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Abstract Objective: The purpose of this study was to translate the Environmental Assessment Tool–Higher Care (EAT-HC) into Japanese and validate its use in small-scale group living facilities in Japan. Background: Environment of a facility is shown to improve its residents’ quality of life (QOL). Japan’s “welfare-based nursing homes for the elderly” are gradually shifting to a small-scale group living concept called group care units (GCUs). However, there is no appropriate environmental tool available for evaluating GCUs. The application of valid environmental assessment tools brings about a better understanding of the nature of good environments and the relationship between environments and outcomes for residents living with dementia. Methods: The study had a mixed method design conducted in several steps, covering translation and adaptation. The translation phase involved (1) forward translation and (2) backward translation. The adaptation phase involved (3) conten ....