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* 1. Please confirm which Care Provider you are registered with

  Springfield Homecare Services Ltd Human Support Group Dale Care Ltd Cera Homecare Ltd
Care Providers

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* 2. PART 1 - Visit from my carers

  Always Sometimes Never Don't know/not sure Prefer not to say
The care and support I receive at every care visit is what has been agreed in my care and support plan
It is important to know which carers are and when they will be visiting me
I am informed before a visit if there is going to be a change in who will be visiting me or if they are going to be late
It is important that my carers arrive on time
My carers arrive for my visit at the time that has been planned

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* 3. Please add any comments below about part 1 (please give as much detail as possible)

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* 4. PART 2 -Quality of care and treatment

  Always Sometimes Never Don't know/not sure Prefer not to say
The carers who support me are the same carers
The carers who support me know me well and know how I like and need to be supported
I feel that I am listened to and that my carers talk to me in a way that I understand
The carers who support me involve me in how I would like my support to be provided
The carers who support me treat me with kindness, dignity and respect
The carers who support me help me to be independent

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* 5. Please add any comments below about part 2 (please give as much detail as possible)

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* 6. PART 3 -Time

  Always Sometimes Never Don't know/not sure Prefer not to say
Carers have enough time to support me in a way that makes me feel safe and comfortable
My carers stay at my visit for the length of time they should
My care visits have been missed and the carers has not visited when they should have

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* 7. Please add any comments below about part 3 (please give as much detail as possible)

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* 8. PART 4 - Skills and training

  Always Sometimes Never Don't know / not sure Prefer not to say
The carers know how to use the equipment in my home (hoists , electric bed, medication safe, cooker / microwave)
I feel safe when the carers are using the equipment in my home (hoists, electric bed, medication safe, cooker / microwave)
The carers have the correct skills to give me the support I need

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* 9. Please add any comments below about part 4 (please give as much detail as possible)

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* 10. Part 5 - Contacting the care agency

  Always Sometimes Never Don't know / not sure Prefer not to say
I find it easy to contact the care agency office if I need to
If I need to contact the office the staff are friendly and helpful
I know who to contact if I have a concern or a complaint about the service I am receiving

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* 11. Please add any comments below about part 4 (please give as much detail as possible)

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* 12. PART 6 - Further information

Overall how happy are you with the service you receive from your care agency?

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* 13. Please explain your answer here

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* 14. If you are not happy have you ever told anyone

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* 15. If yes who did you tell?

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* 16. What happened about it?

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* 17. If you didn't tell anyone - why was this?

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* 18. Would you recommend the agency to a family member or friend?

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* 19. Explain your answer

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* 20. In your opinion, what makes a good care agency?

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* 21. A bit about yourself

By telling us a bit about yourself you can help us to understand how peoples experiences may differ depending on their characteristics. However if you do not wish to answer these questions you do not have to.

Gender (please tick)

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* 22. Age range (please tick)

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* 23. Employment status (please tick)

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* 24. Ethnicity (please tick)

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