Dementia Care - Quality Improvment Questionnaire



1460538100Health Information and Quality AuthorityResidential Services for Older PeopleProvider Quality Improvement Questionnaire for Dementia CareIntroductionHIQA worked with an expert advisory group to design this quality improvement questionnaire, based around regulatory requirements and evidence based standards for dementia care. The questionnaire which compliments HIQA’s Provider Guidance and the Self- Assessment tool aims to help providers to review aspects of their service that relate particularly to residents with dementia. The questionnaire may also be used when completing the self-assessment to highlight areas of good practice and to identify areas of improvement to inform the action plan. About the questionnaireThis questionnaire contains five sections. Each section has an outcome to aim for and a series of questions relevant to an aspect of service provision specific to the needs of residents with dementia. Section 1 Health and Social Care Needs Section 3 assesses Safeguarding and SafetySection 2 Safeguarding and SafetySection 3 Residents Rights, Dignity and ConsultationSection 4 Suitable StaffingSection 5 The Environment Please note that section 5 contains two parts; one about the physical environment in the general nursing home and another about the physical environment of the Dementia Specific Unit (DSU).Everyone has responsibility for quality improvement and providers should engage with staff, residents, and relatives when gathering information to completing the quality improvement questionnaire.This questionnaire is a resource for providers to help them to improve service provision to people with dementia.Please note: This quality improvement questionnaire is for internal use only and you are not required to submit this completed questionnaire to the AuthoritySection 1: Health and Social Care NeedsThe outcome against which you should access your service is as follows:Each resident’s wellbeing and welfare is maintained by a high standard of evidence-based nursing care and appropriate medical and allied health care. The arrangements to meet each resident’s assessed needs are set out in an individual care plan, that reflect his/her needs, interests and capacities, are drawn up with the involvement of the resident and reflect his/her changing needs and circumstances.Assessment 1Are there systems in place to ensure that each resident with dementia: YesNoAIs assessed prior to admission? FORMCHECKBOX FORMCHECKBOX BIs assessed on admission? FORMCHECKBOX FORMCHECKBOX CHas planned assessments on a regular basis and at least four monthly? FORMCHECKBOX FORMCHECKBOX 2When a new resident changes their GP, what arrangements are in place to ensure that the attending GP has access to all the relevant medical information?Please provide details: 3Has each resident’s legal status been confirmed before he/she is admitted? For example, has the resident the legal capacity to give consent for admission, for treatments and for care interventions? FORMCHECKBOX Yes FORMCHECKBOX NoPlease provide details:4Does each resident’s assessment include the following?YesNoAPhysical functioning ability FORMCHECKBOX FORMCHECKBOX BPsychological wellbeing FORMCHECKBOX FORMCHECKBOX CSocial care needs and preferences FORMCHECKBOX FORMCHECKBOX DEmotional wellbeing FORMCHECKBOX FORMCHECKBOX ESpiritual needs and preferences FORMCHECKBOX FORMCHECKBOX FTheir use of prescription and non-prescription medications FORMCHECKBOX FORMCHECKBOX 5Are residents with dementia assessed for clinical issues of later life on admission, and thereafter on an ongoing basis?YesNoAContinence FORMCHECKBOX FORMCHECKBOX BTissue viability FORMCHECKBOX FORMCHECKBOX CSensory deficits FORMCHECKBOX FORMCHECKBOX DNutrition and hydration FORMCHECKBOX FORMCHECKBOX EMobility and risk of falls FORMCHECKBOX FORMCHECKBOX FPain FORMCHECKBOX FORMCHECKBOX GBehavioural and psychological symptoms and signs of dementia (BPSD) FORMCHECKBOX FORMCHECKBOX HOrientation to time, place and person FORMCHECKBOX FORMCHECKBOX ICommunication FORMCHECKBOX FORMCHECKBOX 6How do you capture personal information about a resident with dementia regarding their preferences, daily routines, their family and significant life events?7How do you ensure that all staff involved in direct care of the resident are aware of this information and it is used to deliver the best care possible?8Is the resident with dementia and their carers or relatives aware of the nurse or key worker responsible for coordinating care? FORMCHECKBOX Yes FORMCHECKBOX No9Is verbal information sought from the resident with dementia and their carers or relatives to inform the resident’s assessment