Dementia-Friendly Environment and Practice Audit - Care Homes

Evidence to check

• • Dementia care strategy, framework or model is current and accessible
• • Strategy covers environment, communication, activities, nutrition, distress, medication, family involvement and end-of-life care
• • Staff can explain how the approach is used in daily practice
• • Audits, care plans and observations show the strategy is implemented, not just written

Evidence to check

• • Dementia training records for care, domestic, catering, activities and night staff
• • Staff can explain how they adapt communication for residents with dementia
• • Supervision or observations check dementia care practice
• • Training is refreshed after incidents, distress, complaints or identified poor practice

Evidence to check

• • Environment includes clear signage, contrast colours, familiar cues and meaningful objects
• • Bedroom doors, toilets, bathrooms, dining areas and lounges are easy to identify
• • Residents can find key areas with minimal staff direction where possible
• • Environmental adaptations are reviewed when residents' needs change

Evidence to check

• • Environmental checks include lighting, glare, shadows, noise and clutter
• • Staff reduce unnecessary noise from alarms, televisions, radios, trolleys or call bells
• • Layouts are calm, familiar and easy to navigate
• • Changes are made where residents show signs of distress or disorientation

Evidence to check

• • Corridors are free from trip hazards and unnecessary clutter
• • Handrails, seating, landmarks or visual cues support safe movement
• • Residents who walk with purpose are supported safely and respectfully
• • Risks are managed without unnecessary restriction or locked-in feeling

Evidence to check

• • Personalised door signs, memory boxes, photo cues or activity boards are used where helpful
• • Memory aids are individualised and meaningful to the resident
• • Aids are kept up to date and in good condition
• • Staff use memory aids during support rather than relying only on verbal prompts

Evidence to check

• • Communal areas include meaningful, familiar and age-appropriate objects or activities
• • Sensory stimulation is balanced with quiet spaces
• • Residents can choose between activity, rest and quieter areas
• • Staff observe whether the environment increases comfort or distress

Evidence to check

• • Care plans include life story, relationships, work history, interests and routines where known
• • Triggers, distress signs and reassurance strategies are clearly recorded
• • Staff can describe what matters to the resident
• • Care plans are updated when staff or relatives learn new information

Evidence to check

• • Observation shows staff using calm tone, body language, patience and reassurance
• • Staff avoid arguing, correcting unnecessarily or rushing residents
• • Care plans include preferred communication approaches
• • Distress incidents are reviewed for staff response and learning

Evidence to check

• • Activities are adapted to different cognitive abilities and interests
• • Residents have access to one-to-one, small group and spontaneous meaningful activity
• • Activities include reminiscence, music, sensory engagement, household tasks, movement or creative options
• • Participation and enjoyment are reviewed, not only attendance

Evidence to check

• • Care plans identify causes of distress and de-escalation approaches
• • Staff understand behaviour as communication of unmet need, pain, fear or distress
• • Incidents are reviewed to identify triggers and better support
• • Use of sedating medication or restraint is monitored and clinically justified

Evidence to check

• • Residents can access outdoor space safely where appropriate
• • Garden or outdoor area is secure, accessible and dementia-friendly
• • Seating, paths, sensory planting or familiar features support use
• • Access is not unnecessarily restricted due to staff convenience

Evidence to check

• • Bedrooms include personal items, photos, familiar objects or preferred decor where the resident wishes
• • Personalisation supports recognition and comfort
• • Staff respect personal belongings and private space
• • Room layout supports safety, orientation and independence

Evidence to check

• • Care plans identify what the resident can do independently or with prompts
• • Staff use step-by-step prompts, time, encouragement and adaptive equipment where helpful
• • Daily notes show participation in washing, dressing, eating, mobility or meaningful routines
• • Support balances independence with safety and dignity

Evidence to check

• • Rotas consider continuity for residents who become anxious with unfamiliar staff
• • Staff know residents' routines, preferences and communication needs
• • Agency or new staff receive clear handover and resident-specific guidance
• • Residents' distress linked to staffing changes is reviewed and acted on

Evidence to check

• • Care records show behaviour changes trigger health checks and escalation
• • Pain assessment tools are used where residents cannot verbalise pain
• • Staff consider delirium, infection, discomfort, hunger, thirst, fatigue or environmental triggers
• • GP, nurse or specialist input is sought when behaviour changes suddenly

Evidence to check

• • Observations of noise levels in lounges, dining rooms, corridors and bedrooms
• • Televisions, radios, alarms and equipment noise are managed sensitively
• • Residents have access to quiet spaces
• • Staff respond when residents appear distressed by noise

Evidence to check

• • Dining environment uses contrast, clear table settings and appropriate lighting where helpful
• • Residents are offered choice in a way they can understand
• • Staff support pacing, prompting, hand-over-hand assistance or finger foods where appropriate
• • Nutrition and hydration concerns are monitored and escalated

Evidence to check

• • Medication reviews include antipsychotics, sedatives and PRN use
• • Reason for use, target symptoms and review date are recorded
• • Non-medication approaches are attempted and documented where appropriate
• • GP, pharmacist or mental health professional review is requested where concerns arise

Evidence to check

• • Activity plans reflect individual preferences and life history
• • Residents have opportunities for music, art, animals, nature or sensory engagement where desired
• • Staff observe and record emotional response and enjoyment
• • Activities are adapted where residents' abilities change

Evidence to check

• • Falls risk assessments consider cognition, perception, walking with purpose, night-time movement and communication
• • Interventions are dementia-friendly and least restrictive
• • Staff understand how to support safe mobility without unnecessary restraint
• • Falls reviews consider unmet needs, environment, pain, continence and distress

Evidence to check

• • Family or representative input is recorded in life history and care planning
• • Resident's own views and responses remain central
• • Relatives help identify routines, triggers, likes, dislikes and reassurance strategies
• • Care plans are updated after family input

Evidence to check

• • Advance care planning is considered where appropriate
• • Pain, comfort, nutrition, hydration, communication and family support are addressed
• • DNACPR or treatment escalation decisions are recorded and communicated where relevant
• • End-of-life care plans reflect dignity, culture, faith and resident preferences where known

Evidence to check

• • Environmental audits include dementia accessibility
• • Flooring patterns, thresholds, mirrors, signage and exit visibility are reviewed for confusion or distress
• • Handrails, toilets and communal areas are easy to identify
• • Actions from environmental reviews are tracked and completed

Evidence to check

• • Resident experience is assessed through observation as well as verbal feedback
• • Staff record signs of enjoyment, distress, refusal, comfort or engagement
• • Family or advocate insight is used where appropriate
• • Feedback leads to changes in care, activity, environment or staff approach

Evidence to check

• • Records describe behaviour factually and respectfully
• • Care plans identify what the behaviour may communicate
• • Staff explore pain, fear, boredom, overstimulation, unmet need or environmental triggers
• • Support plans are changed when patterns are identified

Evidence to check

• • Audit includes observation of staff interaction and resident experience
• • Audit checks environment, care plans, activities, nutrition, distress response and medication practice
• • Residents and relatives are involved where possible
• • Actions from audits are followed up and reviewed for impact