DEMENTIA DESIGN BUILDING AUDIT Hospital Design. Community Hospitals NHS Dumfires and Galloway

DEMENTIA SERVICES DEVELOPMENT CENTRE, UNIVERSITY OF STIRLING DEMENTIA DESIGN BUILDING AUDIT Hospital Design Community Hospitals NHS Dumfires and Galloway

DEMENTIA SERVICES DEVELOPMENT CENTRE, UNIVERSITY OF STIRLING Date of issue: Issued by: Prepared by: 11/01/2018 Mr Martin Quirke (Revision 2) Mr. Martin Quirke Ms. Lesley Palmer Version: Comment: Revision 2 Audit scoring adjusted. Ticks and crosses clarified. Thornhill Hospital Address and contact information corrected 2

DEMENTIA SERVICES DEVELOPMENT CENTRE, UNIVERSITY OF STIRLING CONTENTS 1.0 INTRODUCTION 1.1 Scope of Review 1.2 Intellectual Property 1.3 Copyright statement 1.4 Caveat 2.0 PROJECT PARTICULARS 2.1 Outline Project Description 2.2 Summary of points 3.0 DESIGN AUDITS 3

DEMENTIA SERVICES DEVELOPMENT CENTRE, UNIVERSITY OF STIRLING 1.0 INTRODUCTION 1.1 SCOPE OF REVIEW This Building Review Report has been prepared following observational site visits to the buildings by members of DSDC s approved building Auditors and constitutes an evaluation of the existing building in relation to DSDC Dementia Design Principles. The evaluation is based on information and advice contained in the under-noted set of designing for dementia guide booklets published by the Dementia Services Development Centre at the University of Stirling: Designing Gardens for People with Dementia Designing Interiors for People with Dementia Light and Lighting design for People with Dementia Hearing, sound and the acoustic environment for people with dementia Designing balconies, roof terraces and roof gardens for people with dementia Designing outdoor spaces for people with dementia Dementia Design for General Hospitals and Emergency Departments The review of the building design also takes into account the Equality Act 2010, the recommendations and guidance provided by the British Standards BS8300:2009 Design of buildings and their approaches to meet the needs of disabled people - Code of practice and applicable national building regulations. Comments and recommendations made throughout this review relate principally to matters of design and the appropriateness of the building for people with dementia and do not refer to any general merits or otherwise of the design of the building for older and more frail people or to service and management issues. It should be noted that a building review report based on an observational site visit is not the same as a full audit and it will still remain the responsibility of the designers to comply with the detailed requirements of the Dementia Design for General Hospitals and Emergency Departments 1.2 INTELLECTUAL PROPERTY Any ideas expressed or concepts outlined, or methods of working set out in this paper remain the intellectual property of The Dementia Services Development Centre, University of Stirling. 1.3 COPYRIGHT STATEMENT The information contained in this document is and remains the property of The Dementia Services Development Centre, University of Stirling and must not be reproduced or transmitted to any third party without express written consent from Christopher McAdam, Business Manager. 1.4 CAVEAT Provision of design consultancy services by The Dementia Services Development Centre does not constitute endorsement of the completed building provided by your organisation. The name or branding of The Dementia Services Development Centre cannot be used in any format to promote the completed building, unless your organisation has received certification through our design audit service. 4

DEMENTIA SERVICES DEVELOPMENT CENTRE, UNIVERSITY OF STIRLING 2.0 PROJECT PARTICULARS BUILDING(S): ORGANISATION NAME: BUILDING CLASSIFICATION: NAME OF AUDITORS: Eight Community Hospitals NHS Dumfries and Galloway Hospitals: in-patient, out-patient & day care address: various as outlined below (8 sites) Martin Quirke Annan, Kirkcudbright, Langholm, & Newton-Stewart Lesley palmer Castle Douglas, Lochmaben, Moffat, & Thornhill DATE OF AUDIT: Mon 13th & Tues 14th March 2017 2.1 OUTLINE PROJECT DESCRIPTION This report covers the environmental design assessments undertaken of eight community hospitals in the area covered by the NHS Dumfries and Galloway. These small to-medium sized hospitals are spread out in various locations across the Dumfries and Galloway region. The ages, positions, configurations and general conditions of the buildings was varied, with all possessing a combination of both positive and negative features in terms of supporting the wellbeing of occupants. Each of the hospitals was visited for a morning or afternoon, by one of the two above named approved dementia design auditors from the Dementia Services Development Centre at University of Stirling. Assessments were carried out in a systematic manner using the Dementia Design for General Hospitals and Emergency Departments (Cunningham et al, 2012), a formal tool based on the most reliable research evidence in the field of design for dementia, sight loss and age-related impairment. Please Note: All audit items marked with a tick All audit items marked with a 'cross are considered to be a Pass are considered to be a Fail Please ignore which column these ticks and crosses have been placed. Crossed Out Items and Sections, and those marked N/A were deemed Not Applicable - Score callcualtions were adjusted accordingly. 5

