Respite Care Satisfaction Surv

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Longhurst and Havelok Homes, Leverett House, Gilbert Drive, Endeavour Park, Boston, Lincolnshire,
PE21 7TQ
Tel: 0800 111 4013


Section A - Care
How satisfied were you with the level of care you recieved?*	Very Satisfied Satisfied Unsatisfied Very Unsatisfied
How satisfied were you with the level of service provided to you during your stay?*	Very Satisfied Satisfied Unsatisfied Very Satisfied
When decisions that affected you were being made, do you feel your views were taken into account?*	Yes No
Did you have a care plan?*	Yes No
If_yes,_please_continue_to_question_5._If_no_please continue_to_section_B
How satisfied were you with your care plan?*	Very Satisfied Satisfied Unsatisfied Very Unsatisfied
Do you feel you were involved when decisions were made about your care plan?*	Yes No
Section B - Staff
Did you feel you were treated with dignity and respect?*	Yes No
If no please comment
Did you feel you were treated badly or discriminated during your stay?*	Yes No
If yes please comment
Did you recieve a copy of our complaints leaflet?*	Yes No
Did you know how and who to make a complaint to?*	Yes No
How satisfied were you with the way your complaint was dealt with?*	Very Satisfied Satisfied Unsatisfied Very Unsatisfied
Section C - Health and Wellbeing
Did you self medicate?*	Yes No
If no, would you have preferred to self-medicate?*	Yes No
If yes, did you feel you recieved enough support to self medicate?	Yes No
How satisfied were you with the quality of the meals provided?*	Very Satisfied Satisfied Unsatisfied Very Unsatisfied
How satisfied were you with the choice of meals provided?*	Very Satisfied Satisfied Unsatisfied Very Unsatisfied
Section_D-_Environment_&_Services
How Satisfied were you with the flat provided?*	Very Satisfied Satisfied Unsatisfied Very Unsatisfied
How satisfied were you with the communal areas? This includes the bathrooms, garden, lounge and dining room*	Very Satisfied Satisfied Unsatisfied Very Unsatisfied
How satisfied were you with the level of cleanliness in the care home?*	Very Satisfied Satisfied Unsatisfied Very Unsatisfied
How satisfied were you with the laundry service?*	Very Satisfied Satisfied Unsatisfied Very Unsatisfied
Did you feel safe living at the care home?*	Yes No
Were you provided with a secure space to keep your valuables?*	Yes No
Would you stay in our care home again?*	Yes No
Would you recommend our services?*	Yes No
Would you be happy for us to contact you about the comments you have made?*	Yes No
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Respite Care Satisfaction Survey