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How are we doing?
(a survey to collect client feedback)
19
Questions
Start
Accessibility
Enabled Form
1
What service does AmeCare provide for you?
Tick all that apply.
In-home support
Outreach & community support
Group activities
Support Coordination
Psychosocial Recovery Coaching
Supported Independent Living (SIL)
Independent Living Options (ILO)
I'm a service provider with a mutual AmeCare client
I'm an informal support person for an AmeCare client
Other
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2
What was your first impression of AmeCare? Were you excited about our service?
Rate from 1 (very bad) to 5 (very good)
0
1
2
3
4
5
0 = Bad
5 = Good
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3
Think about the people from AmeCare that work with you. These are GENERAL questions about the way we provide support.
Rate the following statements.
Select
N/A
if you feel the statement is
Not Applicable
for you.
Never
Rarely
Sometimes
Often
Always
N/a
I understand my rights and feel comfortable exercising them.
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
Row 0, Column 5
AmeCare respects my privacy.
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
Row 1, Column 5
AmeCare employees have clear boundaries with me. I am clear on what AmeCare employees can and cannot do for me;
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
Row 2, Column 5
AmeCare employees are caring, considerate and treat me fairly. They make me feel valued.
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Row 3, Column 4
Row 3, Column 5
I am included in decisions about my care or the way I receive support.
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Row 4, Column 3
Row 4, Column 4
Row 4, Column 5
AmeCare staff respect my identity, including my culture, religion, sexual identity, and gender. I feel safe to express myself, my views, and my beliefs. This is part of my service planning.
Row 5, Column 0
Row 5, Column 1
Row 5, Column 2
Row 5, Column 3
Row 5, Column 4
Row 5, Column 5
I have experienced bullying or discrimination by an AmeCare employee
Row 6, Column 0
Row 6, Column 1
Row 6, Column 2
Row 6, Column 3
Row 6, Column 4
Row 6, Column 5
I am included in creating and reviewing my goals, including any changes to my support plan.
Row 7, Column 0
Row 7, Column 1
Row 7, Column 2
Row 7, Column 3
Row 7, Column 4
Row 7, Column 5
Information is given to me in a way I can easily access and understand
Row 8, Column 0
Row 8, Column 1
Row 8, Column 2
Row 8, Column 3
Row 8, Column 4
Row 8, Column 5
Staff have good understanding, skills, and abilities to meet my needs.
Row 9, Column 0
Row 9, Column 1
Row 9, Column 2
Row 9, Column 3
Row 9, Column 4
Row 9, Column 5
AmeCare values me. They want to make sure I have positive experiences with their services.
Row 10, Column 0
Row 10, Column 1
Row 10, Column 2
Row 10, Column 3
Row 10, Column 4
Row 10, Column 5
I feel comfortable asking questions and staff answer me in a way I can understand
Row 11, Column 0
Row 11, Column 1
Row 11, Column 2
Row 11, Column 3
Row 11, Column 4
Row 11, Column 5
After contacting AmeCare, they respond within a reasonable amount of time
Row 12, Column 0
Row 12, Column 1
Row 12, Column 2
Row 12, Column 3
Row 12, Column 4
Row 12, Column 5
I am supported and encouraged to be involved in any of AmeCare's activities (e.g., milestones, special events)
Row 13, Column 0
Row 13, Column 1
Row 13, Column 2
Row 13, Column 3
Row 13, Column 4
Row 13, Column 5
The feedback and complaints process is good and easy to understand
Row 14, Column 0
Row 14, Column 1
Row 14, Column 2
Row 14, Column 3
Row 14, Column 4
Row 14, Column 5
I feel satisfied with the way AmeCare manage an incident.
Row 15, Column 0
Row 15, Column 1
Row 15, Column 2
Row 15, Column 3
Row 15, Column 4
Row 15, Column 5
I am supported and encouraged to make a complaint or give feedback if I need or want to
Row 16, Column 0
Row 16, Column 1
Row 16, Column 2
Row 16, Column 3
Row 16, Column 4
Row 16, Column 5
(Where relevant) AmeCare responded quickly to complaints or feedback I made.