process? FORMCHECKBOX Yes FORMCHECKBOX No10Is each resident with dementia and his/her family, if appropriate, given the opportunity to discuss his/her future healthcare and end of life needs and preferences in a timely manner? FORMCHECKBOX Yes FORMCHECKBOX No11How well are decisions recorded in each resident’s medical notes? Are they clear and sufficiently detailed to guide any on call doctor who is not familiar with the resident or their family? In the rating scale below 0 indicates “Not at all” and 6 indicates “Fully documented” Not at allFully documented0123456 FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX 12If assessment identifies the need for consultation or assessment by health and social care professionals or other professionals, are these services available to residents with dementia?(This covers a number of professionals including those listed below) Tick all appropriate boxes.Name of serviceIn-houseOff-siteNot availableAvailable at weekendsAMedical practitioner FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX BGeriatrician services FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX CMental health of later life FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX DAdult psychiatry FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX EOccupational therapy FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FPhysiotherapy FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX GDietetics FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX HSpeech and Language Therapy FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX IAn expert in dementia care FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX JSpecialist palliative care FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX KPodiatry FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX LOptometry FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX MDentistry FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX NAudiology FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX 13To what extent does the service meet the needs of residents with dementia?Name of serviceAlmost alwaysVery OftenAdequatelySome-timesRarelyNot ApplicableAGeneral practitioner FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX BGeriatrician services FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX CMental health of later life FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX DAdult Psychiatry FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX EOccupational therapy FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FPhysiotherapy FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX GDietetics FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX HSpeech and language therapy FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX IAn expert in dementia care FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX JSpecialist palliative care FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX KPodiatry FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX LOptometry FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX MDentistry FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX NAudiology FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX 14What procedures are in place to identify, assess and manage the needs of a resident who becomes acutely confused?Please provide details:15Do you have access to the common summary assessment (CSARs) for each resident admitted under the Nursing Home Support Scheme? FORMCHECKBOX Yes FORMCHECKBOX NoCare Planning16Are the assessed needs, preferences and wishes of each resident with dementia included in a written care plan? FORMCHECKBOX Yes FORMCHECKBOX No17Are measures to promote health and support residents to function to their full potential set out in the care plan? FORMCHECKBOX Yes FORMCHECKBOX No18Is the ongoing assessment of the resident with dementia reflected in the care plan? FORMCHECKBOX Yes FORMCHECKBOX No19Do care plans reflect the changing status of the resident with dementia? FORMCHECKBOX Yes FORMCHECKBOX No20Do care plans clearly set out the care interventions for staff? FORMCHECKBOX Yes FORMCHECKBOX No21Are there systems in place to monitor that care is being delivered in line with the care plan? FORMCHECKBOX Yes FORMCHECKBOX No22Please rate how well residents’ care plans are implemented. In the rating scale below 6 indicates Fully and 0 indicates Not at allNot at allFully0123456 FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX 23How often is each resident’s care plan formally reviewed? MONTHSPlease provide details:24How often does a review of the resident’s medication take place?MONTHSPlease describe the process:25How do you ensure that appropriate