picture of the patient – from which we can identify what staff can best do to try to minimise the individual’s distress. Medication is by no means the first line of treatment; we harness many activities, focusing on meaningful engagement. It’s no longer simply about observation and policing, but rather about engaging with patients and understanding them – a job which our healthcare assistants, nurses, psychiatrists, and a multidisciplinary team, take considerable pride in.”

Addressing key issues

Having discussed the patient group and care model, I asked Alex Caruso to explain the background to the recent refurbishment. He said: “Maister Lodge was built in the 1980s, and central to our work was addressing a number of key issues with the layout which were not conducive to effective recovery or therapy for the patients housed here. While the 14 rooms were previously all single, en suite, the design was tired, and the layout generally confined, dark, and claustrophobic; it certainly didn’t provide the light, airy, and open environment we know is crucial to recovery. On first entering, many of the central spaces were dark, screened, or had closed doors. These spaces became the residents’ congregation points, because this was easier to manage, but they were neither therapeutic nor comfortable to spend time in. The main day rooms had little natural light, there were few positive distractions, and residents tended to pace up and down corridors, because there were no end ‘destination’ points, leading to them over-exercising, and causing observation issues.” Jo Inglis added: “The previous layout also saw patients get more tired, agitated, and distressed. We still see some patient wandering, but it is much reduced. Prior this fantastic recent scheme, we had only seen one small refurbishment – of the foyer area – undertaken here since the unit was built.”

Poor flooring choices

Alex Caruso added: “There were a number of significant inadequacies with the 1980s interior. Some of the existing flooring specification, for example, was especially poor. For instance the timber finish vinyl floors featured quite visible ‘knots’, which led some patients to constantly pick at the floor. The colour strategy – with lots of magnolias and whites – also failed to aid orientation. The environment was far from uplifting, and the lack of effective wayfinding meant that many residents found it hard to orientate themselves. The signage was inadequate, and had only been only made functional at all by the nursing team using ad-hoc images on the doors.” I asked who took the decision for the refurbishment and remodelling to go ahead. Jo Inglis explained that it was the Trust’s Board, partly as a result of a CQC inspection in early 2014, which praised the high standard of care, but dubbed the environment ‘poor’. Jo Inglis said: “I have


The striking mural on one wall of the main lounge, showing Hull’s Paragon Street Bus Station.

been at Maister Lodge for a number of years, and it was certainly a difficult environment to work in.” Following the CQC report, the ACA team began by meeting key staff, including the then Modern Matron and previous charge nurse, and taking them to visit a recently refurbished dementia assessment ward in Sunderland to see what sensitive remodelling could achieve. Alex Caruso said: “We took staff from both the Trust’s Estates and Facilities and nursing teams – with me acting as a dementia design champion – to try to understand ‘what best practice would look like’. The trip instigated a number of conversations on what we might do here. The Estates and Facilities and nursing teams also engaged us to produce an audit of the current facilities, identifying the areas most in need of improvement. At the time, as an associate at Stirling University, I could harness both my knowledge of its auditing process for dementia facilities, and relevant King’s Fund guidance.”

Design meetings with stakeholders He continued: “I had also studied dementia facility design principles at Stirling. Initially, though, I was appointed more as a dementia design champion than as an architect to guide the exploratory work to understand what we were starting from, and what we could achieve. From there we held design team meetings involving director-level stakeholders, and developed the design for the alterations to the layout, before further progressing matters by bringing sample and mood boards to Maister Lodge so that residents and carers could see first-hand what they would be getting. As a result of that work, the design was finalised and went out to tender in March 2017.

“In developing the design for a comprehensive refurbishment of the bedrooms and communal areas,” he explained, “we devised a wide range of improvements to make the environment more conducive to recovery and wellbeing. Unfortunately,” Alex Caruso explained, “the

All the key signage incorporates an activity-associated pictogram, and the room’s name in both conventional text and Braille.


ACA/Nazia Hussain

ACA/Nazia Hussain

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