2nomi Resident/Family Satisfaction Survey

Nursing Home Resident/Family Satisfaction Survey

This survey collects anonymous feedback of your satisfaction residing in this nursing home. Your responses will help improve our culture and overall satisfaction with care and services. Thanking for taking the time to complete the survey!
Your survey responses will…
· Help your opinions be heard.
· Help make leadership aware of areas that need improvement.
· All responses are confidential and anonymous.

You can call our toll free number (855)938-4226 for any questions you may have.

PLEASE CHECK BOX FOR RESIDENT OR FAMILY THEN ?CLICK YOUR RESPONSES TO EACH QUESTION

Question Title

1. Please enter nursing home name

Nursing Home Name

Question Title

2. Resident or Family Representative

Resident

Family Representative

Question Title

3. Staff takes the time to learn about you/resident’s habits, past experiences, medical and psychosocial needs, and preferences.

Excellent

Good

Fair

Poor

Question Title

4. Are you/resident satisfied with the 2nomi (“To Know Me”) life story book project?

Excellent

Good

Fair

Poor

Question Title

5. Resident/family participates in care plans that consider the residents life history.

Excellent

Good

Fair

Poor