moya Treherne in 1999. Mrs Treherne started primarily with the Consultancy aspect of her business, commissioned by Mental Health Law Solicitors to conduct assessments and produced reports on individuals who had applied for Mental Health Review Tribunals. Another aspect of the business was providing holidays for adults with enduring Mental Health problems or those with a Learning Disability in Tremora cottage next to Mrs Treherne’s home.

Moya wanted Treherne Care services to be about offering opportunities for those with Complex Mental Disorders who were difficult to place/rehabilitate in community settings, particularly those who were in long stay hospital environments. Her ethos and belief was about building care and support packages with robust risk management strategies around the individual (as we say now we do not fit people into boxes we build the box no matter how mis-shapen around the individual). Moya felt that everyone (within reason) deserved a chance to live in a safe community environment to further aid their rehabilitation and recovery, this has remained the mainstay of our ethos ever since and further developments of the business.

In early 2000 Mrs Treherne set up Tremora cottage as a small Registered Residential Home which could accommodate three adults (specifically those with Complex Mental Disorders who were difficult to place within Community settings).

From this the company has grown with the development of our Domiciliary Care & Supported Living service. We became registered as a Domiciliary Care service in 2005 under the Care Standards Act 2000, Domiciliary Care Agencies (Wales) Regulations 2004 which enabled us to provide a specialist service for adults with complex mental disorders within accommodation that was not a residential home.

Treherne Care Group achieved -reregistration with CIW in October 2018, under the Regulation and Inspection of Social Care (Wales) Act 2016 which covers both our Domiciliary Care and Residential Care services.

Our services consist of:

Tremora Cottage our small registered residential care home in Llanaber, Barmouth for 3 adults.

We provide support under our Domiciliary Care services within individuals homes be they in Treherne Properties Ltd dwellings or other local community housing.

Treherne Properties have the following options for accommodation:

Clogwyn Hall a small country estate within 22 acres in Dolgellau, with cottages and apartments for 9 individuals.

Garthangharad a country estate in Penmaenpool, Dolgellau which has a number of buildings within its 66-acre grounds with single person dwellings for 12 individuals.

Llyndir a cottage (with an annex) in Dolgellau which accommodates 2 people.

Yr Hen Ysgol a converted school house and separate Studio Apartment, in Llanelltyd, Dolgellau, which accommodates 4 individuals.

We also provide care and support to individuals who reside in properties in Dolgellau, Barmouth and other houses within the Meirionnydd area of Gwynedd.

What we do:

Treherne Care Group provides a Specialist Domiciliary Care/Support Living arrangements and Residential Care Service for adults with a Mental Disorder (mainly Learning Disability and/or Complex Mental Health Problems) which is unique for its service user group. It is a therapeutic service that offers specifically tailored packages of care that enables individuals who live in their own home (rented or owned) or need residential care in a community-based location; that enables them to maintain their own level of independence through support and supervision, as their particular needs dictate, from experienced and trained care teams.

The care teams are trained and developed to work with those who may present any of the following range of complex needs due to their Mental Disorder in addition to a Learning Disability and/or complex Mental Health Problems

  • Severe challenging and aggressive behaviours
  • Service users with a history of serious offending behaviours (forensic background)
  • Those with enduring and complex mental health problems often poorly controlled by medical intervention
  • People with an acquired brain injury
  • Individuals with autistic spectrum disorder
  • Individuals with Personality Disorders
  • Individuals with alcohol and drug related problems that impact on their mental health and ability to live independently
  • Service users subject to aspects of the 1983/2007 Mental Health Act that support community living including Community Treatment Order (CTO)
  • Service users with complex needs moving from children to adult services
  • Service users with other mental disorders such as Dementia, Pick’s Disease (Frontotemporal Dementia)
  • Service users with aging related disorders in addition to existing mental disorder.

The service we provide is person centred and all packages of care/support are tailored to meet specific and individual needs and circumstances.

As part of Treherne Care Group’s care and support packages we offer support to individuals to access accommodation predominantly within the Snowdonia National Park, presently within the Barmouth and Dolgellau area, however over time we aim to develop our service to offer support further afield such as Porthmadog, Bala or other locations within a 30-mile radius of our central office. Within the packages of care, we support individuals to manage their daily lives and home environment; this includes supporting them to access appropriate tenancies if required if they are not already residing in their own homes. NB: service user may have been in long-stay hospitals/institutions and do not have anywhere to reside when they move back into the community. The tenancies may be offered by Treherne Properties Ltd or other landlords within the locality.

Individuals have a choice (supported by their representatives and commissioners) on who the Care Provider will be to provide their care and support. Individuals can choose (particularly in supported living) to use another service provider should Treherne Care Group no longer be able to meet their particular needs and personal preferences, or this may be in collaboration with other providers.

Clinical Team

Supporting the Care and Support aspect of our services is our in-house Clinical Team who provide Clinical support on management and enablement of our service users and in-house counselling interventions for staff.

