Please rate the QUALITY OF CARE or SERVICE PROVIDED by checking the circle with the level that best reflects your satisfaction with our services. As this is a multi-purpose evaluation for rehabilitation patients and long-term care residents, please rate only the areas or departments for which there has been contact during the past quarter. If there has been no experience with a service, individual or activity, select No Rating which means non applicable.
Frequently
No Rating
Never
Seldom
Sometimes
Always
Please select the name of the facility
1. The facility is a comfortable and clean building in which to live.
2. I am invited to participate in my relative/friend's care plan conferences.
14. My relative/friend has had no belongings damaged, missing, or taken without permission.
15. The facility manages my relative/friend's personal funds. I am given a quarterly statement of what is in the relative/friend's account.
16. I would recommend this facility to my friends and family.
13. I am satisfied with my relative/friend's Physician services.
12. The food is appealing to my friend/relative.
11. My relative/friend's therapy services are timely and appropriate.
10. The staff members are not rough with my relative/friend or talk in a demeaning way towards him or her.
9. There is enough staff available to make sure that my relative/ friend gets the care, service and assistance he or she needs.
8. The staff speaks privately (without being overheard) about my relative/friend's medical condition.
6. My relative/friend's call light is answered in a timely manner.
7. The facility staff treats my relative/friend with respect and dignity.
5. My relative/friend receives assistance with dressing and grooming including oral hygiene.
4. I am informed timely of my relative/friend's change in condition, treatment, or unexpected events.
3. The facility staff encourages my relative/friend to attend activities and provides assistance if needed.
Is there someone that you would like to recommend for recognition?
If so, please provide your name and telephone number.
If yes, what is his/her name?
Would you like someone from Management to give you a call?