Row 17, Column 0
Row 17, Column 1
Row 17, Column 2
Row 17, Column 3
Row 17, Column 4
Row 17, Column 5
When AmeCare investigate or resolve issues, I feel listened to and my concerns are taken seriously.
Row 18, Column 0
Row 18, Column 1
Row 18, Column 2
Row 18, Column 3
Row 18, Column 4
Row 18, Column 5
I have been supported to link in with other community organisations and services
Row 19, Column 0
Row 19, Column 1
Row 19, Column 2
Row 19, Column 3
Row 19, Column 4
Row 19, Column 5
The service actively involves my informal support network (for example, carers, advocates, and other family members)
Row 20, Column 0
Row 20, Column 1
Row 20, Column 2
Row 20, Column 3
Row 20, Column 4
Row 20, Column 5
The information about the service I received matches my service delivery experience
Row 21, Column 0
Row 21, Column 1
Row 21, Column 2
Row 21, Column 3
Row 21, Column 4
Row 21, Column 5
Support is available when I need it, at suitable times (for example, shift length, time of day)
Row 22, Column 0
Row 22, Column 1
Row 22, Column 2
Row 22, Column 3
Row 22, Column 4
Row 22, Column 5
It is easy to request support. Support is flexible and responsive.
Row 23, Column 0
Row 23, Column 1
Row 23, Column 2
Row 23, Column 3
Row 23, Column 4
Row 23, Column 5
I would recommend AmeCare's services to other people
Row 24, Column 0
Row 24, Column 1
Row 24, Column 2
Row 24, Column 3
Row 24, Column 4
Row 24, Column 5
I feel included in a change of policies and processes
Row 25, Column 0
Row 25, Column 1
Row 25, Column 2
Row 25, Column 3
Row 25, Column 4
Row 25, Column 5
It is easy to request support. Support is flexible and responsive.
Row 26, Column 0
Row 26, Column 1
Row 26, Column 2
Row 26, Column 3
Row 26, Column 4
Row 26, Column 5
After contacting AmeCare, they respond within a reasonable amount of time
Row 27, Column 0
Row 27, Column 1
Row 27, Column 2
Row 27, Column 3
Row 27, Column 4
Row 27, Column 5
I like AmeCare's culture and what they represent as an organisation
Row 28, Column 0
Row 28, Column 1
Row 28, Column 2
Row 28, Column 3
Row 28, Column 4
Row 28, Column 5
I am aware of processes to make complaints and give feedback, and felt comfortable that I could do so.
Row 29, Column 0
Row 29, Column 1
Row 29, Column 2
Row 29, Column 3
Row 29, Column 4
Row 29, Column 5
(Where Relevant) My complaints and feedback were well-managed and resolved.
Row 30, Column 0
Row 30, Column 1
Row 30, Column 2
Row 30, Column 3
Row 30, Column 4
Row 30, Column 5
I am aware of processes to make complaints and give feedback, and feel comfortable that I could do so.
Row 31, Column 0
Row 31, Column 1
Row 31, Column 2
Row 31, Column 3
Row 31, Column 4
Row 31, Column 5
The feedback and complaints process is good and easy to understand
Row 32, Column 0
Row 32, Column 1
Row 32, Column 2
Row 32, Column 3
Row 32, Column 4
Row 32, Column 5
I am supported and encouraged to make a complaint or give feedback if I need or want to
Row 33, Column 0
Row 33, Column 1
Row 33, Column 2
Row 33, Column 3
Row 33, Column 4
Row 33, Column 5
AmeCare respond quickly to complaints or feedback I make.
Row 34, Column 0
Row 34, Column 1
Row 34, Column 2
Row 34, Column 3
Row 34, Column 4
Row 34, Column 5
When AmeCare investigate or resolve issues, I feel listened to and my concerns are taken seriously.
Row 35, Column 0
Row 35, Column 1
Row 35, Column 2
Row 35, Column 3
Row 35, Column 4
Row 35, Column 5
I am aware of processes to make complaints and give feedback, and felt comfortable that I could do so.
Row 36, Column 0
Row 36, Column 1
Row 36, Column 2
Row 36, Column 3
Row 36, Column 4
Row 36, Column 5
My complaints and feedback were well-managed and resolved.
