Buildings

The design of the home is an important influence on the residents' qualify of life. Design should be geared to satisfying the needs of residents and staff providing care within the home. A well-designed home will:

• provide a safe and secure environment for residents;
• ensure their privacy and provide their own personal space under their own control;
• protect their dignity;
• offer them a stimulating setting for daily activities;
• enable them to have easy access around the home; minimise residents' difficulties in understanding their surroundings;
• provide a work setting which enables staff to deliver high quality care;
• meet the standards relating to the design and fabric of residential and nursing homes required by law, regulations and directives.

Over time, expectations have risen and standards are continually improving. Prospective residents will look for homes where they can expect many of the features outlined here.

If a home is to be newly built, then careful consideration should be given to its location and setting as part of the preparatory process. These, along with its accessibility to public transport, local shops and other community facilities such as pubs and libraries, are likely to influence the choice of individuals and their families.

8.2.1 Access to the local community

It is important that a home should not feel isolated from the surrounding community. In some cases residents may be frail and unable to get out and about but they are still likely to value links with the local community, schools, community organisations and places of worship.

8.2.2 Transport

If residents cannot get about by themselves, the home should consider hiring or purchasing its own transport for outings and trips to shops and places of worship, or arrange for friends, relatives and volunteers to provide it. Such help might also be arranged for relatives and friends who have no transport of their own and who cannot use public transport. Car parking for visitors (and residents in some cases) should be available.

8.2.3 Views and aspect

First impressions of a home its setting and the building itself will have an important impact on potential residents. Open views on to gardens or on to scenes of activity (such as a school or a street) may be important for different individuals. Good landscape design and planting at the initial development stage of a new home will be a worthwhile investment in terms both of resident satisfaction and in enhancing the value of the property.

Homes should make clear in their brochures the advantages of their location and accessibility.

This code recognises that most homes have not been purpose-built and that many have been open for a period of years. Building work is expensive and in any case many existing buildings may not be amenable to adaptation and improvement. The cost implications of some improvements (for example, conversion of rooms into single rooms with en suite facilities) will have revenue as well as capital consequences.

At present, properties do not have to be brought in line with current local authority building regulations on change of ownership; however, under the Registered Homes Act 1984, it is possible to impose new requirements on the new owner. Although this may seem unfair, clearly homeowners should be aware of this possibility. Many of the standards outlined here can be described as 'best practice' which all homes should seek to achieve over time. All homes should have a policy of continuous improvement and this should take account of the standards outlined in this document. A plan and timetable for attainment of the standards laid down in the policy should be drawn up and progress against it monitored regularly.

This should not be taken as a reason to avoid meeting certain standards below which quality should not be allowed to fall under any circumstances. These are the standards which guarantee the privacy and dignity of residents, promote their independence and enable them to live their lives in the way that suits them best. Some are contained in legislation, regulations and guidance; others will be set by national associations (of the professions, homeowners and others) or be the outcome of agreement between homeowners and inspection and registration units. The standards outlined in this code can provide a basis for such agreements.

8.3.1 Purpose-built

In line with the trend which has developed in recent years, the population of residential and nursing homes is likely to become frailer and more dependent in the future. New purpose-built homes should take this into account from the outset. All new homes should be built with single occupancy accommodation with en suite toilet and washing facilities (this should not preclude the possibility of couples, friends, relatives from sharing accommodation if so wished, through, for example, being able to use two rooms, one as bedroom and one as living room). The standards and guidance outlined here should be incorporated into all newly built homes, particularly in relation to issues of privacy, control, activity, adaptations, room size, and features which minimise confusion. This applies equally to newly built extensions to existing properties.

8.3.2 Improvements

Where homes are already established, opportunities should be taken to improve the accommodation as and when possible, either as part of the development programme or, for example, when redecorations are being carried out or between residencies.