DEMENTIA SERVICES DEVELOPMENT CENTRE, UNIVERSITY OF STIRLING NHS Dumfries & Galloway STRATHCLYDE Wanlockhead KIRKCONNEL SANQUHAR AYRSHIRE & ARRAN Carsphairn Dalry Moniaive THORNHILL Thornhill Community Hospital Built 1902 Nithsdale LHP Dunscore LOCHMABEN DUMFRIES MOFFAT Lochmaben Community Hospital Built 1996 Moffat Community Hospital Built 1927 Annandale & Eskdale LHP Johnstonebridge LOCKERBIE BORDERS LANGHOLM Thomas Hope Hospital Built 1898 "B" listing Aug 1971 STRANRAER Galloway Community Hospital Built 2006 Glenluce Wigtown LHP NEWTON STEWART N.S Community Hospital Built 1897 Creetown Stewartry LHP Gatehouse of Fleet New Galloway CASTLE DOUGLAS C.D Community Hospital Built 1897 DALBEATTIE New Abbey Annan Community Hospital Built 1987 Eaglesfield ANNAN Gretna Canonbie Carlisle Kirkcowan Sandhead Wigtown K'bt Community Hospital Built 1897 KIRKCUDBRIGHT CUMBRIA Port William Drummore Whithorn DUMFRIES and GALLOWAY Prepared by: 04/11/2008 Amanda Henderson, Estates & Property Services, Criffel South, Crichton Hall, Crichton Royal Hospital. ( 01387 244209 8 amanda.henderson@nhs.net (updated 14/10/2016-s:\estates shared area\autocad\comm\hb wide map community hospitals only.dwg) 6

DEMENTIA SERVICES DEVELOPMENT CENTRE, UNIVERSITY OF STIRLING 3.0 DESIGN AUDITS SUMMARY OF RECOMMENDATIONS The forthcoming pages comprise of the 8 systematic DSDC Dementia Design audits and we recommend that each is reviewed in detail for the observations and recommendations given to the individual community hospital. In addition, we recommend that all audits are reviewed as a collective set, whereby recommendations or explanations given in one audit may further support the content of another. As a summary, the following common themes were identified across all 8 hospitals: 1. The flooring throughout the hospitals varies in tonal contrast between adjacent / adjoining floor finishes. Evidence suggests that where adjoining floor finishes have less than 10 units of Light Reflectance Value of a difference, there is a reduced likelihood of people with dementia and / or a visual impairment from wrongly perceiving a change in level. Often this can result in high-stepping which may result in a trip and fall. In addition changes in tonal contrast in flooring have been attributed to reducing the persons confidence in walking where the environment is perceived as confusing. This also occurs where visual obstacles are created such as the red wash your hands vinyl which is fixed to the floor. A person with dementia will avoid walking over this, therefore increasing anxiety, and reducing confidence in walking through the circulation areas. Where there is planned maintenance or proposals to replace flooring, we recommend that flooring is reviewed throughout to ensure there is not greater than 10units of LRV between each finish. This extends to transitional strips, which should also match tonally and not offer glare. 2. Walls and floors should contrast. The normal ageing of the eye results in lower colour discrimination. Where walls and floors contrast, this will improve the persons ability to see the three-dimensional aspects of the room, thus supporting movement and use. Walls and floors should contrast by 30 units of Light Reflectance Values difference. This information is widely published by paint and flooring manufacturers. 3. The assisted bathrooms and toilets are very clinical in their design. We acknowledge the need for wipeable surfaces for infection control measures. However the colours of the room, use of lighting and materials can make the room more appealing and relaxing. This is considered important to reduce anxiety in the patient when being bathed. 4. Visual contrast within the assisted bathrooms and toilets was very poor. There was very little contrast between grabrails and walls or toilet / paper towel dispensers and the walls on which they are fixed. This will make it difficult for patients with normal age related visual impairments from locating these items and using them. We recommend that walls are painted to improve contrast at grab rail locations. 5. There is significant visual clutter throughout and in particular at entrance doors. As such, information can be difficult to decipher; key messages are lost and in one occasion the entrance pad was concealed. We recommend that signage is reviewed throughout and unnecessary notices and signs removed. Over stimulation through visual clutter can increase anxiety and distressed behaviour in people with dementia. 6. The gardens and day rooms have the potential to be bright, well designed and social spaces. In many of the buildings there were excellent, direct connections between common areas and the gardens. We recommend further investment in these areas to encourage more social activity and use of the garden. 7. In all hospitals the auditors were impressed by the cleanliness and support from the care staff. Good care and good design often serve as a proxy to the other and we would recommend some investment in the overall design as noted in the forthcoming audits. This will support both patient and staff during their time within these buildings. 7

DEMENTIA SERVICES DEVELOPMENT CENTRE, UNIVERSITY OF STIRLING The entrance mat offers too much contrast with the adjacent floor & can be perceived as a step. The vinyl sign can create confusion for a person with dementia. There is very poor contrast between the toilet, grab rails and wall behind make it difficult to see and make use of the fittings independently. Corridors host a significant amount of equipment which can increase risk to patients from trips, collision and in some cases confusion. Storing items in the corridors also detracts from the legibility of the space. Vertical blinds can create shadows and banding on the floor which can be perceived as a change in level thus increasing risk of fall. They can also create visual illusions or where the PWD has hallucinations can create anxiety and distressed behaviour. There is significant visual clutter and over-signing within each of the 8 hospitals. This can create confusion and difficulty in using the built environment. Recommend that signage is reduced to only those required and notices reduced / dispersed throughout the building. 8

DEMENTIA SERVICES DEVELOPMENT CENTRE, UNIVERSITY OF STIRLING Floor finishes should be matt to reduce glare. The ageing eye is more sensitive to glare and this can impact on the persons ability to move freely, perceive and see the environment correctly and can increase risk of falls. Good contrast between the toilet seat and the toilet bowl. Poor contrast between the grab rails and the walls & flooring. The light creep through the windows and highly reflective flooring creates patches of glare and shadow on the floor which can be perceived as water or wet. This can reduce the person with dementia s confidence in moving across the floor. In general we do not recommend sliding doors where the patient is likely to be elderly. Sliding doors require greater core strenght, are not always familiar and don t offer the same level of acoustic privacy as a swing door. The change in flooring at doors offers too great a contrast and can be perceived as a change in level thus resulting in increased likelihood of high-stepping. 9