Row 37, Column 0
Row 37, Column 1
Row 37, Column 2
Row 37, Column 3
Row 37, Column 4
Row 37, Column 5
I understand my rights and feel comfortable exercising them.
AmeCare respects my privacy.
AmeCare employees have clear boundaries with me. I am clear on what AmeCare employees can and cannot do for me;
AmeCare employees are caring, considerate and treat me fairly. They make me feel valued.
I am included in decisions about my care or the way I receive support.
AmeCare staff respect my identity, including my culture, religion, sexual identity, and gender. I feel safe to express myself, my views, and my beliefs. This is part of my service planning.
I have experienced bullying or discrimination by an AmeCare employee
I am included in creating and reviewing my goals, including any changes to my support plan.
Information is given to me in a way I can easily access and understand
Staff have good understanding, skills, and abilities to meet my needs.
AmeCare values me. They want to make sure I have positive experiences with their services.
I feel comfortable asking questions and staff answer me in a way I can understand
After contacting AmeCare, they respond within a reasonable amount of time
I am supported and encouraged to be involved in any of AmeCare's activities (e.g., milestones, special events)
The feedback and complaints process is good and easy to understand
I feel satisfied with the way AmeCare manage an incident.
I am supported and encouraged to make a complaint or give feedback if I need or want to
(Where relevant) AmeCare responded quickly to complaints or feedback I made.
When AmeCare investigate or resolve issues, I feel listened to and my concerns are taken seriously.
I have been supported to link in with other community organisations and services
The service actively involves my informal support network (for example, carers, advocates, and other family members)
The information about the service I received matches my service delivery experience
Support is available when I need it, at suitable times (for example, shift length, time of day)
It is easy to request support. Support is flexible and responsive.
I would recommend AmeCare's services to other people
I feel included in a change of policies and processes
It is easy to request support. Support is flexible and responsive.
After contacting AmeCare, they respond within a reasonable amount of time
I like AmeCare's culture and what they represent as an organisation
I am aware of processes to make complaints and give feedback, and felt comfortable that I could do so.
(Where Relevant) My complaints and feedback were well-managed and resolved.
I am aware of processes to make complaints and give feedback, and feel comfortable that I could do so.
The feedback and complaints process is good and easy to understand
I am supported and encouraged to make a complaint or give feedback if I need or want to
AmeCare respond quickly to complaints or feedback I make.
When AmeCare investigate or resolve issues, I feel listened to and my concerns are taken seriously.
I am aware of processes to make complaints and give feedback, and felt comfortable that I could do so.
My complaints and feedback were well-managed and resolved.
Never
Row 0, Column 0
Rarely
Row 0, Column 1
Sometimes
Row 0, Column 2
Often
Row 0, Column 3
Always
Row 0, Column 4
N/a
Row 0, Column 5
Never
Row 1, Column 0
Rarely
Row 1, Column 1
Sometimes
Row 1, Column 2
Often
Row 1, Column 3