information to ensure the wellbeing and quality of life of a resident with dementia is shared with another service in the event that the resident is transferred to an acute hospital or another setting? For example: ‘Mrs X likes to be addressed as Marie and she must have her handbag with her at all times. When Marie calls for Timmy, she is seeking reassurance that her dog ‘Timmy” is well. Please provide details:Health and Social Care Needs Areas of Good Practice Health and Social Care Needs Areas for ImprovementHealth and Social Care Needs The action plan should specify the following:Improvement to be achieved.Actions that need to be takenResources (if any that are needed.How the improvement is to be measuredTimescales by which improvements will be achieved.Person ResponsibleAction Plan:Section 2: Safeguarding and SafetyHIQA sets out the outcome for Safeguarding and Safety as follows:Measures to protect residents being harmed or suffering abuse are in place and appropriate action is taken in response to allegations, disclosures or suspected abuse. Residents are provided with support that promotes a positive approach to behaviour that challenges and a restraint-free environment is promoted. 1Is there a policy on the prevention, detection and response to abuse? FORMCHECKBOX Yes FORMCHECKBOX No2Are all staff trained in the prevention, detection and response to abuse? FORMCHECKBOX Yes FORMCHECKBOX No3How do the provider and person in charge monitor the systems in place to protect residents?4Are all allegations, suspicions or disclosures of abuse recorded appropriately and investigated and responded to in line with the centre’s policy? FORMCHECKBOX Yes FORMCHECKBOX No5Where restraint is used, is it in line with the national policy on restraint published by the Department of Health? (Towards a Restraint free Environment in Nursing Homes). FORMCHECKBOX Yes FORMCHECKBOX No6Are residents who develop behavioural and psychological symptoms of dementia offered a timely and detailed assessment in order to determine any underlying causes or triggers? FORMCHECKBOX Yes FORMCHECKBOX NoSafeguarding and Safety: Areas of Good Practice Safeguarding and Safety: Areas for ImprovementSafeguarding and Safety : The action plan should specify the following:Improvement to be achieved.Actions that need to be takenResources (if any that are needed.How the improvement is to be measuredTimescales by which improvements will be achieved.Person ResponsibleAction Plan:Section 3: Residents’ Rights, Dignity and ConsultationHIQA sets out the outcome for Residents’ Rights, Dignity and Consultation as follows:Residents are consulted with and participate in the organisation of the centre. Each resident’s privacy and dignity is respected, including receiving visitors in private. He/she is facilitated to communicate and enabled to exercise choice and control over his/her life and to maximise his/her independence. Each resident with dementia has opportunities to participate in meaningful activities, appropriate to his or her interests and preferences.1Is there a nominated independent person who advocates for residents with dementia/cognitive impairment? FORMCHECKBOX Yes FORMCHECKBOX No2Please describe arrangements in place for residents with dementia to access advocacy services:3Are residents provided with opportunities to use their own personal assets (such as their personal finances) to improve their quality of life? How is this achieved?Please provide details:4What communication devices and aids are used to help communicate with people who have dementia? (For example: electronic communication aids, pictures, symbols etc.)Please provide details:5Are staff trained and competent in the use of all communication equipment and aids? FORMCHECKBOX Yes FORMCHECKBOX No6How do you ensure that staff know about and are respectful of the cultural background of each individual resident they work with? Please provide details: 7Please answer “Yes” or “No” to the following statements.YesNoAThe right of residents with dementia to decline admission/treatment or care is respected? FORMCHECKBOX FORMCHECKBOX BOptions and risks associated with declining admission/treatment or care are fully discussed and documented? FORMCHECKBOX FORMCHECKBOX CDResidents with dementia are facilitated to vote in local and national elections and referenda in accordance with their wishes?Each resident with dementia is supported to observe or abstain from religious practice in accordance with their wishes? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX EIs each resident’s privacy and dignity respected in relation to the following:YesNoi) Receiving visitors FORMCHECKBOX FORMCHECKBOX ii) Expressions of intimacy and sexuality FORMCHECKBOX FORMCHECKBOX iii) Medical consultations and examination FORMCHECKBOX FORMCHECKBOX iv) The provision of intimate care and support FORMCHECKBOX FORMCHECKBOX v) Circumstances where confidential and/or sensitive information is being discussed FORMCHECKBOX FORMCHECKBOX vi) Access to bedrooms FORMCHECKBOX FORMCHECKBOX vii) Access to toilets FORMCHECKBOX FORMCHECKBOX viii) Access to bathrooms FORMCHECKBOX FORMCHECKBOX 8Are procedures in place to protect the private information of residents, including residents who have dementia? FORMCHECKBOX Yes FORMCHECKBOX No9Is each resident with dementia asked how they would like to be addressed (for example Mrs. Smith or Mary) and is this respected? FORMCHECKBOX Yes FORMCHECKBOX No10Are residents with dementia encouraged and supported to contribute ideas to and participate in, the day-to-day activities of the centre FORMCHECKBOX Yes FORMCHECKBOX No11Is feedback sought from residents with dementia and their families on how care should be delivered? FORMCHECKBOX Yes FORMCHECKBOX No12Is a balanced approach taken when managing risk and promoting independence, taking the residents preferences into account? FORMCHECKBOX Yes FORMCHECKBOX NoPlease give an example:13Can each resident with dementia access safe and appropriate outdoor space independently, or with support if necessary? FORMCHECKBOX Yes FORMCHECKBOX No14Can residents maintain contact with family, friends and others through video call technology, such as Skype? FORMCHECKBOX Yes FORMCHECKBOX No15How do you support residents with dementia to develop new friendships and maintain relationships with family and others, if they so wish?Please provide details:16Do you support residents with dementia to develop and maintain links with the wider community? FORMCHECKBOX Yes FORMCHECKBOX NoPlease provide details:17If an issue or complaint is made by a resident with dementia, is it received in the same way as complaints raised by others? FORMCHECKBOX Yes FORMCHECKBOX No18Are residents with dementia given choice and control in decisions affecting their everyday lives, care and support? FORMCHECKBOX Yes FORMCHECKBOX NoPlease provide details:19How do you ensure that each resident, as their dementia progresses, has opportunities to participate in activities that are meaningful and purposeful to him/her, and which suit his/her needs, interests, and, capabilities?Please provide details:20Do residents have access to a social kitchen with suitable equipment to enable them to engage in domestic activities? FORMCHECKBOX Yes FORMCHECKBOX NoResidents’ Rights, Dignity and Consultation: Areas of Good Practice Residents’ Rights, Dignity and Consultation: Areas for ImprovementResidents’ Rights, Dignity and Consultation The action plan should specify the following:Improvement to be achieved.Actions that need to be takenResources (if any that are needed.How the improvement is to be measuredTimescales by which improvements will be achieved.Person ResponsibleAction Plan:Section 4: Suitable StaffingHIQA sets out the outcome for Residents’ Rights, Dignity and Consultation as follows:There are appropriate staff numbers and skill mix to meet the assessed needs of residents, and to the size and layout of the designated centre. Staff have relevant up-to-date training and access to education and training to meet the needs of residents with dementia. All staff and volunteers are supervised on an appropriate basis, and recruited, selected and vetted in accordance with best recruitment practice.1Do staff and volunteer induction programmes include dementia awareness? FORMCHECKBOX Yes FORMCHECKBOX No2Is there is a training and knowledge framework or strategy that identifies necessary skills development for staff working with and caring for people with dementia? FORMCHECKBOX Yes FORMCHECKBOX No3How are staffing levels determined, to ensure consideration of the measure of acuity and dependency, sensitive to the care of people with dementia?4How do you ensure that staff know and are familiar with the needs of each resident and are equipped with the knowledge and skills to meet these needs in a person-centred way? 5The following questions are about training provided to staff caring for people with dementia, including those suspected to have dementia. (Please note: only training received in the previous three years is relevant.)Tick all that apply for each of the staff group.Staff groupDementia awareness trainingCommunication skills specific for people with dementiaApproaches to behaviour that challengesDeliriumPreventionIdentification and ManagementANurses FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX BHealth Care Assistants (HCAs) FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX COther health and social care professionals e.g. physiotherapists, activity co-ordinator etc. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX DSupport staff in the centre e.g. housekeepers, porters, receptionists, catering. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX 6Tick all that apply for each of the staff group.Staff groupSafeguarding and prevention of abuse*7Psychosocial interventions*11Supporting residents with hearing/visual impairment*16ANurses FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX BHealth Care Assistants (HCAs) FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX COther health and social care professionals, e.g. physiotherapists, activity co-ordinator etc. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX ESupport staff e.g. housekeepers, porters, receptionists, catering. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX 7Are health care assistants who frequently interact with residents involved in the development and review of care plans for residents with dementia? FORMCHECKBOX Yes FORMCHECKBOX No8How is relevant information about the care of each resident with dementia, including care plan interventions, communicated to all staff who deliver care?9What measures are in place to support staff to develop trusting relationships and to communicate effectively with residents who have dementia?Staff trainingPlease provide details of additional staff training provided to support staff to provide care for residents who have dementia as appropriate to their role.(Please do not repeat the information provided in Section 5, Q7 and Q18)Type/name of trainingYear training provided?(DD/MM/YYYY)Who provided the training?What were the key topics covered?How many staff attended the training?NURSESCARE SUPPORT STAFFHOUSE-HOLD STAFFOTHER1) 2) 3) 4) Suitable Staffing: Areas of Good Practice.Suitable Staffing: Areas for Improvement.Suitable Staffing: The action plan should specify the following:Improvement to be achieved.Actions that need to be takenResources (if any that are needed.How the improvement is to be measuredTimescales by which improvements will be achieved.Person ResponsibleAction Plan:Section 5: The Environment There are two parts to this section:Part A relates to the general nursing home and excludes dementia specific units.Part B relates to a Dementia Specific Unit (DSU).(Please note: You should only complete Section 5B if the centre has a separate section for people with dementia or cognitive impairment).HIQA sets out the outcome for Residents’ Rights, Dignity and Consultation as follows:The location, design and layout of the centre are suitable for its stated purpose and meets residents’ individual and collective needs in a comfortable and homely way. The premises, having regard to the needs of residents with dementia, conform to the matters set out in Schedule 6 of the Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 20131Is the centre purpose built to cater for the needs of people with dementia? FORMCHECKBOX Yes FORMCHECKBOX No2Design Features that support best practice in dementia careYesNoAAre all areas bright and well lit, with maximum use of natural light and avoiding bright/dark shadows? FORMCHECKBOX FORMCHECKBOX BCan residents see out the windows while seated? FORMCHECKBOX FORMCHECKBOX CCan glare from sunlight be controlled? FORMCHECKBOX FORMCHECKBOX DAre noise levels monitored appropriately? FORMCHECKBOX FORMCHECKBOX EDo the colour schemes help residents with dementia to find their way around the centre? FORMCHECKBOX FORMCHECKBOX FAre key areas such as bedrooms, bathrooms and sitting rooms clearly marked? FORMCHECKBOX FORMCHECKBOX GAre signs fixed to the doors rather than on adjacent walls? FORMCHECKBOX FORMCHECKBOX HAre signs placed at or below eye level (E.g. 1.2 meters high) FORMCHECKBOX FORMCHECKBOX IAre signs/maps large, bold, and distinctive? FORMCHECKBOX FORMCHECKBOX JIs information (words and pictures) on signs in clear contrast to the background? FORMCHECKBOX FORMCHECKBOX 3Flooring in the residential centreYesNoAAre floor coverings consistent in colour so as to avoid contrast in areas where residents walk, including door thresholds? FORMCHECKBOX FORMCHECKBOX BAre level changes and contrasts (gentle slopes and steps) in the flooring clearly marked? FORMCHECKBOX FORMCHECKBOX CAre floors plain or subtly patterned? (Not busy with bold or high contrast design or pattern which could affect orientation) FORMCHECKBOX FORMCHECKBOX DAre floor surfaces subtly polished rather than polished to a high gloss? FORMCHECKBOX FORMCHECKBOX EAre all floor surfaces non-slip? FORMCHECKBOX FORMCHECKBOX 4Bedrooms in the residential centreYesNoAAre