DEMENTIA SERVICES DEVELOPMENT CENTRE, UNIVERSITY OF STIRLING 3.1 ANNAN HOSPITAL 10

NHS Dumfries and Galloway: Dementia Design Audits Annan Community Hospital Dementia design for general hospitals and emergency departments: Audit tool/checklist Part 2: Workbook Design to develop a better quality of life for people with dementia

NHS Dumfries and Galloway: Dementia Design Audits General information Annan Community Hospital Organisation name: Unit/ward/centre name: Define the type of unit: General / Community Care Year of opening: Contact name: Address: Names of auditors: Alice Wilson - Deputy Nurse Director Carole Shannon - CN at Annan Annan Hospital Stapleton Road Annan DG12 6NQ Position: Phone: Mobile Email: 01387 272789 (Alice Wilson) Alice.Wilson@nhs.net Others present: Date of audit: DISCLAIMER This booklet forms part of a suite of materials produced by the Dementia Services Development Centre (DSDC) at the University of Stirling. It should only be used to carry out an audit in conjunction with the accompanying guidance booklets. Carrying out an audit using this tool does not constitute any form of endorsement of the building or surrounding environment by the Dementia Services Development Centre of the University of Stirling. Endorsements are made only of buildings audited and certified by University of Stirling trained and registered design auditors. Organisations using this tool may state in publicity that they have referred to and utilised dementia-friendly design materials produced by the University of Stirling. No further assertions may be made in any publicity or published materials without the express consent of the University of Stirling. The guidance and advice presented in this document is compiled from research evidence, international design literature and observation of implemented best practice. It has been produced by the University of Stirling with due diligence and in good faith. However the University of Stirling cannot be held liable for design or operational decisions made by users of this material resulting from the contained advice. This tool assesses only the environment in terms of suitability for people with dementia, it does not evaluate quality of care. For further information contact: Dementia Services Development Centre Iris Murdoch Building University of Stirling Stirling FK9 4LA t +44 (0)1786 467740 f +44 (0)1786 466846 dementia@stir.ac.uk www.dementia.stir.ac.uk First published 2012 ISBN 978 1 908063 03 8

NHS Dumfries and Galloway: Dementia Design Audits 1: Entrance, corridors, wayfinding and lift Entrance area 1.1 R The entrance to the unit is clean Annan Community Hospital Corridors / Wayfinding 1.2 R The entrance to the unit is welcoming 1.3 R The entrance to the unit is tidy 1.4 R The entrance to the unit is well lit 1.5 E There is good access for those with physical or mobility problems including wheelchair users. Observe: Handrails; lift; ramp; height and accessibility of door handles; disabled parking spaces near building 1.6 R There is seating to provide opportunities for rest 1.7 R The door entry system is discreet. Observe: Alerting staff but not ringing out to disturb patients/people with dementia Bell noise appears to be limited to non-patient reception area only. Corridors 1.8 E The colour and tone of the floor covering contrast with the colour and tone of the furniture 1.9 E The colour and tone of the floor covering contrast with the colour and tone of the walls In a majority of areas the main flooring material appears to lack sufficient contrast with adjacent walls. However, this is partly offset by contrasting skirtings and architraves. 1.10 R The skirting contrasts with both the floor and walls. Observe: contrasting skirting or capping strip 1.11 E The flooring is consistent in colour/tone throughout including threshold strips Darker Floor edging strips to corridors provide undesireable contrast to the main flooring materials. Tonal continuity would be preferable to reduce the risk of falls. 1.12 R Fire doors held open in corridors need a strongly contrasting edge if they are not flush with the wall. Observe: edge highly visible on approach www.dementia.stir.ac.uk University of Stirling 2012 Version 1 1

Corridors / Wayfinding NHS Dumfries and Galloway: Dementia Design Audits 1: Entrance, corridors, wayfinding and lift 1.13 R Large-patterned floor coverings have been avoided Annan Community Hospital 1.14 R Strong wallpaper patterns have been avoided 1.15 R The space has good levels of natural lighting 1.16 R Glare from natural lighting can be managed 1.17 R The space has good levels of artificial lighting 1.18 R The lighting can be controlled according to the time of day 1.19 R Ceilings, floors, floor coverings, are sufficiently sound absorbent to support communication 1.20 R All corridors lead to meaningful places. Observe: Dead ends have been avoided or made interesting All corridors tend to lead to locked doors, storage rooms, or Staff-Only spaces etc 1.21 R Corridors are wheelchair accessible 1.22 R Corridors are of varying widths 1.23 R Corridors have interesting items on the walls in order to provide focal points of interest Some frame images are located on walls, but the number of these could be increased somewhat. 1.24 R There is seating at frequent intervals to provide opportunities for rest Seating is only available within the day room (and in the reception area located outside of the locked ward area) 1.25 R There are comfortable handrails to give both physical assistance and a sense of direction/distance 2 Version 1 University of Stirling 2012 www.dementia.stir.ac.uk

NHS Dumfries and Galloway: Dementia Design Audits Annan Community Hospital 1: Entrance, corridors, wayfinding and lift 1.26 R Corridors are well lit The corridor appears to have high levels of good quality LED lighting installed recently. Corridors / Wayfinding 1.27 R Corridors are evenly lit 1.28 E Notices and leaflet racks are located away from patient areas. They should be located where staff, relatives and patients without dementia can see them such as in alcoves or entrance areas 1.29 R Nurse alarm call systems are discreet, alerting staff but not otherwise disturbing patients/people with dementia No instances of call alarm were heard by the auditor during the survey visit. 1.30 R Edges to steps are clearly delineated for safety. Observe: Nosings are clearly contrasted with the treads and riser Rooms from corridors 1.31 R Doors open easily with minimal physical effort 1.32 E Doors open against the wall to allow a full view of rooms 1.33 E Doors to day rooms are unlocked 1.34 R Doors to bed areas are not directly opposite, facing each other 1.35 R The colour and tone of the door handles contrasts with the colour and tone of the doors 1.36 R Handles are comfortable and easy to use 1.37 E The flooring is consistent in colour/tone throughout including threshold strips Wide flooring edge strips are tonally contrasting to main flooring material. This could cause 'high stepping', and potential increase in falls from patients with dementia. www.dementia.stir.ac.uk University of Stirling 2012 Version 1 3