Always
Row 1, Column 4
N/a
Row 1, Column 5
Never
Row 2, Column 0
Rarely
Row 2, Column 1
Sometimes
Row 2, Column 2
Often
Row 2, Column 3
Always
Row 2, Column 4
N/a
Row 2, Column 5
Never
Row 3, Column 0
Rarely
Row 3, Column 1
Sometimes
Row 3, Column 2
Often
Row 3, Column 3
Always
Row 3, Column 4
N/a
Row 3, Column 5
Never
Row 4, Column 0
Rarely
Row 4, Column 1
Sometimes
Row 4, Column 2
Often
Row 4, Column 3
Always
Row 4, Column 4
N/a
Row 4, Column 5
Never
Row 5, Column 0
Rarely
Row 5, Column 1
Sometimes
Row 5, Column 2
Often
Row 5, Column 3
Always
Row 5, Column 4
N/a
Row 5, Column 5
Never
Row 6, Column 0
Rarely
Row 6, Column 1
Sometimes
Row 6, Column 2
Often
Row 6, Column 3
Always
Row 6, Column 4
N/a
Row 6, Column 5
Never
Row 7, Column 0
Rarely
Row 7, Column 1
Sometimes
Row 7, Column 2
Often
Row 7, Column 3
Always
Row 7, Column 4
N/a
Row 7, Column 5
Never
Row 8, Column 0
Rarely
Row 8, Column 1
Sometimes
Row 8, Column 2
Often
Row 8, Column 3
Always
Row 8, Column 4
N/a
Row 8, Column 5
Never
Row 9, Column 0
Rarely
Row 9, Column 1
Sometimes
Row 9, Column 2
Often
Row 9, Column 3
Always
Row 9, Column 4
N/a
Row 9, Column 5
Never
Row 10, Column 0
Rarely
Row 10, Column 1
Sometimes
Row 10, Column 2
Often
Row 10, Column 3
Always
Row 10, Column 4
N/a
Row 10, Column 5
Never
Row 11, Column 0
Rarely
Row 11, Column 1
Sometimes
Row 11, Column 2
Often
Row 11, Column 3
Always
Row 11, Column 4
N/a
Row 11, Column 5
Never
Row 12, Column 0
Rarely
Row 12, Column 1
Sometimes
Row 12, Column 2
Often
Row 12, Column 3
Always
Row 12, Column 4
N/a
Row 12, Column 5
Never
Row 13, Column 0
Rarely
Row 13, Column 1
Sometimes
Row 13, Column 2
Often
Row 13, Column 3
Always
Row 13, Column 4
N/a
Row 13, Column 5
Never
Row 14, Column 0
Rarely
Row 14, Column 1
Sometimes
Row 14, Column 2
Often
Row 14, Column 3
Always
Row 14, Column 4
N/a
Row 14, Column 5
Never
Row 15, Column 0
Rarely
Row 15, Column 1
Sometimes
Row 15, Column 2
Often
Row 15, Column 3
Always
Row 15, Column 4
N/a
Row 15, Column 5
Never
Row 16, Column 0
Rarely
Row 16, Column 1
Sometimes
Row 16, Column 2
Often
Row 16, Column 3
Always
Row 16, Column 4
N/a
Row 16, Column 5
Never
Row 17, Column 0
Rarely
Row 17, Column 1
Sometimes
Row 17, Column 2
Often
Row 17, Column 3
Always
Row 17, Column 4
N/a
Row 17, Column 5
Never
Row 18, Column 0
Rarely
Row 18, Column 1
Sometimes
Row 18, Column 2
Often
Row 18, Column 3
Always
Row 18, Column 4
N/a
Row 18, Column 5
Never
Row 19, Column 0
Rarely
Row 19, Column 1
Sometimes
Row 19, Column 2
Often
Row 19, Column 3
Always
Row 19, Column 4
N/a
Row 19, Column 5
Never
Row 20, Column 0
Rarely
Row 20, Column 1
Sometimes
Row 20, Column 2
Often
Row 20, Column 3
Always
Row 20, Column 4
N/a
Row 20, Column 5
Never
Row 21, Column 0
Rarely
Row 21, Column 1
Sometimes
Row 21, Column 2
Often
Row 21, Column 3
Always
Row 21, Column 4
N/a
Row 21, Column 5
Never
Row 22, Column 0
Rarely
Row 22, Column 1
Sometimes
Row 22, Column 2
Often
Row 22, Column 3
Always
Row 22, Column 4
N/a
Row 22, Column 5
Never
Row 23, Column 0
Rarely
Row 23, Column 1
Sometimes
Row 23, Column 2
Often
Row 23, Column 3
Always
Row 23, Column 4
N/a
Row 23, Column 5
Never
Row 24, Column 0
Rarely
Row 24, Column 1
Sometimes
Row 24, Column 2
Often
Row 24, Column 3
Always
Row 24, Column 4
N/a
Row 24, Column 5
Never
Row 25, Column 0
Rarely
Row 25, Column 1
Sometimes
Row 25, Column 2
Often
Row 25, Column 3
Always
Row 25, Column 4
N/a
Row 25, Column 5
Never
Row 26, Column 0
Rarely
Row 26, Column 1
