This paper reports the outputs of 2 pilot studies to develop an environmental audit tool for care facilities using a checklist and a hierarchical task analysis. Ten wards at 6 hospitals (10 wards) were audited using the checklist and 3 wards assisted with the development of the HTA. It was found that the audit tool needed further development to include empirical measurements (lighting, contrast and signage) and international environmental standards. The HTA described a complex hierarchy of tasks and subtasks for the goal of going to the toilet without assistance for a frail and/or confused older person in an unfamiliar environment. There is a need for an in-depth understanding of the person-environment interaction to support patient autonomy (reduce the level of disorientation and distress) and improve safety. A validated environmental audit tool will support the delivery of (and evaluate) system level and design solutions.