Such improvements may include:

• phasing out all shared rooms (apart from one or two for couples);
• using former double rooms for small lounges or dining rooms, for single rooms with en suite facilities or for activity rooms;
• where practicable, adding en suite facilities to rooms;
• adopting a policy of redecoration between residencies, ideally with the new resident taking responsibility for deciding what should be done;
• personalising doors with nameplates or pictures;
• changing the use of communal areas for community activities or day care for older people from outside the home (especially if smaller lounges and dining rooms have been created);
• building a sun lounge;
• improving access to the garden and incorporating new features for example, sheltered areas, raised flowerbeds.

8.3.3 Architects and other professional advisors

When designing a new building or an extension, it is important to use an architect and builder who understand the needs of older people and the principles of good practice. Their previous work should be reviewed and if possible visited. Homes inspectors should be consulted, along with other professional staff, for example occupational therapists, landscape gardeners, crime prevention officers, security consultants.

The size of home will be determined by many factors: the size of an existing building, the style and purpose of the organisation, the relative costs involved. Whatever the size, though, the principles of good quality care outlined in this code should be observed. How they are put into practice will relate to the scale of the operation and will involve:

• the capacity of the residents and the level of care given;
• the daily pattern of life;
• the ethos of the home and its management philosophy;
• the attitudes and training of staff;
• the deployment of staff and duty rotas;
• the use of equipment and technology;
• the use of space within the home.

So long as the central aim is to support and enhance the quality of life for residents, the fostering of individuality and the maintenance of privacy and dignity, a variety of living arrangements is possible. Adherence to that central aim may compensate for shortfalls in the building itself.

8.4.1 Unit or group living

The aim should be, regardless of the overall size of the home, for life to be on a domestic scale for every resident. This can be achieved, particularly in larger settings, by breaking living arrangements into smaller units. In this way residents should be able to identify with a group of other residents however large or small the whole home may be. Each group or unit of this sort should be able to have its own small lounge or dining room with some facilities being shared with the other units, such as a kitchen, transport, communal lounge, garden, laundry or activity rooms. A group can then be cared for by a particular team of staff, thus facilitating the development of a sense of common identity.

8.4.2 People with dementia

There are particular advantages in looking after people with dementia in small groups and there are some proven therapeutic benefits in doing so. These may either be provided through a small home, or through group living as described above. There is some evidence to suggest that a group no larger than eight to twelve residents can best provide the individual care which people with dementia require.

8.4.3 Domestic style

Every effort should be made to prevent the home from having an institutional feel. The setting, design and decoration of the building can contribute to this (along with the way in which staff and management operate). The chart on the following page sets out some of the differences:

Design features within a home
Feature	Non-institutional	Institutional
Corridors	short, bright and spacious, carpeted; leading somewhere with alcoves and variety of spaces for sitting, with natural light, windows	long, no natural light, dimly lit; rows of similar-looking doors leading to a dead-end
Individual rooms	for single occupancy; different shapes; individually decorated and furnished in a variety of styles (chosen by residents); individualised doors and entrances	multi-occupancy; uniform size and shape; plain and utilitarian decoration; doors all the same with no identification
Furniture within rooms	brought in by residents themselves	all supplied by the home; same in every room
Overall plan	variation between parts; attractive and interesting layout	block arrangement; each floor and section the same
Toilets and bath rooms	en suite in residents' rooms; domestic and cosy; patterned and coloured tiles; coloured sanitary were; domestic-style baths	harsh lighting; clinical appearance; cubicles in large room
Communal rooms	variety of furniture of different heights; chairs arranged with small tables; settees, carpeted	chairs all the same, plastic covered; arranged around walls; drab appearance
Dining facilities	attractive setting (even if large); carpeted, with domestic-style tables and chairs	large, canteen-style, with plastic-topped tables and hard floor covering

8.4.4 A supportive environment

The built environment should recognise that older people may have restricted mobility or sensory impairments. Many will have dementia. Supportive features should be incorporated so as to minimise and compensate for all these difficulties. The following design characteristics are important:

• it should be easy for residents to find their way around the building. It is essential that they should be able to locate their own private space, identify how to get to a toilet wherever they are in the building, know where and how to find help and assistance, and know how to get to sitting areas;
• there should be simple, obvious routes around larger buildings, with points of interest as 'landmarks' (for example, plants or pieces of furniture) so that the individuals know where they are, and with as few dead-ends as possible;
• long featureless corridors with similar-looking doors and dead-ends are confusing and should be avoided, particularly in new build;
• there should be easy movement between all parts of the building with doors which can be opened easily and used by people in wheelchairs;
• there should be passenger lifts to upper floors big enough for wheelchairs;
• easy-to-climb stairs with handrails both sides, midway landings and seating are important;
• good levels of lighting are essential; changes of floor levels should be clearly marked, for example the edges of steps. Good lighting is important in helping to reduce confusion. Lighting which casts shadows on to floors should be avoided because they can be misinterpreted for example, they may give the impression that there is something to step over;
• signs should be in bold, clear and large letters fixed at eye level (including for those in wheelchairs). They should contrast with door colour and include pictures as well as words. They should mean what they say; thus signs for the toilet should show a picture of a toilet rather than a man or a woman;
• when colours are used to convey information (for example, the colour of toilet doors) they should be distinctive: bright colours such as red, orange and yellow are the most effective, blue and green the least;
• doors not for use by residents should not be brightly coloured but should tone in with the surrounding wall;
• exit doors should be carefully signed and in a new building placed so as not to create confusion;
• any specially designed fixtures and fittings, for example in toilets and bathrooms, should be in as domestic-style as possible;
• the use of technology should be sensitive, for example communication systems which are non-intrusive;
• loop-hearing systems in lounges should be available;
• individual residents' doors should be personalised for easy recognition (for example, by colour, favourite object or photograph); their rooms should be personalised with their own fittings and furniture and other bits and pieces which have meaning for the individual;
• a number of smaller lounges and activity rooms rather than a single large lounge will help people to mix with each other. A view into a room, such as through an open door or room divider will make a room seem more accessible to the person approaching it;
• homes should provide a safe environment which provides a balance between overprotection and risk with unobtrusive fire and security precautions;
• there should be access to a safe and interesting garden with 'wandering' paths that is, a route which leads a person through the garden and back into the building unobtrusively.

8.4.5 Pleasant environment

In addition to being functional, the building should provide a pleasant and secure environment in which to live. Attention should be paid to the aesthetic qualities of a building. For example:

• lighting, especially the maximum use of natural daylight;
• the imaginative use of colour and decorations;
• having points of interest which may provide stimulation and conversation;
• a variety of usable spaces both inside and outside the building, some of which may be semi-protected for example, porches, conservatories.

Gardens

The gardens in homes are an important part of the premises. They should be safe for people to walk in, without steps (if possible) and accessible for wheelchairs. Security measures should be unobtrusive but reliable. Seats at strategic points with sheltered and shaded areas enable residents to spend time outside. Raised flowerbeds, herb gardens and greenhouses make it easier for residents to take an active interest in the garden. Fountains and ponds may be appreciated. Scented gardens are valued by people who are visually impaired. Birds and other wildlife can be encouraged.

8.4.6 Progressive privacy

Where a building is used for a number of purposes or as a community building (as may be the case in some larger developments), the concept of progressive privacy (physically determined stages in the building which permit increasing levels of privacy to be established) protects the privacy of residents whilst allowing the building to be used in other ways. Three types of space should be distinguished, both in terms of use, design and 'physical barriers' (for example, a door, lift, corridor or separate wing):

• semi-public, a partially 'open door' through which anyone in the community can pass who has a reason for doing so, for example for day care, to attend a coffee morning or to ask for information;

• semi-private areas, closed to outsiders and only open to people who have a reason to be in the residential area, for example residents, staff and visitors;
• private accommodation, open only to the individual resident. No one else should cross the threshold without seeking and gaining permission; this includes staff and visitors.