Sometimes
Row 26, Column 2
Often
Row 26, Column 3
Always
Row 26, Column 4
N/a
Row 26, Column 5
Never
Row 27, Column 0
Rarely
Row 27, Column 1
Sometimes
Row 27, Column 2
Often
Row 27, Column 3
Always
Row 27, Column 4
N/a
Row 27, Column 5
Never
Row 28, Column 0
Rarely
Row 28, Column 1
Sometimes
Row 28, Column 2
Often
Row 28, Column 3
Always
Row 28, Column 4
N/a
Row 28, Column 5
Never
Row 29, Column 0
Rarely
Row 29, Column 1
Sometimes
Row 29, Column 2
Often
Row 29, Column 3
Always
Row 29, Column 4
N/a
Row 29, Column 5
Never
Row 30, Column 0
Rarely
Row 30, Column 1
Sometimes
Row 30, Column 2
Often
Row 30, Column 3
Always
Row 30, Column 4
N/a
Row 30, Column 5
Never
Row 31, Column 0
Rarely
Row 31, Column 1
Sometimes
Row 31, Column 2
Often
Row 31, Column 3
Always
Row 31, Column 4
N/a
Row 31, Column 5
Never
Row 32, Column 0
Rarely
Row 32, Column 1
Sometimes
Row 32, Column 2
Often
Row 32, Column 3
Always
Row 32, Column 4
N/a
Row 32, Column 5
Never
Row 33, Column 0
Rarely
Row 33, Column 1
Sometimes
Row 33, Column 2
Often
Row 33, Column 3
Always
Row 33, Column 4
N/a
Row 33, Column 5
Never
Row 34, Column 0
Rarely
Row 34, Column 1
Sometimes
Row 34, Column 2
Often
Row 34, Column 3
Always
Row 34, Column 4
N/a
Row 34, Column 5
Never
Row 35, Column 0
Rarely
Row 35, Column 1
Sometimes
Row 35, Column 2
Often
Row 35, Column 3
Always
Row 35, Column 4
N/a
Row 35, Column 5
Never
Row 36, Column 0
Rarely
Row 36, Column 1
Sometimes
Row 36, Column 2
Often
Row 36, Column 3
Always
Row 36, Column 4
N/a
Row 36, Column 5
Never
Row 37, Column 0
Rarely
Row 37, Column 1
Sometimes
Row 37, Column 2
Often
Row 37, Column 3
Always
Row 37, Column 4
N/a
Row 37, Column 5
1
of 38
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4
This is about AmeCare COMPLAINTS & FEEDBACK PROCESS.
Use the
sliding scale
to tell us if you're not happy, neutral, or very happy.
Easy to understand
Non-judgmental
Professional
In-Depth Investigation
Reasonable Outcome
Validation & Empathy
Concerns are taken seriously
Communication
Reasonable Timeframe
Active Listening
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Row 3, Column 4
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Row 4, Column 3
Row 4, Column 4
Row 5, Column 0
Row 5, Column 1
Row 5, Column 2
Row 5, Column 3
Row 5, Column 4
Row 6, Column 0
Row 6, Column 1
Row 6, Column 2
Row 6, Column 3
Row 6, Column 4
Row 7, Column 0
Row 7, Column 1
Row 7, Column 2
Row 7, Column 3
Row 7, Column 4
Row 8, Column 0
Row 8, Column 1
Row 8, Column 2
Row 8, Column 3
Row 8, Column 4
Row 9, Column 0
Row 9, Column 1
Row 9, Column 2
Row 9, Column 3
Row 9, Column 4
Easy to understand
Non-judgmental
Professional
In-Depth Investigation
Reasonable Outcome
Validation & Empathy
Concerns are taken seriously
Communication
Reasonable Timeframe
Active Listening
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Row 3, Column 4
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Row 4, Column 3
Row 4, Column 4
Row 5, Column 0
Row 5, Column 1
Row 5, Column 2
Row 5, Column 3
Row 5, Column 4
Row 6, Column 0
Row 6, Column 1
Row 6, Column 2
Row 6, Column 3
Row 6, Column 4
Row 7, Column 0
Row 7, Column 1
Row 7, Column 2
Row 7, Column 3
Row 7, Column 4
Row 8, Column 0
Row 8, Column 1
Row 8, Column 2
Row 8, Column 3
Row 8, Column 4
Row 9, Column 0
Row 9, Column 1
Row 9, Column 2
Row 9, Column 3
Row 9, Column 4
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5
Do you currently reside in an AmeCare-supported property?