Corridors / Wayfinding NHS Dumfries and Galloway: Dementia Design Audits 1: Entrance, corridors, wayfinding and lift 1.38 R Annan Community Hospital Staff facilities are located where they do not cause noise for patients. Observe: Nurses station; staff sitting room 1.39 R Service areas such as machine room are located where they do not cause noise for patients 1.40 R Doors to staff-only facilities are well concealed. Observe: Doors are the same colour as the walls; skirting or handrail extends along the door with no or minimum door furniture Wayfinding and signage 1.41 E There is clear signage to help wayfinding for everybody 1.42 E There is a contrast between the colour and tone of the writing on the sign and the colour and tone of the background of the sign 1.43 E There is a relevant, easy to understand picture or graphic image as well as words on each sign An image is provided on many Toilet Signs but not signage to other spaces 1.44 E There is a contrast between the colour and tone of the background of the sign and the colour and tone of the door/wall 1.45 R Signs are fixed to the doors they refer to, not to adjacent wall surfaces, except where they are needed for directions 1.46 E The bases of all signs offering wayfinding for patients are around 4 feet/1.2 metres from the ground. Measure 1.47 R There is extensive use of glass to show what is behind doors and walls and to increase visibility. Observe: Glass is not covered 1.48 R There are landmark objects such as memorabilia and art to aid wayfinding 4 Version 1 University of Stirling 2012 www.dementia.stir.ac.uk

NHS Dumfries and Galloway: Dementia Design Audits Annan Community Hospital 1: Entrance, corridors, wayfinding and lift Lifts 1.49 R The interior is calming e.g. the lining is pastel coloured, not reflective or shiny Corridors / Wayfinding N/A NOT APPLICABLE 1.50 R The flooring matches that of the adjacent landing N/A NOT APPLICABLE 1.51 R The lighting is bright, but glare-free and uniform N/A NOT APPLICABLE 1.52 R There are no mirrors or reflecting surfaces N/A NOT APPLICABLE 1.53 R A sensor keeps the doors open until people reversing in wheelchairs are safely inside the lift N/A NOT APPLICABLE 1.54 R Button controls are large and clear and contrast with the door frame N/A NOT APPLICABLE 1.55 R Lift is not in the bed areas N/A NOT APPLICABLE 1.56 R Lift is not on the adjoining wall of a bed area N/A NOT APPLICABLE Unit 1 subtotal Essential (out of 13): Recommended 7 (out of 35) 31 8 Audit Items omitted so score is out of 35 Are any of the positive design features compromised by the observed use of space e.g. inappropriate storage, signs or windows covered, access obstructed? www.dementia.stir.ac.uk University of Stirling 2012 Version 1 5

Nurses station NHS Dumfries and Galloway: Dementia Design Audits 2: Nurses station General 2.1 R There is no large nurses station for the whole ward Annan Community Hospital 2.2 R There is a small reception desk 2.3 R There is seating by the reception desk 2.4 R There are small desks/tables and seats for staff to undertake written work near the single rooms 2.5 R There are small desks/tables and seats for staff to undertake written work in the bays 2.6 R There is a separate office, not visible to patients Unit 2 subtotal Essential (out of 0): Recommended 0 3 (out of 6): Are any of the positive design features compromised by the observed use of space e.g. inappropriate storage, signs or windows covered, access obstructed? 6 Version 1 University of Stirling 2012 www.dementia.stir.ac.uk

NHS Dumfries and Galloway: Dementia Design Audits 3: Waiting room Entrance area 3.1 R The entrance is clean Annan Community Hospital Waiting room 3.2 R The entrance is welcoming 3.3 R The entrance is tidy 3.4 R The entrance is well lit 3.5 E There is good access for those with physical or mobility problems including wheelchair users. Observe: Handrails; lift; ramp; height and accessibility of door handles; disabled parking spaces near building 3.6 R There is comfortable seating Corridors 3.7 E The colour and tone of the floor covering contrast with the colour and tone of the furniture 3.8 E The colour and tone of the floor covering contrast with the colour and tone of the walls Although some contrast is provided between walls and floor, this appears to be less than the 30% difference in Light Reflectance Values required for good dementia design. 3.9 R The skirting contrasts with both the floor and walls. Observe: contrasting skirting or capping strip 3.10 E The flooring is consistent in colour/tone throughout including threshold strips The floor boarder strip contrasts too much against the main areas of flooring material. 3.11 R Large-patterned floor coverings have been avoided 3.12 R Strong wallpaper patterns have been avoided www.dementia.stir.ac.uk University of Stirling 2012 Version 1 7

Waiting room NHS Dumfries and Galloway: Dementia Design Audits 3: Waiting room 3.13 R The space has good levels of natural lighting Annan Community Hospital 3.14 R Glare from natural lighting can be managed 3.15 R The space has good levels of artificial lighting 3.16 R The lighting can be controlled according to the time of day 3.17 R Ceilings, floors, floor coverings, are sufficiently sound absorbent to support communication 3.18 E The flooring is consistent in colour/tone throughout including threshold strips 3.19 R Staff facilities are located where they do not cause noise. Observe: Nurses station; staff sitting room 3.20 R Service areas such as machine room are located where they do not cause noise Unit 3 subtotal Essential (out of 5): Recommended 2 15 (out of 15): Are any of the positive design features compromised by the observed use of space e.g. inappropriate storage, signs or windows covered, access obstructed? 8 Version 1 University of Stirling 2012 www.dementia.stir.ac.uk