Whilst all three types of space only apply to larger establishments, the last two should apply to all homes. From a resident's standpoint, such an arrangement allows a resident 'to go out' without actually having to do so and facilitates contact between the outside world and the residents. At the same time, it recognises and protects the residents' privacy and sense of home'.

Facilities and space which are shared by residents should be provided in domestic-style rooms in a non-institutional and non-clinical manner. They should be interesting and varied.

8.5.1 Communal rooms

The amount of common space will depend on the size and nature of residents' rooms. In some cases, personal accommodation might be accorded greater priority than common space, depending on the lifestyle of residents. Two or more smaller communal rooms may be better than one large space, although this would preclude everyone gathering together on special occasions which may be important for some homes. Rooms should be well decorated and accessible for everyone. Efforts should be made to ensure that common space is welcoming. For example, too much noise is as disabling for people with dementia as steps are for someone in a wheelchair.

Within the rooms:

• chairs and furniture should be of different styles and heights;
• easy chairs should be domestic in appearance and not be covered in a plastic;
• some settees should be included;
• side tables should be available (waist-height for drinks, papers, paraphernalia);
• chairs should not just be arranged around walls (unless for a special occasion or because residents prefer this) because small groupings are more homely and intimate;
• furniture should be arranged for easy access, both to allow use of wheelchairs and to provide support for those who have difficulty walking;
• fabric and furnishings should be fire-retardant.

8.5.2 Activity rooms

Rooms should be provided for a variety of activities. Options include:

• a quiet room and library;
• a craft room with sinks and water;
• use of functional rooms by residents, depending on their capacity and legal restrictions, for example the laundry for ironing, the kitchen(ette) for making snacks.

8.5.3 Connecting spaces

All corridors and entrance lobbies should:

• have level access and meet all the mobility criteria;
• have sufficient width and space for wheelchairs and walking frames (electric wheelchairs need more space);
• minimise the distance between private and communal space;
• have passenger lifts to all parts of the building with accommodation above the ground floor. These should have simple controls which can be reached from a wheelchair;
• provide a variety of spaces for sitting and looking out of a window.

One option in larger buildings may be to create en 'indoor street' instead of corridors (natural light, hard surface, external-type doors, slightly lower temperature) to give residents the impression that they are moving from their personal area to a more public one.

8.5.4 The needs of ethnic and other groups

In some homes, there may be special building requirements for particular groups of people. This may relate to homes wholly serving particular ethnic groups or serving a culturally mixed clientele. Such requirements might include:

• washing and toilet facilities of particular specifications;
• segregated male and female quarters;
• areas for prayer and meditation;
• requirements relating to food storage, preparation and cooking.

8.5.5 Toilets, bathrooms in common areas

Access to toilets in common areas should be immediately obvious either by clear sign-posting or by having them situated close by lounges and activity rooms. Privacy in using them is essential. Where toilets and baths/ showers are not provided in individual accommodation, common facilities should be available on each floor at the following ratios:

• toilets/residents, 1:4;
• bathrooms/residents, 1:8.

Toilets should be designed to full mobility and disability standards without having a clinical appearance. Bathing equipment should be as domestic in style as possible, for example baths might have integral lifting seats. If hoists are used care should be taken to minimise fear.

8.5.6 Storage space

There should be space to store luggage, spare equipment including hoists, furniture and other bulky items which are infrequently used. Proper storage should be provided for wheelchairs (including space to recharge electric wheelchairs) and walking frames. It should be out of sight and not impinge on corridors. Regulations relating to fire and safety must be observed.

The single most important aspect of living in residential care is the living accommodation provided for the individual resident. All research shows that most residents prefer a single room and that this colours their attitudes towards all other aspects of residential life. If they have to share rooms they rate lower all other elements of the service they receive.

