Agenda-Item-7-Appendix-1-University-of-Stirling-Dementia-Hospital-Design

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: 11/01/2018 Issued by: Mr Martin Quirke (Revision 2) Prepared by: Mr Martin Quirke Ms Lesley Palmer Version: Comment: Revision Audit scoring adjusted Ticks and crosses clarified Thornhill Hospital Address and contact information corrected 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 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 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 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: 2.1 Mon 13th & Tues 14th March 2017 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 are considered to be a Pass All audit items marked with a 'cross 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 Dumfries & Galloway NHS Drummore DUMFRIES LOCHMABEN KIRKCUDBRIGHT K'bt Community Hospital Built 1897 Gatehouse of Fleet DUMFRIES and GALLOWAY Whithorn Wigtown Port William Kirkcowan Dunscore CASTLE C.D Community Hospital New Abbey Built 1897 DOUGLAS DALBEATTIE New Galloway Dalry Johnstonebridge ANNAN Annan Community Hospital Built 1987 Gretna Canonbie CUMBRIA Eaglesfield LOCKERBIE LANGHOLM BORDERS Carlisle Thomas Hope Hospital Built 1898 "B" listing Aug 1971 Annandale & Eskdale LHP Moffat Community Hospital Built 1927 MOFFAT Lochmaben Community Hospital Built 1996 Thornhill Community Hospital Built 1902 Nithsdale LHP Moniaive THORNHILL SANQUHAR Wanlockhead © Prepared by: 04/11/2008 Amanda Henderson, Estates & Property Services, Criffel South, Crichton Hall, Crichton Royal Hospital ( 01387 244209 amanda.henderson@nhs.net (updated 14/10/2016-s:\estates shared area\autocad\comm\hb wide map community hospitals only.dwg) Sandhead Galloway Community Hospital Built 2006 Glenluce STRANRAER Stewartry LHP NEWTON N.S Community Hospital STEWART Built 1897 Creetown Wigtown LHP AYRSHIRE & ARRAN Carsphairn KIRKCONNEL STRATHCLYDE DEMENTIA SERVICES DEVELOPMENT CENTRE, UNIVERSITY OF STIRLING DEMENTIA SERVICES DEVELOPMENT CENTRE, UNIVERSITY OF STIRLING 3.0 DESIGN AUDITS SUMMARY OF RECOMMENDATIONS The forthcoming pages comprise of the 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 hospitals: 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 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 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 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 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 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 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 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 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 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 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’ DEMENTIA SERVICES DEVELOPMENT CENTRE, UNIVERSITY OF STIRLING 3.1 ANNAN HOSPITAL 10 6: Communal toilets/bathrooms No Notes 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 Communal facilities Yes Wash hand basin area 6.29 R Wash hand basin taps are recognisable in appearance (e.g cross-head) 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 23 6: Communal toilets/bathrooms Communal facilities Yes No 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 6.40 R Extractor fans are quiet Unit subtotal Notes Essential (out of 16): Recommended (out of 24): 14 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 © University of Stirling 2012 www.dementia.stir.ac.uk 7: Physiotherapy and occupational therapy room Yes No Notes General examination room features 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 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 ADL kitchen 7.1 Version 25 7: Physiotherapy and occupational therapy room Yes No 7.13 R Unit subtotal Notes There is adequate concealed storage for equipment Essential (out of 3): Recommended (out of 10): 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 © University of Stirling 2012 www.dementia.stir.ac.uk 8: Day room Yes No Notes General lounge features E The colour and tone of the floor covering contrast with the colour and tone of the furniture 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 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 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 Day room 8.1 Version 27 8: Day room Day room Yes No 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 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 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 Notes Version © University of Stirling 2012 www.dementia.stir.ac.uk 8: Day room Yes No 8.25 R The layout incorporates fittings and furniture that will encourage staff/patient interaction 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 8.30 E Large, analogue, accurate clocks are visible Unit subtotal Notes Essential (out of 9): Recommended (out of 21): 17 Day room 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 29 9: External areas Please specify what kind of outdoor area this is: External garden Yes No  Balcony  Patio  Courtyard Roof Garden Notes Access to external area External areas 9.1 E The access to the outdoor area is visible and/or very well signed 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 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 © University of Stirling 2012 www.dementia.stir.ac.uk 9: External areas Yes No Notes 9.12 E The door handle is recognisable 9.13 E The door handle is easy to operate 9.14 E The door handle is clearly visible and contrasts against the door Safety features E The external space is enclosed 9.16 E The enclosure is difficult or impossible to climb (e.g there are no footholds or horizontal fencing bars on the internal side) 9.17 E There is barrier planting to deter access to the enclosure 9.18 E Where adjacent surfaces vary in level, e.g from a single step height to much greater heights, a balustrade of suitable height is provided Observe: Balustrade 1.1 metres high and where there is a significant drop, is higher and slopes inward or has a sloping top 9.19 R The external lighting is evenly distributed Observe: External lighting fixtures 9.20 R The shadows cast from fencing and railings are not confusing Observe: Orientation 9.21 R The gates are disguised 9.22 R Handles and latches are hidden 9.23 E Hard surfacing is level www.dementia.stir.ac.uk © University of Stirling 2012 External areas 9.15 Version 31 9: External areas Yes No Notes 9.24 E Hard surfacing is non-slip 9.25 E Hard surfacing is non-reflective Observe: Sunlight does not create glare 9.26 R Hard surfacing has defined