NHS Dumfries and Galloway: Dementia Design Audits Annan Community Hospital 4a: Bed area: single room General 4a.1 E The colour and tone of the floor covering contrast with the colour and tone of the furniture 4a.2 E The colour and tone of the floor covering contrast with the colour and tone of the walls Bed area 4a.3 R The skirting contrasts with both the floor and walls 4a.4 E The flooring is consistent in colour/tone throughout including threshold strips 4a.5 R Large-patterned floor coverings have been avoided 4a.6 R Strong wallpaper patterns have been avoided 4a.7 R Ceilings, floors, floor coverings, are sufficiently sound absorbent to support communication 4a.8 R The room is made recognisable by easy visibility of the bed 4a.9 E The entrance to the patient s bed area is differentiated. Observe: Doors should have a picture or motif on them to make each room door different 4a.10 E Where possible, there are personal items by the patient s bed 4a.11 R The door to the bed area is easy to open, the handles comfortable and easy to use Lighting 4a.12 E The room can be made dark overnight but there is an optional facility for very low-level lighting Supplemental localised lamps available in some spaces www.dementia.stir.ac.uk University of Stirling 2012 Version 1 9

NHS Dumfries and Galloway: Dementia Design Audits Annan Community Hospital 4a: Bed area: single room 4a.13 R There is a soft light in the en suite which can be left on if necessary Bed area 4a.14 R There is a mechanism to facilitate night-time checks by staff without disturbing sleep. Observe: A discreet dimmer switch by the door; a discreet switch by the door to an ultra low output lamp; a torch made available in the corridor 4a.15 R The room has good levels of natural lighting 4a.16 R Glare from natural lighting can be managed 4a.17 R The lighting can be controlled according to the time of day 4a.18 R There is good lighting over the bed/chair beside the bed 4a.19 R There is enough space for the visitor to remain while treatment is on-going. Observe: Enough space at both sides of the bed Windows/view 4a.20 R Window sills are low enough to be able to see out to the garden/balcony/roof terrace or street from a sitting position. Assess by sitting down. Observe: Furniture or foliage does not obscure the view 4a.21 R There are no screens or equipment blocking the window 4a.22 R There are light blinds to control glare 4a.23 R There are blinds or screens to allow dark conditions 10 Version 1 University of Stirling 2012 www.dementia.stir.ac.uk

NHS Dumfries and Galloway: Dementia Design Audits Annan Community Hospital 4a: Bed area: single room General features 4a.24 R The floors, floor coverings and ceilings minimise noise 4a.25 R Mirrors are well situated Bed area 4a.26 R Mirrors are designed to be removable or easily covered 4a.27 R Doors open easily with minimal physical effort Eating area (in bed, bedside bed, at table) 4a.28 R Table should contrast with bedcover/floor. Observe: Strong contrast 4a.29 E Crockery, glassware and cutlery contrast with table. Observe: Strong contrast Toilet wayfinding (en suite or alternative) 4a.30 R The individual has access to private en suite toilet facilities 4a.31 R There is not a sliding door 4a.32 R There is a sign on the door 4a.33 R The toilet can be made visible from the bed for those who need this cue In most but not all cases. 4a.34 E If there is no en suite toilet, there are toilet facilities nearby. Observe: Toilet facilities 4a.35 E There is clear signage to aid wayfinding to the nearest toilet www.dementia.stir.ac.uk University of Stirling 2012 Version 1 11

NHS Dumfries and Galloway: Dementia Design Audits 4a: Bed area: single room Annan Community Hospital 4a.36 E There is provision for relatives and friends to remain within or near bed areas for 24 hours if necessary. Observe: place for folding bed or space for recliner chair Bed area 4a.37 E The appears to be practicible only in the larger single room at the end of the corridor - this is an exemplary room is many respects. Large, analogue, accurate clocks are visible to all patients. Observe. Clocks in all bed areas visible to all beds Unit 4a subtotal Essential (out of 11): Recommended 8 21 (out of 26): Are any of the positive design features compromised by the observed use of space e.g. inappropriate storage, signs or windows covered, access obstructed? 12 Version 1 University of Stirling 2012 www.dementia.stir.ac.uk

NHS Dumfries and Galloway: Dementia Design Audits Annan Community Hospital 4b: Bed area: bay General 4b.1 E The colour and tone of the floor covering contrasts with the colour and tone of the furniture 4b.2 E The colour and tone of the floor covering contrasts with the colour and tone of the walls Bed area 4b.3 R The skirting contrasts with both the floor and walls 4b.4 E The flooring is consistent in colour/tone throughout including threshold strips 4b.5 R Large-patterned floor coverings have been avoided 4b.6 R Strong wallpaper patterns have been avoided 4b.7 R Ceilings, floors, floor coverings, are sufficiently sound absorbent to support communication 4b.8 R The room is made recognisable by easy visibility of the bed 4b.9 E The entrance to the patient s bedroom is differentiated. Observe: Doors should have a picture or motif on them to make each room door different 4b.10 E In addition, for some people, there are personal items by the patient s bed 4b.11 R The door to the bed area is easy to open, the handles comfortable and easy to use Lighting 4b.12 E The room can be made dark overnight but there is an optional facility for very low-level lighting www.dementia.stir.ac.uk University of Stirling 2012 Version 1 13