8.6.1 Single occupancy

Good practice now requires that all residents in continuing care should have their own single room accommodation (unless they prefer otherwise). This applies to both residential homes and nursing homes. It is strongly recommended that single room accommodation should be a requirement for all new registrations subject to the proviso that couples, relatives or close friends are able to live together if they so wish.

8.6.2 Shared occupancy

Involuntary shared occupancy is never acceptable. Two people should only be living in the same accommodation if they have chosen to do so. The accommodation should be specifically designed for two people (in terms of size and facilities), paying due account to privacy. One practical option is for a couple to have two single rooms, one used as a living room, the other as a bedroom.

Arguments are sometimes advanced in favour of shared rooms, namely the benefits of companionship and the reduction of loneliness. Both these can be achieved in better ways than by relying on two strangers sharing accommodation:

• in a properly run and organised home loneliness should not be an issue, and certainly not a reason for anyone wanting to share;
• market forces are indicating that double rooms are proving extremely difficult to let;
• the vast majority of residents are choosing single rooms.'

From: A Room of One's Own, a survey of residential care homes carried out by the Association of Directors of Social Services, 1995

8.6.3 En suite toilet and washing facilities

It is strongly recommended that a requirement for all newly built or extended homes should be that all accommodation should have en suite toilet and washing facilities. En suite facilities should be large enough and designed to allow for help to be given in using the toilet or basin, or for a wheelchair to be used. Careful design will reduce the amount of space taken from the living area of the accommodation although it must be recognised that installing en suite facilities into existing accommodation eats into available space and can therefore only be done where practicable. There should be a washbasin and associated storage space for toiletries. Level entry showers (with a seat and a drain in the floor) may be valuable for those who enjoy them and a help for people with continence problems. Floors should have a non-slip surface and handrails should be fitted. For accommodation without en suite facilities the minimum requirement should be a washbasin in each room.

Toilets should be of a comfortable height with built-in support. Taps designed for people with weak or arthritic hands should be fitted. Advice should be sought from an occupational therapist for particular requirements.

There are a number of factors to consider when deciding whether accommodation is suitable. Most are checked prior to registration and the following provide a guide. Some should be regarded as minimum requirements while others should be included in the home's improvement programme.

8.7.1 Size of room

The total area of a room is one of the key input measures that is checked by inspection and registration units before registration. Whilst important, an overconcentration on size may lead to other factors being overlooked. The generally accepted minimum size is ten square metres for single accommodation. This code recommends that all homes aim to ensure that over time their provision will enable residents to have their own private rooms large enough to hold a reasonable amount of their own furniture and to accommodate all the activities of daily living that a resident can expect to carry out. This will mean that there should be room for a table and chairs, an armchair, a television and other leisure activity paraphernalia. There should be space for turning a wheelchair and for staff to provide assistance. It should also be possible to move the bed into alternative positions, including into the centre of the room should access be required from both sides for nursing care. If standard room measurements are used for planning or registration and inspection purposes, they should exclude unusable space such as low ceilings, odd corners, and en suite toilets.

In new buildings or extensions, the size of the individual's accommodation is the single greatest determinant of cost. Providers and funders and prospective residents will have to assess the conflicting demands of capital costs and fee levels. Compromises may need to be made. For example, if residents tend to spend much of their time in their own rooms, then it may be possible to have smaller communal areas and increase the size of individual rooms. The architecture of an already established home needs to be taken into account, especially in relation to local planning and building regulations.

Other factors

Other factors to consider include:

• the proportion of a room (a long narrow room may not have enough space adjacent to the bed);
• there should be adequate soundproofing to ensure residents are not unnecessarily disturbed by outside noise (for example, other people's televisions). This should not, however, be such as to make the resident feel isolated and cut off from the normal bustle of daily activity;
• where a room has a poor view such as a blank wall, efforts should be made to counteract this by, for example, planting a shrub or growing climbing plants;
• window(s) should be of an adequate size and be of good proportion in relation to size of room. Where possible the window-sill should be low enough for the resident to look out without obstructed vision when seated or when lying in bed.