For example, Supported Independent Living (SIL)
Yes
No
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6
These questions are about the MEALS & NUTRITION in an AmeCare SIL house, or similar accommodation setting.
Rate the following statements.
Select "N/A" if you feel the statement is Not Applicable for you.
Never
Rarely
Sometimes
Often
Always
N/a
Meals meet my expectations in terms of quality and quantity
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
Row 0, Column 5
Meals are suitable for my nutritional needs and requirements
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
Row 1, Column 5
My cultural and religious beliefs are considered
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
Row 2, Column 5
The menu has variety, and changes regularly.
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Row 3, Column 4
Row 3, Column 5
Meals are eaten in an inviting social dining environment
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Row 4, Column 3
Row 4, Column 4
Row 4, Column 5
Meals are well presented
Row 5, Column 0
Row 5, Column 1
Row 5, Column 2
Row 5, Column 3
Row 5, Column 4
Row 5, Column 5
Food is served at appropriate temperatures (not raw or over-cooked)
Row 6, Column 0
Row 6, Column 1
Row 6, Column 2
Row 6, Column 3
Row 6, Column 4
Row 6, Column 5
Mealtimes are at an appropriate time
Row 7, Column 0
Row 7, Column 1
Row 7, Column 2
Row 7, Column 3
Row 7, Column 4
Row 7, Column 5
(Where required) I am adequately supported to consume my meal.
Row 8, Column 0
Row 8, Column 1
Row 8, Column 2
Row 8, Column 3
Row 8, Column 4
Row 8, Column 5
I have enough fluids to prevent feeling dehydrated
Row 9, Column 0
Row 9, Column 1
Row 9, Column 2
Row 9, Column 3
Row 9, Column 4
Row 9, Column 5
I can access nutritious snacks and drinks, including water, whenever I wanted
Row 10, Column 0
Row 10, Column 1
Row 10, Column 2
Row 10, Column 3
Row 10, Column 4
Row 10, Column 5
I am easily able to provide feedback on the food being served. I felt this feedback was listened to and acted on.
Row 11, Column 0
Row 11, Column 1
Row 11, Column 2
Row 11, Column 3
Row 11, Column 4
Row 11, Column 5
(Where possible) I was included in meal planning and provided with choices.
Row 12, Column 0
Row 12, Column 1
Row 12, Column 2
Row 12, Column 3
Row 12, Column 4
Row 12, Column 5
Meals meet my expectations in terms of quality and quantity
Meals are suitable for my nutritional needs and requirements
My cultural and religious beliefs are considered
The menu has variety, and changes regularly.
Meals are eaten in an inviting social dining environment
Meals are well presented
Food is served at appropriate temperatures (not raw or over-cooked)
Mealtimes are at an appropriate time
(Where required) I am adequately supported to consume my meal.
I have enough fluids to prevent feeling dehydrated
I can access nutritious snacks and drinks, including water, whenever I wanted
I am easily able to provide feedback on the food being served. I felt this feedback was listened to and acted on.
(Where possible) I was included in meal planning and provided with choices.