bedrooms personalised and easily identifiable to the resident with dementia? FORMCHECKBOX FORMCHECKBOX BIs the size of bedrooms suitable for residents to have personal furnishings, pictures and other items in their living area? FORMCHECKBOX FORMCHECKBOX CCan each resident with dementia see a clock from their bed area? FORMCHECKBOX FORMCHECKBOX DCan each resident with dementia see a calendar from their bed area? FORMCHECKBOX FORMCHECKBOX EAre personal objects (such as self care items, photographs and messages from relatives) situated where the resident can see them? FORMCHECKBOX FORMCHECKBOX FAre bed covers /curtain patterns relatively subdued? FORMCHECKBOX FORMCHECKBOX GIs there is a functioning call bell system in the bedroom? FORMCHECKBOX FORMCHECKBOX HIs the call bell accessible from the bed and seating areas? FORMCHECKBOX FORMCHECKBOX GIs the en suite door visible from the head of the bed? FORMCHECKBOX FORMCHECKBOX 5Toilet and bathroom facilities in the residential centreYesNoAAre signs to locate the toilets visible from the bed or bedroom door of the resident with dementia? FORMCHECKBOX FORMCHECKBOX BDo toilet doors carry signs? FORMCHECKBOX FORMCHECKBOX CAre toilet and bathroom doors a different colour to the surrounding wall? FORMCHECKBOX FORMCHECKBOX DAre bathroom and toilet doors a consistent colour throughout the premises? FORMCHECKBOX FORMCHECKBOX EAre contrasting colours used in the bathrooms? FORMCHECKBOX FORMCHECKBOX FDo toilet seats contrast with the toilets? FORMCHECKBOX FORMCHECKBOX GDo toilets contrast with the surrounding wall? FORMCHECKBOX FORMCHECKBOX HDo toilets have handrails, large handles and a raised toilet seats for support? FORMCHECKBOX FORMCHECKBOX IAre door handles a different colour to the doors so that they stand out? FORMCHECKBOX FORMCHECKBOX JAre facilities available so that residents have choices about bathing or assisted bathing (e.g. at the sink, overhead showering, hand held shower head, full bath)? FORMCHECKBOX FORMCHECKBOX KAre there call/alarm buttons in the toilets/bathrooms? FORMCHECKBOX FORMCHECKBOX LAre the call/alarm buttons in the toilets/bathrooms visible and in reach? FORMCHECKBOX FORMCHECKBOX MCan mirrors be easily removed or covered? FORMCHECKBOX FORMCHECKBOX 6Promoting independenceYesNoAIs there a space for active residents to walk up and down where they are visible to staff and staff are visible to them? FORMCHECKBOX FORMCHECKBOX BAre the premises adapted to assist residents with mobility difficulties (e.g. wheelchair ramps, grab rails, handrails, seating areas at regular intervals)? FORMCHECKBOX FORMCHECKBOX CIs the furniture layout designed to enable rather that restrain residents? FORMCHECKBOX FORMCHECKBOX DDoes the centre provide hearing aids such as amplifiers/ communicators/hearing loops/ batteries for personal aids or other assistive devices? FORMCHECKBOX FORMCHECKBOX EDo residents have access to a quiet/ peaceful space if they want to be alone or to have quiet? FORMCHECKBOX FORMCHECKBOX FIs the focus in the main sitting room areas something other than a television? FORMCHECKBOX FORMCHECKBOX 7YesNoADo residents have independent access to safe, secure external garden or patio area? FORMCHECKBOX FORMCHECKBOX BAre the garden and patio areas easily visible from inside the building? FORMCHECKBOX FORMCHECKBOX CAre there seating areas inside and outside at frequent intervals that provide opportunity to rest e.g. long corridors? FORMCHECKBOX FORMCHECKBOX DPlease include any additional information:Please complete section 6B, below, only if there is a dementia specific unit in the centre. Section 5, Part B. Questions 1-8 relate to a dementia specific unit.Section 6B- Special Care Dementia Unit (DSU)6B.1Design features that support best practice in dementia careYesNoACan residents see out the windows while seated? FORMCHECKBOX FORMCHECKBOX BCan glare from sunlight be controlled? FORMCHECKBOX FORMCHECKBOX CAre noise levels monitored appropriately? FORMCHECKBOX FORMCHECKBOX DDo the colour schemes help residents with dementia to find their way around the centre? FORMCHECKBOX FORMCHECKBOX EAre key areas such as bedrooms, bathrooms and sitting rooms clearly marked? FORMCHECKBOX FORMCHECKBOX FAre signs fixed to the doors rather than on adjacent walls? FORMCHECKBOX FORMCHECKBOX GAre signs placed at eye level? FORMCHECKBOX FORMCHECKBOX HAre signs/maps large, bold, and distinctive? FORMCHECKBOX FORMCHECKBOX IIs information (words and pictures) on signs in clear contrast to the background? FORMCHECKBOX FORMCHECKBOX 6B.2Flooring in the Special Care Dementia Unit (DSU)YesNoAAre floor coverings consistent in colour so as to avoid contrast in areas where residents walk, including door