8.7.2 Furniture

Accommodation should be large enough to contain:

• a bed (at least three feet wide) or double bed if preferred (helpful for people with dementia);
• at least one comfortable armchair (preferably two);
• a table and an upright chair which a resident can use for eating meals, writing and other leisure activities;
• storage space for clothes, for example a chest of drawers and hanging space;
• storage space for other possessions, for example shelves, cupboards;
• lockable storage for money and valuables.

8.7.3 Doors to individual accommodation

Doors represent, both physically and psychologically, the entrance to a resident's private space. It is important, therefore, that as far as possible the resident controls who enters, both through locks and keys and staff and visitors knocking and waiting for an invitation to enter. Doors and locks must comply with fire regulations.

Locks

Doors to individual accommodation should be lockable from both sides with staff holding a master key or other override mechanism in case of emergency. As far as possible, residents should hold their own keys with no restriction as to when they can lock the door. Locks on doors with residents holding keys is one of the main indicators that residents' privacy is respected.

Opening doors

Doors should be easy to open especially for people in wheelchairs or for people who are frail. Where appropriate, their wishes to keep doors open should be respected.

Personalised

The outside of doors should be sufficiently distinct and personalised so that residents can easily recognise their own door. If they wish, their doors could display their names (but in large enough type to be easily read, for example at least one centimetre high) or a wooden or pottery plaque. Other options include photographs, coloured panels, paintings, a familiar number, plant or other distinguishable feature. Doors set back in an alcove make it easier to incorporate features and reduce the institutional appearance of a corridor. A door which is easily recognised, by whatever means, is important for people with dementia.

Letterboxes

In some homes, letterboxes might be provided (in line with fire regulations) depending on the intellectual and physical capacity of residents. If not, other systems of delivering and receiving mail and messages personally (not to individuals whilst in a group, for example at the breakfast table) should be established.

The details described above should be considered best practice, many of which can be achieved at little extra cost within an overall improvement budget. In some cases, depending on the degree of frailty experienced by residents, particularly in nursing homes, they may be less appropriate than will generally be the case. Recognition of this, however, should not be used as a way of avoiding meeting best practice standards in most homes.

8.7.4 Furniture, fittings and decoration

It should be normal practice for people to bring their own suitable furniture with them when moving in on a permanent basis. They should also be able to decorate and furnish their rooms in their own style (including bedding, carpets and curtains). If not, they should be freshly decorated by the home, although this may not be reasonable where the length of the previous residence has been very short. Soft furnishings and bedding should be fire-proofed or fire-retardant where possible.

Rooms which are larger than the minimum size will make it easier for people to bring in their own furniture and possessions. Familiarity with their own belongings is an important support for people with dementia. If residents do not have their own furniture or if they are staying for a short period, then homes should provide suitable domestic furniture as described above.

Rooms should be equipped to allow residents to continue a familiar life style and should include (though individual requirements are likely to vary):

• sufficient electric power points, with at least two double-switched outlets set at waist-height;
• light switches set at convenient points around the room and set at waist-height so that people using wheelchairs can operate them;
• an aerial socket;
• a telephone socket, either for their own telephone line, or for linking to the home's system so that outside calls can be made and received in private;
• loop systems (for televisions, radios, music players) may be installed if cost permits.

8.7.5 Emergency communications system

There should be a straightforward, easy-to-use communications system for both emergency situations and minor calls, ideally voicedbased. Once activated, the system should indicate the origin of the call without disturbing other residents or staff. Communication systems should not replace personal contact by staff.

8.8.1 Temperature

Heating systems should maintain adequate temperature and comply with all safety regulations, be controllable in sectors and, where possible, with individual control in each room. A resident should be able to choose the temperature level in his or her own accommodation. If they are resident-controlled, heating systems should be easy to understand and operate. Water temperature should comply with safety regulations.