edges 9.27 R Raised edges not create a trip hazard 9.28 E Location of accessible areas does not extend within reach of opening windows 9.29 R Hard surfacing is well drained Observe: The water could drain off to soft landscape; there are gullies 9.30 E Service covers (manhole covers) where people are likely to walk are concealed N/A General design principles External areas 9.31 R The outside areas are sunny during at least one part of the day and preferably for most of the day 9.32 R There are pergolas, a summer house or a gazebo to break up the space 9.33 R There are trellises to break up the space 9.34 R There are some features that will be of particular interest to patients Observe: Items of local interest; artworks such as sculptures; wind chimes; water features etc 9.35 R There are trees to provide shade Observe: The items in the garden/roof terrace/roof garden/balcony provide shelter and protection but not prevent direct sunlight reaching the patient 32 Version © University of Stirling 2012 www.dementia.stir.ac.uk 9: External areas No Notes 9.36 R There are awnings/parasols to provide shade Observe: The items in the garden/roof terrace/roof garden/balcony provide shelter and protection but not prevent direct sunlight reaching the patient 9.37 R There are wind breaks 9.38 E Seating and furniture are available 9.39 E The arms of the seating furniture are comfortable to use when sitting down or getting up 9.40 E Seating and furniture are robustly constructed Observe: Chairs and benches not move when sitting down or getting up 9.41 E Seating and furniture are stable Observe: The tables and seat not easily move, get knocked over or shift when leaning on them 9.42 E There is sufficient colour and tone contrast between the furniture and the ground surface 9.43 R Items/furniture in the garden/balcony/roof terrace/roof garden are in good condition 9.44 R There is a toilet near the building entrance (either inside or outside the building) Observe: The toilet door is clearly visible from the garden/balcony/roof terrace/roof garden or the toilet door is clearly signed 9.45 R To avoid sound reflecting into the building, there should be no large areas of hard surfacing outside bed areas, offices or treatment rooms 9.46 R There is access to outdoor areas in all weathers Observe: There is a lobby/veranda or similar space to allow access outside in all weathers www.dementia.stir.ac.uk © University of Stirling 2012 Version 33 External areas Yes 9: External areas Yes No Notes Design features: paths 9.47 R If space allows, there is a path of minimum wheelchair width that returns either to the starting point or alternative safe access to the building 9.48 R The path route can be generally seen from the communal areas and/or staff offices 9.49 R There are resting areas along the path 9.50 R Dead ends and locked gates Design features: patios 9.51 R The hard-surfaced patio is large enough for the number of people that might use it 9.52 R There is no colour contrast between the paths leading from the patio and the patio itself Design features: planting and grass External areas 9.53 E Plants are not harmful Observe: No poisonous or spiny plants within reach of users 9.54 R Planting does not overhang access routes 9.55 R There is a range of plants providing ‘year round’ interest 9.56 R There are raised planters 9.57 R Planting beds are well maintained 34 Version © University of Stirling 2012 www.dementia.stir.ac.uk 9: External areas Yes No 9.58 R Grass areas are well maintained Observe: Grass is level, well drained and usable 9.59 R There are landmarks to aid wayfinding such as trees, plants and garden furniture Unit subtotal Notes Essential (out of 25): 20 Recommended (out of 18): 13 External areas 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 35 10: General principles Yes No Notes General design features 10.1 R There is imaginative use of techniques to make fire doors less obvious or to conceal areas where patients are denied access for safety reasons Observe: Doors blended into colour schemes, with lengths of skirting and handrails applied to them 10.2 R There is evidence of respect for patient’s ethnic, cultural and religious backgrounds Observe: Space for prayers If multicultural, no dominance of one particular religion’s image 10.3 E The doors to the toilet areas should have a consistent signature colour throughout the building 10.4 E The colour and tone of the toilet doors should contrast clearly with adjacent walls 10.5 R Highly visible calendars are available Calendars are visible on the ward 10.6 E There is adequate storage for equipment Observe: Unused hoists and trolleys are not stored in patient areas Unit subtotal Essential (out of 3): Recommended (out of 3): Are any of the positive design features compromised by the observed use of space e.g inappropriate storage, signs or windows covered, access obstructed? General principles 36 Version © University of Stirling 2012 www.dementia.stir.ac.uk Overall score Unit 1: Subtotal Entrance, corridors, wayfinding and lift Essential: (out of 12) Recommended :(out of 34) 18 Unit 2: Subtotal Nurses’ station Essential: (out of 0) Recommended :(out of 5) Unit 3: Subtotal Waiting room Essential: (out of 0) Recommended :(out of 0) Unit 4a: Subtotal Bed area: single room Essential: (out of 0) Recommended :(out of 0) Unit 4b: Subtotal Bed area: bay Essential: (out of 11) Recommended :(out of 24) 13 Unit 5: Subtotal En suite or adjacent toilet provision Essential: (out of 15) Recommended :(out of 15) Unit 6: Subtotal Communal toilets/bathrooms Essential: (out of 16) Recommended: (out of 24) 14 Unit 7: Subtotal Physiotherapy and occupational therapy room Essential: (out of 0) Recommended :(out of 0) Unit 8: Subtotal Day room Essential: (out of 9) Recommended: (out of 21) 17 Unit 9: Subtotal External areas Essential: (out of 26) 20 Recommended :(out of 18) 14 Unit 10: Subtotal General principles Essential: (out of 3) Recommended: (out of 3) Points scored during audit (A) 46 Points scored during audit (D) 87 Total points available (B) 91 Total points available: (E) 145 51 Recommended percentage (F): DữEì100 60 Essential percentage (C): AữBì100 Total Score 57% The final score on which the audit result is based is weighted according to category The ‘essential’ percentage makes up 34% of the overall rating, and the ‘recommended’ percentage makes up 66% of the overall rating Use the following equation to calculate the final score: Final score = (C×0.34) + (F×0.66) 38 Version © University of Stirling 2012 www.dementia.stir.ac.uk