Never
Row 0, Column 0
Rarely
Row 0, Column 1
Sometimes
Row 0, Column 2
Often
Row 0, Column 3
Always
Row 0, Column 4
N/a
Row 0, Column 5
Never
Row 1, Column 0
Rarely
Row 1, Column 1
Sometimes
Row 1, Column 2
Often
Row 1, Column 3
Always
Row 1, Column 4
N/a
Row 1, Column 5
Never
Row 2, Column 0
Rarely
Row 2, Column 1
Sometimes
Row 2, Column 2
Often
Row 2, Column 3
Always
Row 2, Column 4
N/a
Row 2, Column 5
Never
Row 3, Column 0
Rarely
Row 3, Column 1
Sometimes
Row 3, Column 2
Often
Row 3, Column 3
Always
Row 3, Column 4
N/a
Row 3, Column 5
Never
Row 4, Column 0
Rarely
Row 4, Column 1
Sometimes
Row 4, Column 2
Often
Row 4, Column 3
Always
Row 4, Column 4
N/a
Row 4, Column 5
Never
Row 5, Column 0
Rarely
Row 5, Column 1
Sometimes
Row 5, Column 2
Often
Row 5, Column 3
Always
Row 5, Column 4
N/a
Row 5, Column 5
Never
Row 6, Column 0
Rarely
Row 6, Column 1
Sometimes
Row 6, Column 2
Often
Row 6, Column 3
Always
Row 6, Column 4
N/a
Row 6, Column 5
Never
Row 7, Column 0
Rarely
Row 7, Column 1
Sometimes
Row 7, Column 2
Often
Row 7, Column 3
Always
Row 7, Column 4
N/a
Row 7, Column 5
Never
Row 8, Column 0
Rarely
Row 8, Column 1
Sometimes
Row 8, Column 2
Often
Row 8, Column 3
Always
Row 8, Column 4
N/a
Row 8, Column 5
Never
Row 9, Column 0
Rarely
Row 9, Column 1
Sometimes
Row 9, Column 2
Often
Row 9, Column 3
Always
Row 9, Column 4
N/a
Row 9, Column 5
Never
Row 10, Column 0
Rarely
Row 10, Column 1
Sometimes
Row 10, Column 2
Often
Row 10, Column 3
Always
Row 10, Column 4
N/a
Row 10, Column 5
Never
Row 11, Column 0
Rarely
Row 11, Column 1
Sometimes
Row 11, Column 2
Often
Row 11, Column 3
Always
Row 11, Column 4
N/a
Row 11, Column 5
Never
Row 12, Column 0
Rarely
Row 12, Column 1
Sometimes
Row 12, Column 2
Often
Row 12, Column 3
Always
Row 12, Column 4
N/a
Row 12, Column 5
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7
These questions are about the PHYSICAL ENVIRONMENT of an AmeCare SIL house, or similar accommodation setting.
Rate the following statements.
Select "N/A" if you feel the statement is Not Applicable for you.
Never
Rarely
Sometimes
Often
Always
N/a
My home is clean
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
Row 0, Column 5
My home is comfortable
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
Row 1, Column 5
My home is practical for my needs
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
Row 2, Column 5
My home is inviting and welcoming of visitors
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Row 3, Column 4
Row 3, Column 5
My home is safe
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Row 4, Column 3
Row 4, Column 4
Row 4, Column 5
I can maintain personal independence and control over decisions made about my living arrangements and in-home support.
Row 5, Column 0
Row 5, Column 1
Row 5, Column 2
Row 5, Column 3
Row 5, Column 4
Row 5, Column 5
My home is easy to navigate and easy to get around
Row 6, Column 0
Row 6, Column 1
Row 6, Column 2
Row 6, Column 3
Row 6, Column 4
Row 6, Column 5
Staff encourage interactions between residents.
Row 7, Column 0
Row 7, Column 1
Row 7, Column 2
Row 7, Column 3
Row 7, Column 4
Row 7, Column 5
My home is clean
My home is comfortable
My home is practical for my needs
My home is inviting and welcoming of visitors
My home is safe
I can maintain personal independence and control over decisions made about my living arrangements and in-home support.
My home is easy to navigate and easy to get around
Staff encourage interactions between residents.
Never
Row 0, Column 0
Rarely
Row 0, Column 1
Sometimes
Row 0, Column 2
Often
Row 0, Column 3
Always
Row 0, Column 4
N/a
Row 0, Column 5
Never
Row 1, Column 0
Rarely
Row 1, Column 1
Sometimes
Row 1, Column 2
Often
Row 1, Column 3
Always
Row 1, Column 4
N/a
Row 1, Column 5
Never
Row 2, Column 0
Rarely
Row 2, Column 1
Sometimes
Row 2, Column 2
Often
Row 2, Column 3
Always
Row 2, Column 4
N/a
Row 2, Column 5
Never
Row 3, Column 0
Rarely
Row 3, Column 1
Sometimes
Row 3, Column 2
Often
Row 3, Column 3
Always
Row 3, Column 4
N/a
Row 3, Column 5
Never
Row 4, Column 0
Rarely
Row 4, Column 1
Sometimes
Row 4, Column 2
Often
Row 4, Column 3
Always
Row 4, Column 4
N/a
Row 4, Column 5
Never
Row 5, Column 0
Rarely
Row 5, Column 1
Sometimes
Row 5, Column 2
Often
Row 5, Column 3
Always
Row 5, Column 4
N/a
Row 5, Column 5
Never
Row 6, Column 0
Rarely
Row 6, Column 1
Sometimes
Row 6, Column 2
Often
Row 6, Column 3
Always
Row 6, Column 4
N/a
Row 6, Column 5
Never
Row 7, Column 0
Rarely
Row 7, Column 1
Sometimes
Row 7, Column 2
Often
Row 7, Column 3
Always
Row 7, Column 4
N/a
Row 7, Column 5
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8
These questions are about how an AmeCare supports your GENERAL, SOCIAL, and EMOTIONAL NEEDS.