NHS Dumfries and Galloway: Dementia Design Audits Annan Community Hospital 4b: Bed area: bay 4b.13 R There is a soft light in the en suite which can be left on if necessary Bed area 4b.14 R There is a mechanism to facilitate night-time checks by staff without disturbing sleep Observe: A discreet dimmer switch by the door; a discreet switch by the door to an ultra low output lamp; a torch made available in the corridor 4b.15 R The room has good levels of natural lighting 4b.16 R Glare from natural lighting can be managed 4b.17 R The lighting can be controlled according to the time of day 4b.18 R There is good lighting over the bed/chair beside the bed 4b.19 R There is enough space for the visitor to remain while treatment is on-going. Observe: Enough space at both sides of the bed Windows/view 4b.20 R Window sills are low enough to be able to see out to the garden/balcony/roof terrace or street from a sitting position. Assess by sitting down. Observe: Furniture or foliage does not obscure the view 4b.21 R There are no screens or equipment blocking the window 4b.22 R There are light blinds to control glare 4b.23 R There are blinds or screens to allow dark conditions 14 Version 1 University of Stirling 2012 www.dementia.stir.ac.uk

NHS Dumfries and Galloway: Dementia Design Audits Annan Community Hospital 4b: Bed area: bay General features 4b.24 R The floors, floor coverings and ceilings minimise noise 4b.25 R Mirrors are well situated Bed area 4b.26 R Mirrors are designed to be removable or easily covered 4b.27 R Doors open easily with minimal physical effort Eating area (in bed, bedside bed, at table) 4b.28 R Table should contrast with bedcover/floor. Observe: Strong contrast 4b.29 E Crockery, glassware and cutlery contrast with table. Observe: Strong contrast Toilet wayfinding (en suite or alternative) 4b.30 R The bay has adjacent toilet facilities 4b.31 R There is not a sliding door 4b.32 R There is a sign on the door 4b.33 R At least one bed should have the toilet visible from the bed 4b.34 E If there is no adjacent toilet, there are toilet facilities nearby. Observe: Toilet facilities 4b.35 E There is clear signage to aid wayfinding to the nearest toilet www.dementia.stir.ac.uk University of Stirling 2012 Version 1 15

NHS Dumfries and Galloway: Dementia Design Audits 4b: Bed area: bay Annan Community Hospital 4b.36 E There is provision for relatives and friends to remain within or near bed areas for 24 hours if necessary. Observe : Is there provision for an overnight stay? Limited, but possible Bed area 4b.37 E Large, analogue, accurate clocks are visible to all patients. Observe. Clocks in all bed areas visible to all beds Unit 4b subtotal Essential (out of 11): Recommended 8 22 (out of 26): Are any of the positive design features compromised by the observed use of space e.g. inappropriate storage, signs or windows covered, access obstructed? 16 Version 1 University of Stirling 2012 www.dementia.stir.ac.uk

NHS Dumfries and Galloway: Dementia Design Audits Annan Community Hospital 5: En suite or adjacent toilet provision General features 5.1 E The colour and tone of the door contrast clearly with the colour and tone of the adjacent walls 5.2 E The colour and tone of the floor covering contrast with the colour and tone of any furniture 5.3 E The colour and tone of the floor covering contrast with the colour and tone of the walls OK in many, but not all ensute spaces. 5.4 R The skirting contrasts with both the floor and walls. Observe: contrasting skirting or capping strip En suite 5.5 E The flooring is consistent in colour/tone throughout including threshold strips 5.6 R Strong patterns on the wall finishes have been avoided 5.7 R Ceilings, floors, floor coverings, are sufficiently sound absorbent to minimise noise and support communication 5.8 E There is a sign on the door to aid wayfinding 5.9 R There are a minimum of two artificial lights in the room 5.10 E Wall colours are warm and light to maximise light levels 5.11 E Ceramic wall tiling or waterproof lining materials are domestic in appearance 5.12 E The colour and tone of the tiling/wall contrast clearly with the colour and tone of sanitary fittings www.dementia.stir.ac.uk University of Stirling 2012 Version 1 17

NHS Dumfries and Galloway: Dementia Design Audits Annan Community Hospital 5: En suite or adjacent toilet provision 5.13 E The colour and tone of the tiling/wall contrast clearly with the colour and tone of grab rails 5.14 R Grab rails are comfortable to grip 5.15 R The room is homely 5.16 E The room does not smell unpleasant En suite 5.17 R Extractor fans are quiet Toilet area 5.18 E The colour and tone of the toilet seat contrast clearly with the colour and tone of the toilet bowl 5.19 E The colour and tone of the toilet seat contrast clearly with the colour and tone of the floor 5.20 R Cisterns are traditional in appearance Toilet Cisterns generally of the concealed type, making the WC less recognisable to people with dementia. 5.21 R Lever handles or pull chains contrast in colour/tone and tone with the cistern or background wall 5.22 E There are domestic-style toilet roll holders Most soap, towel and toilet roll holders etc are commercial / medical type, so unlikely to be familiar to older people with dementia. 5.23 E Toilet roll holders contrast clearly with the background wall (or contain contrasting coloured toilet rolls) 18 Version 1 University of Stirling 2012 www.dementia.stir.ac.uk

NHS Dumfries and Galloway: Dementia Design Audits Annan Community Hospital 5: En suite or adjacent toilet provision 5.24 E The toilet roll is within easy reach of the toilet. Observe: Location/height. Assess by sitting on toilet 5.25 R There is adequate space for transfer to toilet from wheelchair or hoist, especially when two carers are required Wash hand basin area 5.26 R Wash hand basin taps are recognisable in appearance (e.g. cross-head) Extended lever taps used in many cases. 5.27 R Wash hand basin taps are simple to operate En suite 5.28 R Wash hand basin taps have clear indications to help people understand which is hot and which is cold Some taps have more challenging controls (eg. Single action for all functions) 5.29 R The mirrors are well positioned. Observe: Location/height (e.g. over wash hand basin) 5.30 R The mirrors are designed to be removable or easily covered Mirrors are generally not easily removed or covered. Shower/bath area 5.31 R There is convenient shelving close by for toiletries 5.32 E Shower/bath controls are simple to operate 5.33 E Shower/bath controls have clear indications to help people understand which is hot and which is cold 5.34 R There is provision in place to maintain privacy while showering (e.g. shower curtain) www.dementia.stir.ac.uk University of Stirling 2012 Version 1 19