8.8.2 Ventilation

Windows should be easy to open with no risk of the resident falling out. The amount of air coming in should be controllable. Size of openings should conform to building regulations in relation to rate of exchange of air within the room. There should be curtains or blinds which residents can operate easily to provide privacy at night-time and during the day when necessary.

8.8.3 Lighting

Different forms and type of lighting should be available, at a minimum a main room light, bedside light and direct light over chair or table. Where necessary, account should be taken of a resident's reduced vision. Trailing flexes should he avoided.

During the coming decade, technology will become an integral, familiar and natural part of care provision. It is important that homeowners keep up to date with new developments from which their residents and staff can benefit.

8.9.1 Uses

Some of its uses will be:

• as a reminder for the resident to do something: for example, that it is a meal time or to take some medication;
• as a compensation for memory loss: for example, switching off the tap if the bath is overflowing;
• as relaxation: for example, snoezelen rooms;
• as stimulation: for example, personal reminiscence videos;
• for environmental management: for example, to keep the heating at an individually comfortable level;
• for behaviour management: for example, to adjust aspects of the environment (heat or light) which are causing restlessness and agitation;
• as a reminder: for example, to shut the window when the resident goes out of the room or remind him or her to take the walking frame if it has been forgotten;
• for surveillance: for example, as a passive alarm which will increasingly be programmed individually so that it is activated only when someone does not get back into bed after fifteen minutes (but never as active surveillance, replacing staff alertness);
• for control: for example, new-style locks on doors;
• for safety: for example, passive infra-red sensors which will turn on the light when someone gets out of bed;
• for communication: for example, using video telephones to keep in touch;
• for coordination: for example, shared use of resident's records in the resident's room by all professional staff.

These new technologies will increasingly be controlled by personal computers which will make it possible to tailor the use of them to fit the individual care plan. It will also be possible to programme their use by prompting regular reviews. While the benefits will be enormous, there may be dangers which must be guarded against. The unethical use of technology is an infringement of residents' civil liberties and should be regarded in the same way as restraint and abuse.

8.9.2 Guidelines on the use of technology

The following guidelines should apply for the use of equipment or technology:

• it should only be used for the positive benefit of a resident which results in improvement in quality of life;
• it should be the least intrusive of equally beneficial actions: that is, simple actions should be used first;
• wherever possible it should be used only with the active consent of the resident who recognises the action as beneficial;
• any risks or side effects should be fully understood by the resident (or relatives and staff);
• proper protocols should be followed for actions which are controversial, and proper records kept (as below);
• its use and effectiveness should be reviewed at appropriate intervals;
• it should never be used solely for the convenience of staff.

The records kept should state:

• the nature of the problem being addressed;
• what methods have been used to resolve the problem;
• why a particular action or technology has been chosen;
• how long it is to be used for and a date set for its review;
• who agreed to its use and who will participate in the review.

8.10.1 Staff rooms

Staff should have their own communal rest room where they can rest and relax between duties and also a room where training can take place when required. Care should be taken to provide a big enough space to cater for staff numbers and it should be comfortably furnished, with storage facilities for personal clothes and belongings. There should be separate toilets and washing facilities for staff. The home should have a smoking or preferably a no smoking policy which is strictly adhered to. It is well recognised that attention paid to the welfare of staff will have a beneficial effect on staff morale and on the quality of their work. Facilities provided for staff, however, should not take precedence over those provided for residents or be seen to be better than residents' facilities. Meeting standards for both should be seen as complementary activities.

8.10.2 Design of staff areas

Where kitchens and laundries are newly installed, account should be taken of current ergonomic standards to make for efficient and safe working. Guidance should be sought from the appropriate authorities. Minimum standards as laid down by legislation, regulations and directives must be met. Other standards should be achieved as part of the improvement programme.