Who pays for the care, and who pays for the building

• Care is funded by both health and social care sources. ICBs support health-led care through continuing healthcare, Section 117 aftercare, and personal health budgets. Local authorities fund social care placements. For this group, joint or pooled health and council funding is common.
• Building costs are funded separately. ICBs and councils rarely provide capital. New schemes are typically developed and funded by care providers, specialist supported-housing developers, or SSH investors, who build and lease them to a registered provider that holds the care contract.

The cost case, presented transparently

• An inpatient bed for this group costs approximately £180,000 to £260,000 per year. The average annual cost of detaining one person is about £237,000, with lifetime costs reaching seven figures.
• A quality community placement for a complex individual typically costs £130,000 to £185,000 per year, excluding the highest-cost cases.

How we approach the small-scale household model

• We usually build for four to six people in a household, sometimes fewer. The best results often come from settings with just one to three people, or from self-contained flats grouped together with shared staff support. This is known as the core-and-cluster model.
• Each person should have their own space. At minimum, this means a single ensuite bedroom. More often now, we build self-contained flats with a front door, so people have a real tenancy instead of just a bed in a care home.
• We make sure our buildings look and feel like regular housing, in normal residential areas, not next to other care services. The CQC carefully checks location and clustering. We guide clients on this early, before they invest in a site.

Colour and visual environment

• We use muted, low-saturation colours. Calm, natural tones help reduce visual stress. We avoid strong reds and bright colours, which can be agitating. We also avoid all-white schemes, which can be harsh and feel cold.
• We use contrast on purpose. Quiet and sleeping areas are kept simple. We add contrast to help people find their way, such as by making the floor and walls different colours or making doorways and toilet seats easy to spot. This also helps people with visual impairments.
• We choose matte finishes instead of gloss. Matt surfaces reduce glare and reflections. We avoid busy patterns on floors and walls, since these can look like movement or even holes in the floor.

Acoustics

Noise is one of the most common triggers of distress, so we treat acoustics as a core specification item, not an afterthought.

• Absorption to control reverberation. We use acoustic ceilings, wall absorbers and soft furnishings to reduce echo. We match absorber type to room: high-performance Class A absorbent ceilings and panels in living and dining spaces where reverberation is worst, and robust, washable acoustic products where durability matters most.
• Insulation between rooms. We specify higher-rated partitions and floors between bedrooms, and between bedrooms and communal or staff areas, so one person's noise does not disturb another.
• Quiet building services. We specify low-noise ventilation and heating and isolate the plant, so there is no constant hum that an occupant may find unbearable.

Lighting

Lighting is a frequent and under-appreciated source of distress, and we specify it carefully.

• No fluorescent flicker. Many autistic people perceive the flicker of fluorescent tubes, which causes real discomfort. We specify flicker-free LED throughout.
• Dimmable and zoned. Occupants and staff can lower the light for de-escalation and raise it for activity.
• Tunable, circadian-aware lighting. We adjust colour temperature across the day, cooler and brighter in the morning, warmer and lower in the evening, to support sleep and routine and reduce incidents.
• Glare control and daylight. We use indirect, diffused fittings rather than bare bright sources, provide generous but controllable natural light, and specify effective bedroom blackout for reliable sleep.

Robust construction specification

These buildings must withstand far more wear and tear than a standard home, yet never look like a cell. We engineer robustness in and then hide it behind ordinary domestic finishes. The principle we work to is graduated robustness: specification matched to assessed risk, room by room and person by person, rather than a blanket fortress finish.

• Reinforced walls and impact-resistant linings, using high-density and fibre-reinforced boarding or sheet reinforcement behind plasterboard in higher-risk areas.
• Robust, considered doorsets, with heavy-duty doors and frames, anti-barricade arrangements where risk assessment requires them, so a door cannot be used to trap a person, and concealed, tamper-resistant fixings and ironmongery.
• Resilient glazing, laminated or toughened, with polycarbonate where impact risk is high, detailed so it still reads as ordinary windows.
• Durable, safe surfaces and flooring, welded sheet vinyl with coved skirtings, impact-resistant wall protection in high-traffic and higher-risk areas, all chosen so damage can be repaired without the place feeling clinical.
• Concealed and protected services, with boxed-in pipework and cabling, protected radiators and tamper-resistant fittings, reducing both risk and the institutional look of exposed services.

We work to make the most robust detailing invisible to a visitor. If a scheme looks hardened, we have done it wrong.

Predictable, legible layouts

Predictability lowers anxiety, so we design buildings that people can understand and anticipate.

• Simple, legible circulation, with clear routes, few confusing junctions, and consistent layouts, so the building can be learned and trusted. We favour single-storey where the site allows.
• Clear sightlines and natural observation, so staff can stay aware without intrusive surveillance.
• Defined zones, separating active, social areas from quiet, low-stimulation areas, with calm transition spaces rather than abrupt changes.
• Space to withdraw and de-escalate, designed in from the start: somewhere a person can be alone to regulate, and enough room for staff to give space during a difficult moment.
• Wayfinding through the environment, using consistent cues and a logical plan so the building itself orients the person, rather than relying on signage.

Anti-ligature and risk-based safety

Anti-ligature design protects people at risk and is a core part of our specification, but we apply it proportionately. Best practice and CQC guidance both favour homely, non-institutional environments.

• Risk-assessed, not blanket. We concentrate on anti-ligature detailing where risk is genuine, rather than fitting it everywhere by default, which turns a home into a clinical unit and is rarely necessary across a whole building.
• Considered fittings. Where risk requires it, we specify collapsible or sloped fittings, fixtures designed to bear no load, and anti-ligature taps, radiators, shower and curtain fittings, with door tops detailed to remove fixing points.
• Detailed quietly, so safety never comes at the cost of dignity.

We set the level of provision room by room with the provider's clinical and risk teams, and we document it clearly to support CQC registration.

Security that feels domestic

A setting can be secure without looking like one. Institutional security signals control and can raise anxiety in its own right, so we design security that does its job while reading as an ordinary home.

• Discreet perimeter treatment, handled through planting, level changes, garden walls and fencing that read as a domestic boundary.
• Concealed access control, integrated into ordinary domestic doors and ironmongery rather than visible institutional hardware.
• Natural surveillance over cameras, using layout and sightlines for oversight, with discreet electronic measures only where genuinely needed.
• A real front door wherever the model allows, reinforcing tenancy and ordinary living.