NHS Dumfries and Galloway: Dementia Design Audits 5: En suite or adjacent toilet provision Annan Community Hospital 5.35 R There is adequate space for transfer to shower/bath from wheelchair or hoist, especially when two carers are required Unit 5 subtotal Essential (out of 17): Recommended 11 13 (out of 18): Are any of the positive design features compromised by the observed use of space e.g. inappropriate storage, signs or windows covered, access obstructed? En suite 20 Version 1 University of Stirling 2012 www.dementia.stir.ac.uk

NHS Dumfries and Galloway: Dementia Design Audits Annan Community Hospital 6: Communal toilets/bathrooms General communal toilet/bathroom features 6.1 E The colour and tone of the door contrast clearly with the colour and tone of adjacent walls 6.2 E There is a sign on the door to aid wayfinding 6.3 E The room is made recognisable through the visibility of bathroom fittings and other items such as shampoo and towels 6.4 E The colour and tone of the floor covering contrast with the colour and tone of the furniture 6.5 E The colour and tone of the floor covering contrast with the colour and tone of the walls Communal facilities 6.6 R The skirting contrasts with both the floor and walls. Observe: contrasting skirting or capping strip 6.7 E The flooring is consistent in colour/tone throughout including threshold strips Too much contrast exists at thresholds and transitions to other flooring areas. 6.8 R Strong wall finish patterns have been avoided 6.9 R Ceilings, floors, floor coverings, are sufficiently sound absorbent to support communication 6.10 R The room has good artificial lighting 6.11 R There are a minimum of two main artificial lights in the room 6.12 R The main light fitting is not placed directly over the bath www.dementia.stir.ac.uk University of Stirling 2012 Version 1 21

NHS Dumfries and Galloway: Dementia Design Audits Annan Community Hospital 6: Communal toilets/bathrooms 6.13 E Wall colours are warm and light to maximise light levels 6.14 E Ceramic wall tiling or waterproof lining materials are domestic in appearance 6.15 E The colour and tone of the tiling/walls contrasts clearly with the colour and tone of sanitary fittings Communal facilities Wall colours appear to be tonally too light relative to the light coloured sanitaryware 6.16 E Tiling and wall colours contrast clearly with the grab rails Contrast is available in handfull of instances, but not generally. 6.17 R The room is homely 6.18 E The room does not smell unpleasant 6.19 R Grab rails are comfortable to grip 6.20 R There is adequate space for transfer to the toilet from a wheelchair or hoist, especially when two carers are required 6.21 R Extractor fans are quiet Toilet area 6.22 E The colour and tone of the toilet seat contrasts clearly with the colour and tone of the toilet bowl Sufficient contrast provided in some cases, but not always. 6.23 E The colour and tone of the toilet seat contrasts clearly with the colour and tone of the floor 6.24 R Cisterns are traditional in appearance 22 Version 1 University of Stirling 2012 www.dementia.stir.ac.uk

NHS Dumfries and Galloway: Dementia Design Audits Annan Community Hospital 6: Communal toilets/bathrooms 6.25 R Lever handles or pull chains contrast in colour/tone with the cistern or background wall 6.26 R There are domestic-style toilet roll holders 6.27 R These contrast clearly with the background wall (or contain contrasting-colour toilet rolls) 6.28 E The toilet roll is within easy reach of the toilet. Observe: Location/height. Assess by sitting on toilet Wash hand basin area 6.29 R Wash hand basin taps are recognisable in appearance (e.g. cross-head) Communal facilities 6.30 R Wash hand basin taps are simple to operate 6.31 R Wash hand basin taps have clear indications to help people understand which is hot and which is cold 6.32 R Noisy hand-dryers have been avoided in favour of towels. Observe: Listen to the sound of the handdryer 6.33 R Mirrors are well situated 6.34 R Mirrors are designed to be removable or easily covered Shower/bath area 6.35 R There is convenient shelving close by for toiletries 6.36 E Shower/bath controls are simple to operate. Try out www.dementia.stir.ac.uk University of Stirling 2012 Version 1 23

NHS Dumfries and Galloway: Dementia Design Audits 6: Communal toilets/bathrooms Annan Community Hospital 6.37 E Shower/bath controls have clear indications to help people understand which is hot and which is cold. Observe: Are the controls easy to understand with clear colour contrast? 6.38 R There is a shower/bath curtain to provide privacy 6.39 R The floors, floor coverings and ceilings are designed to minimise noise Communal facilities 6.40 R Extractor fans are quiet Unit 6 subtotal Essential (out of 16): Recommended (out of 24): 13 18 Are any of the positive design features compromised by the observed use of space e.g. inappropriate storage, signs or windows covered, access obstructed? 24 Version 1 University of Stirling 2012 www.dementia.stir.ac.uk

NHS Dumfries and Galloway: Dementia Design Audits Annan Community Hospital 7: Physiotherapy and occupational therapy room General examination room features 7.1 E The colour and tone of the floor covering contrast with the colour and tone of the furniture 7.2 E The colour and tone of the floor covering contrast with the colour and tone of the walls 7.3 R The skirting contrasts with both the floor and walls. Observe: contrasting skirting or capping strip 7.4 E The flooring is consistent in colour/tone and tone throughout including threshold strips 7.5 R Large-patterned floor coverings have been avoided 7.6 R Strong wallpaper patterns have been avoided 7.7 R The room has good levels of natural lighting ADL kitchen 7.8 R Glare from natural lighting can be managed 7.9 R The room has good levels of artificial lighting 7.10 R Ceilings, floors, floor coverings, are sufficiently sound absorbent to support communication 7.11 R If there is an ADL kitchen area, it has glass fronted cupboards or open shelves 7.12 R Taps and other equipment are easy to understand www.dementia.stir.ac.uk University of Stirling 2012 Version 1 25