What the Clinical Team Does:

  • Produce annual psychology reports for each individual (including easy-read versions for the service users themselves. These reports are shared with other relevant professionals involved in the individual’s care. These reports are produced as a result of clinical assessments, input from the individual and their significant others including family, their support team and other professionals to determine short and long-term outcomes for the person.
  • Conduct relevant Risk assessments such as HCR-20 ˅3 and SVR-20 along with Structured Assessment of Protective Factors for violence risk (SAPROF).
  • Examine the relationships between physiological and psychological well-being for each service user in order to assess any associated physical and mental health complications.
  • Provided individually tailored Behaviour Support Plans.
  • Coordinate regular clinical meetings with the staff team, offer advice and support regarding current issues of concern and follow this up with other professionals.
  • Hold regular active support meetings guided by the assessments, staff experience and service user needs; outcomes are then reviewed and implemented.
  • Collate evidence of outcomes, using photos, qualitative and quantitative reports and summaries.
  • Provide individual one to one therapy for service users.

Underpinning approaches:

The cornerstone of our service is an individualised approach to assessment, service planning and service delivery. Our approach enables a more personalised and flexible service wherein the type, intensity and frequency of support is carefully tailored to the needs and abilities, goals, aspirations and preferences of individuals.

By providing individualised support packages for individuals in their own homes we are able to facilitate learning and enhance community integration and presence (giving consideration to risk factors present and potential).

We embrace and promote the following principles to enable engagement, personal development and community presence:

  • Low arousal approaches
  • Active support model
  • Positive behaviour approach
  • Person centred planning

We adopt a pro-active and reactive approach to meeting the needs of individuals, the emphasis being on what the service user requires/is presenting as needing in order to maintain his/her presence in the community and their level of independence. This is addressed through effective ongoing assessment and focussed support planning and clear risk management strategies being in place.

Our staff team are trained and skilled in supporting individuals to identify skills and opportunities for personal development no matter what the issues are.

This ethos of service delivery is adopted by many organisations which Treherne Care Group has embraced for many years and to ensure success the key elements are as indicated below:

Person centred approaches:

  • Embracing the Active Support and Positive Behaviour Approaches throughout the organisation through effective training, monitoring support by our Clinical Co-ordinator who works with the teams to ensure focus and progress. See information below.
  • Working in partnership with service users, their significant others (family, friends, and advocates) and members of the Multi-disciplinary team to ensure opportunities are explored from all avenues.
  • Working with local colleges, employment schemes and the local community to enable individuals to participate and be active citizens in the locality.
  • Enabling individuals to take ownership of their service delivery plans, opportunities for learning new skills through a variety of mediums.
  • Regular review of progress is essential, and this is achieved through
    • MDT meetings
    • Service user’s keeping their own records of success/achievement through means of their choice (photographs for example)
    • Internal review meetings
    • Active support meetings with the staff
    • Regular updated skill assessment (e.g. ABAS)
    • Daily, weekly and quarterly reports
  • Regular supervision and staff development/training is essential to ensure success.

We adopt the principles of the SPELL framework with incorporates all of the below:
Structure –timetables, planners, communication aids etc.
Positive approaches
Empathy
Low arousal
Links – achieving consistency and predictability through communication between supporters and agencies, making an activity as socially inclusive as possible.

Active Support and Positive Behaviour Support Approach

Active Support
Person Centred Active Support:

Person Centred Active Support is designed to enable staff to support individuals to engage in meaningful activity and relationships because the taking part in a range of activities provides experience of variety in life and the opportunity to make real and informed choices.

Being actively involved increases the opportunities for individuals to interact with othes in meaningful and purposeful ways, to be on a more equal footing, rather than being the person that is ‘spoken at’ or ‘done to’.

It ensures the individual is seen by others as someone who is taking part and in control, thus increasing her status and promoting opportunities to attract other people into their life.

We see Engagement as being defined by:

  • Doing something constructive with materials (e.g. vacuum cleaning, laying, own dining table, loading a washing machine, other daily household tasks, etc.)
  • Interacting with people (e.g. talking or listening to them or paying attention to what they do, holding a conversation, watching someone show an individual how to do something)
  • Taking part in a group activity (e.g. playing tennis, or engaging in musical sessions, others socially focussed opportunities)

The emphasis is on engagement rather than putting pressure to complete whole tasks. Engaging an individual when an individual is amenable to engagement and is willing to participate (will be for as long as the person is able to concentrate and finds the activity interesting enough

Active Support is designed to make sure that people who need support have the chance to be fully involved in their lives and receive the right range and level of support to be successful. Several research studies have shown that it is effective.

Active Support has 3 components:

  1. Interacting to Promote Participation. People who support the individual learn how to give him or her the right level of assistance so that he/she can do all the typical daily activities that arise in life. Our Clinical Team support the staff team working with each individual to develop and embrace this.
  2. Activity Support Plans. These provide a way to organise household tasks, personal self-care, hobbies, social arrangements and other activities which individuals need or want to do each day and to work out the availability of support so that activities can be accomplished successfully. The Clinical Team work with the support staff to complete relevant assessments including the ABAS to identify each individual’s current level of skill and engagement from which the activity support plans are then produced to enable participation and development of skills.
  3. Keeping Track. A way of simply recording the opportunities people have each day that enables the quality of what is being arranged to be monitored and improvements to be made on the basis of evidence. The staff team are supported and encouraged to produce a range of records and reports including photographs to evidence each individual’s engagement in various activities.

