Resident-Family-Satisfaction Survey

1.Who is Filling out this survey

2.Where do I live

3.Please rate the overall comfort of the facility, which includes factors such as noise level and temperature.

Other (please specify)

4.What number would you use to rate how safe and secure you feel at the facility?

Other (please specify)

5.How satisfied are you with the meals and snacks you are provided?

Other (please specify)

6.How satisfied are you with the cleanliness of the facility?

Other (please specify)

7.What number would you use to rate the accessibility of the facility management?

Other (please specify)

8.What number would you use to rate the accessibility of facility management, such as the Administrator and the Director of Nursing?

Other (please specify)

9.How satisfied are you with the level of gentleness and respect shown to you by staff members?

Other (please specify)

10.How satisfied are you with the amount of communication you received regarding your care plan/care plan meetings?

Other (please specify)

11.How would you rate the assistance provided to you by facility staff during the admission process and during your first week at the facility?

Other (please specify)

12.How satisfied are you with the activities that are offered on a daily basis?

Other (please specify)

13.How satisfied are you with the Social Worker/Social Services Department and the level of assistance you received in meeting your needs?

Other (please specify)

14.Overall, how satisfied are you with the medical care provided by staff (Nursing and Therapy)?

Other (please specify)

15.Overall, how satisfied are you with the personal care provided by staff (daily hygiene, grooming, etc.)?

Other (please specify)

16.Would you recommend our facility to a friend or family member?

Yes

No

Other (please specify)

17.Please share any additional comments or suggestions.

How Are We Doing