NHS Dumfries and Galloway: Dementia Design Audits Annan Community Hospital 7: Physiotherapy and occupational therapy room 7.13 R There is adequate concealed storage for equipment Unit 7 subtotal Essential (out of 3): Recommended (out of 10): 2 9 Are any of the positive design features compromised by the observed use of space e.g. inappropriate storage, signs or windows covered, access obstructed? ADL kitchen 26 Version 1 University of Stirling 2012 www.dementia.stir.ac.uk

NHS Dumfries and Galloway: Dementia Design Audits Annan Community Hospital 8: Day room General lounge features 8.1 E The colour and tone of the floor covering contrast with the colour and tone of the furniture The light coloured wooden tables appear to offer insufficient contrast against the lighter tone of floor finish. Chair seats are generally OK, but arms need more contrast to floor. 8.2 E The colour and tone of the floor covering contrast with the colour and tone of the walls 8.3 R The skirting contrasts with both the floor and walls. Observe: contrasting skirting or capping strip 8.4 E The flooring is consistent in colour/tone throughout including threshold strips The wide boarder strip leading to the main corridor contrasts excessively with both room and corridor flooring. 8.5 R Large-patterned floor coverings have been avoided 8.6 R Strong wallpaper patterns have been avoided 8.7 R The room has good levels of natural lighting 8.8 R Glare from natural lighting can be managed 8.9 R The room has good levels of artificial lighting Day room 8.10 R The lighting can be controlled according to the time of day 8.11 R The room should be recognisable as a place for sitting comfortably, with lounge chairs and coffee tables, pictures on the walls and cupboards 8.12 E The room should be recognisable as a place for eating or activities with tables and chairs www.dementia.stir.ac.uk University of Stirling 2012 Version 1 27

NHS Dumfries and Galloway: Dementia Design Audits Annan Community Hospital 8: Day room 8.13 E No more than ten people should sit and eat together 8.14 E There are extra/enough seats for staff interacting with patients at mealtimes 8.15 R Table layout is designed to allow patients to eat alone if required 8.16 R Crockery/cutlery are of traditional design 8.17 R Crockery, glassware and cutlery contrast in colour/tone to table and/or background surface. Observe: Crockery is not childish or unrecognisable A mixture of crockery appears to be available. 8.18 R Ceilings, floors and floor coverings should absorb sound as much as possible to support audible communication. Observe: is there a lot of reverberation? 8.19 R There are sufficient domestic-style light fittings to help promote a recognition of place 8.20 R Décor is age-appropriate and culturally sensitive Day room 8.21 R The room is small and homely 8.22 R There is a range of furniture suitable for the needs of all, including chairs of different heights/depths 8.23 R Furniture design/placement enables, rather than restrains, patients. Observe: Depth of seat; position of tables and seating 8.24 R Window sills of the main windows are low enough to be able to see out to the garden or street from a sitting position. Assess by sitting down. Observe: Furniture or foliage in the garden does not obscure the view or the natural light 28 Version 1 University of Stirling 2012 www.dementia.stir.ac.uk

NHS Dumfries and Galloway: Dementia Design Audits 8: Day room Annan Community Hospital 8.25 R The layout incorporates fittings and furniture that will encourage staff/patient interaction The furniture was laid out poorly, with large empty spaces between. Promts were lacking for activities other than looking out the window or watching TV. 8.26 R There are enough seats for staff 8.27 E Toilet facilities are visible or are well signposted 8.28 R If there is an adjacent garden/balcony/roof terrace visible from the lounge, there is a door leading to it 8.29 E Doors to safe outdoor areas are unlocked The doors to outdoor spaces were generally locked and / or alarmed. A walled outdoor terrace arewere reported to be used (with staff report) during summer months. 8.30 E Large, analogue, accurate clocks are visible Unit 8 subtotal Essential (out of 9): Recommended (out of 21): 6 18 Are any of the positive design features compromised by the observed use of space e.g. inappropriate storage, signs or windows covered, access obstructed? Day room www.dementia.stir.ac.uk University of Stirling 2012 Version 1 29

NHS Dumfries and Galloway: Dementia Design Audits Annan Community Hospital 9: External areas Please specify what kind of outdoor area this is: External garden Balcony Patio Courtyard Roof Garden Access to external area 9.1 E The access to the outdoor area is visible and/or very well signed This is located slightly around the corner from the day room, off the quiet room. 9.2 E The door threshold to the outdoor area is level 9.3 E The door to the outdoor area is wide enough for wheelchair users 9.4 E Colour and tone contrast between the interior floor finish and exterior surfacing is minimal 9.5 R There should be a water absorbent mat inside the doors to prevent water on internal areas 9.6 E Access to outdoor areas is available during the day. Observe: The doors to the outdoor areas are unlocked 9.7 E Where there is a slope, there are handrails. Observe: Handrails are provided where the gradient of ramps and slopes is greater than 1:20 9.8 E The way back into the building is clearly visible from the outdoor area. Observe: There is visible and clear signage indicating the way back into the building External areas 9.9 E The door contrasts clearly with the surrounding walls 9.10 E There are landmarks to help identify the door e.g. specimen plant, sculpture etc. 9.11 E The door handle is comfortable to use 30 Version 1 University of Stirling 2012 www.dementia.stir.ac.uk