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QUESTIONNAIRE: SERVICE USER/RELATIVES’ FEEDBACK

Please complete the following by putting a tick under the heading in each section that conforms
most closely to your views about the service.
A = Excellent
B = Very Good
C = Good
D = Not Very Good
E = Poor

Understanding your care needs

Providing the services that you want

Appearing honest and trustworthy

Being friendly, polite and respecting you as a person

Showing commitment to helping you

Listening to your concerns and needs and responding to them

Keeping you comfortable and safe

Not hurting you when attending to you

Being willing to change their ways of working to suit you

Arriving on time and not letting you down

Keeping you informed about any changes or difficulties they are having in keeping to the schedule and plan

Following correct procedures, eg in moving and lifting you, washing and bathing, helping you with your medication

Knowing their jobs

Working together as a team (where applicable)

Working with your family and friends where they are involved in your care

HOW WELL DOES THE AGENCY DO IN: Responding to your concerns and questions

Replying to your telephone calls and dealing with your correspondence

Responding to any complaints you may have had about our service

Providing you with up to date information about its services

Keeping you informed and up to date about any changes to its services

OVERALL ASSESSMENT: How satisfied are you in general with the agency’s services?

Completely satisfied
Nearly satisfied
Partly satisfied
Unsatisfied

How would you assess the overall quality of our service?

Excellent
Very Good
Quite good
Not very good
Poor

If you had a friend or neighbour needing care would you recommend our agency to them?

Definitely Yes
Probably
Not certain
Not at all

Have you any additional comments and suggestions on how we might improve our service to you? Please write them in this box.

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