thresholds? FORMCHECKBOX FORMCHECKBOX BAre level changes and contrasts (gentle slopes and steps) in the flooring clearly marked? FORMCHECKBOX FORMCHECKBOX CAre floors plain or subtly patterned? (Not busy with bold or high contrast design or pattern which could affect orientation) FORMCHECKBOX FORMCHECKBOX DAre floor surfaces subtly polished rather than polished to a high gloss? FORMCHECKBOX FORMCHECKBOX EAre all floor surfaces non-slip? FORMCHECKBOX FORMCHECKBOX 6B.3Bedrooms in the Special Care Dementia Unit (DSU)YesNoAAre bedrooms personalised and easily identifiable to the resident with dementia? FORMCHECKBOX FORMCHECKBOX BIs the size of bedrooms suitable for residents to have personal furnishings, pictures and other items in their living area? FORMCHECKBOX FORMCHECKBOX CCan each resident with dementia see a clock from their bed area? FORMCHECKBOX FORMCHECKBOX DCan each resident with dementia see a calendar from their bed area? FORMCHECKBOX FORMCHECKBOX EAre personal objects (such as self care items, photographs and messages from relatives) situated where the resident can see them? FORMCHECKBOX FORMCHECKBOX FAre bed covers /curtain patterns relatively subdued? FORMCHECKBOX FORMCHECKBOX GIs there is a functioning call bell system in the bedroom? FORMCHECKBOX FORMCHECKBOX HIs the call bell accessible from the bed and seating areas? FORMCHECKBOX FORMCHECKBOX IIs the en suite door clearly visible from the head of the bed? FORMCHECKBOX FORMCHECKBOX 6B.4Toilet and bathroom facilities in the Special Care Dementia Unit (DSU)YesNoAAre signs to locate the toilets visible from the bed or bedroom door of the resident with dementia? FORMCHECKBOX FORMCHECKBOX BDo toilet doors carry signs? FORMCHECKBOX FORMCHECKBOX CAre toilet and bathroom doors a different colour to the surrounding wall? FORMCHECKBOX FORMCHECKBOX DAre items such as soap dispensers and hand dryers clearly labelled with pictures, as well as words, so that the resident with dementia can identify them? FORMCHECKBOX FORMCHECKBOX EAre contrasting colours used in the bathrooms? FORMCHECKBOX FORMCHECKBOX FDo toilet seats contrast with the toilets? FORMCHECKBOX FORMCHECKBOX GDo toilets contrast with the surrounding wall? FORMCHECKBOX FORMCHECKBOX HDo toilets have handrails, large handles and a raised toilet seats for support? FORMCHECKBOX FORMCHECKBOX IAre door handles a different colour to the doors so that they stand out? FORMCHECKBOX FORMCHECKBOX JAre door handles a different colour to the doors so that they stand out? FORMCHECKBOX FORMCHECKBOX KAre facilities available so that residents have choices about bathing or assisted bathing (e.g. at the sink, overhead showering, hand held shower head, full bath)? FORMCHECKBOX FORMCHECKBOX Toilet and bathroom facilities in Dementia Specific Unit (continued)YesNoLAre there call/alarm buttons in the toilets/bathrooms? FORMCHECKBOX FORMCHECKBOX MAre the call/alarm buttons in the toilets/bathrooms visible and in reach? FORMCHECKBOX FORMCHECKBOX NCan mirrors be easily removed or covered? FORMCHECKBOX FORMCHECKBOX 6B.5Promoting independence in the Dementia Specific Unit (DSU)YesNoAIs there a space for active residents to walk up and down where they are visible to staff and staff are visible to them? FORMCHECKBOX FORMCHECKBOX BAre the premises adapted to assist residents with mobility difficulties (e.g. wheelchair ramps, grab rails, handrails, seating areas at regular intervals)? FORMCHECKBOX FORMCHECKBOX CIs the furniture layout designed to enable rather that restrain residents? FORMCHECKBOX FORMCHECKBOX DDoes the centre provide hearing aids such as amplifiers/ communicators/hearing loops/ batteries for personal aids or other assistive devices? FORMCHECKBOX FORMCHECKBOX EDo residents have access to a quiet/ peaceful space if they want to be alone or to have quiet? FORMCHECKBOX FORMCHECKBOX FIs the focus in the main sitting room areas something other than a television FORMCHECKBOX FORMCHECKBOX GDo residents have independent access to safe; secure external garden or patio area? FORMCHECKBOX FORMCHECKBOX HAre these areas easily visible and accessible from inside the building? FORMCHECKBOX FORMCHECKBOX IAre there seating areas inside and outside at frequent intervals that provide opportunity to rest e.g. long corridors? FORMCHECKBOX FORMCHECKBOX The Environment: Areas of Good Practice The Environment: Areas for ImprovementThe Environment The action plan should specify the following:Improvement to be achieved.Actions that need to be takenResources (if any that are needed.How the improvement is to be measuredTimescales by which improvements will be achieved.Person ResponsibleAction Plan: ................
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