Each component has a system for keeping track of progress, which gives feedback to the staff team and informs regular reviews.

The aim of Active Support is to help people lead full lives. However, Active Support cannot be used in isolation, at Treherne Care it is used alongside other approaches which include Person Centred Plans, Low Arousal and Positive Behaviour Support.

Person-Centred Plans

Person-centred planning provides a way to consider important developments in people’s lives as part of a regular overall review of what has been achieved and what might be possible in the future. Individual preferences and the involvement of the person concerned in deciding what outcomes to pursue are important. Objectives may be agreed for developing a person’s activity, social relationships, learning, independence, autonomy, health, home, job or some other aspect important to his or her quality of life. Objectives then need to be translated into action and taken forward. Active Support, as a complementary person-centred approach, may have a role to play in developing the person’s opportunities and activities.

Each service user will have a Person-Centred Plan which is regularly reviewed, amended and added to making it a ‘living’ document. In addition to this, all Support Plans are developed through a person-centred approach and regularly reviewed by the Service User themselves as far as is possible and the Support Team.

Positive Behavioural Support
Positive Behaviour Support is now embedded in government policy and is at the heart of the Department of Health policy document ‘Positive and Proactive Care’ published in April 2014.

Positive Behaviour Support is:
An understanding of the behaviour of an individual. It is based on an assessment of the social and physical environment in which the behaviour happens, includes the views of the individual and everyone involved, and uses this understanding to develop support that improves the quality of live for the person and others who are involved with them.

Positive behavioural support concentrates on helping people develop so that their reliance on challenging behaviour is no longer necessary. Active Support and opportunity and learning plans may have a role to play in a comprehensive positive behavioural support plan.

This is a simple overview of how positive behaviour support works.

Stage 1: Collection and analysis of data relating to the behaviour concerned. This includes an examination of what happens before, during and after the behaviour, how intense it is, how often it happens and how long it lasts.

This is coordinated and undertaken by the Clinical Team/Clinical Coordinator, who will produce reports from the analysis and share with all involved including the individual concerned.

Stage 2: When you have a detailed understanding of the behaviour and why it is happening, a number of strategies are designed and put in place to reduce the person’s unwanted behaviours and enhance their lifestyle opportunities and well-being. The strategies are grouped as:

Primary (Proactive) strategies: everything that is put in place that reduces the likelihood of the behaviour happening; for example, managing situations that you know will trigger a behaviour, changing environments, and providing opportunities for new experience and acquiring new skills.

Secondary strategies: these are plans for what to do if the primary strategies do not work and behaviour starts to escalate. These might include using calming approaches, changing the environment, diverting the person’s attention to an activity they enjoy.

Reactive strategies: these are planned, robust strategies that are put in place to be used as a response to an incident of challenging behaviour. They aim to take control of a situation and minimise the risk to the person and others.

The strategies are developed by the Clinical Team/Clinical Co-ordinator with members of the Multi-Disciplinary team, staff team, the individual concerned and significant others. This includes an individual, easy-read, Therapeutic Support Plan which focuses on key areas for a specific duration, this is reviewed at a minimum bi-annually. Evidence of outcomes achieved, and strategies used are recorded in a comprehensive Behaviour Support Plan.

Stage 3: Regularly review and revise the support provided to make sure that it reflects their current needs, interests, health and wellbeing and risks.

The Clinical Team/Clinical Coordinator will meet regularly with the support team and individual concerned (usually every 5 weeks).

Positive Behaviour Support does not assume that a behaviour will cease. Its aim is to reduce the likelihood of it happening, although behaviour can stop. However, this does not mean that the Positive Behaviour Support should be withdrawn. It should be reviewed and adapted to meet the new circumstances.

Opportunity or Learning Plans
Opportunity plans provide a way to focus on a number of skills and organise frequent opportunities to practise them so as to help a person learn. Learning plans provide even more specific guidance on how to teach particular skills. These are developed with the service user and their support team on an individual, person centred basis to ensure that the recording documents compliment the service users’ needs and level of support.

The role of the Support Worker
The key to sustaining these approaches is through the Support Workers attending regular clinical/active support meetings where feedback is shared, plans are reviewed, and strategies modified/implemented.

Support Staff are involved in the process of assessment and planning as far as possible, through contributions at meetings and their own independent resourcefulness mentored by their line manager.

Mentoring Vs Caring
Support workers should view their role as that of a mentor as opposed to a carer. The role of a mentor is to provide education, recreation and support opportunities to individuals. The support provided through mentoring may challenge the mentee with new ideas and encourage the mentee to move beyond the things that are most comfortable. The quality of the mentoring relationship is important for mentees to experience positive results. A mentor relationship is more successful when the mentor cares for the whole person. Successful mentors tend to be available, knowledgeable, educated in diversity issues, empathic, personable, encouraging, supportive, and passionate.

The emphasis is providing a humanistic and holistic approach to service provision.

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