Rate the following statements.
Select "N/A" if you feel the statement is Not Applicable for you.
Never
Rarely
Sometimes
Often
Always
N/a
Staff encourage interactions between residents.
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
Row 0, Column 5
There are frequent opportunities for recreational activities. These are enjoyable and available to me.
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
Row 1, Column 5
AmeCare supports me to establish relationships and socialise
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
Row 2, Column 5
The quality of care I receive is appropriate for my needs
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Row 3, Column 4
Row 3, Column 5
I am informed about how and why I receive support
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Row 4, Column 3
Row 4, Column 4
Row 4, Column 5
I am treated with respect, dignity, and without exploitation, abuse, and neglect
Row 5, Column 0
Row 5, Column 1
Row 5, Column 2
Row 5, Column 3
Row 5, Column 4
Row 5, Column 5
I am treated equally. I am not obligated to be grateful for those providing my care and accommodation.
Row 6, Column 0
Row 6, Column 1
Row 6, Column 2
Row 6, Column 3
Row 6, Column 4
Row 6, Column 5
I can maintain my social and personal relationships without fear, criticism, or restriction
Row 7, Column 0
Row 7, Column 1
Row 7, Column 2
Row 7, Column 3
Row 7, Column 4
Row 7, Column 5
I am aware of processes to make complaints and give feedback, and feel comfortable that I could do so.
Row 8, Column 0
Row 8, Column 1
Row 8, Column 2
Row 8, Column 3
Row 8, Column 4
Row 8, Column 5
AmeCare have made changes to improve the quality of care and services
Row 9, Column 0
Row 9, Column 1
Row 9, Column 2
Row 9, Column 3
Row 9, Column 4
Row 9, Column 5
The personal care I am provided is of a high standard
Row 10, Column 0
Row 10, Column 1
Row 10, Column 2
Row 10, Column 3
Row 10, Column 4
Row 10, Column 5
I can keep in touch with life outside of my home
Row 11, Column 0
Row 11, Column 1
Row 11, Column 2
Row 11, Column 3
Row 11, Column 4
Row 11, Column 5
I can keep in touch with family and friends whilst in my current home
Row 12, Column 0
Row 12, Column 1
Row 12, Column 2
Row 12, Column 3
Row 12, Column 4
Row 12, Column 5
Staff encourage interactions between residents.
There are frequent opportunities for recreational activities. These are enjoyable and available to me.
AmeCare supports me to establish relationships and socialise
The quality of care I receive is appropriate for my needs
I am informed about how and why I receive support
I am treated with respect, dignity, and without exploitation, abuse, and neglect
I am treated equally. I am not obligated to be grateful for those providing my care and accommodation.
I can maintain my social and personal relationships without fear, criticism, or restriction
I am aware of processes to make complaints and give feedback, and feel comfortable that I could do so.
AmeCare have made changes to improve the quality of care and services
The personal care I am provided is of a high standard
I can keep in touch with life outside of my home
I can keep in touch with family and friends whilst in my current home
Never
Row 0, Column 0
Rarely
Row 0, Column 1
Sometimes
Row 0, Column 2
Often
Row 0, Column 3
Always
Row 0, Column 4
N/a
Row 0, Column 5
Never
Row 1, Column 0
Rarely
Row 1, Column 1
Sometimes
Row 1, Column 2
Often
Row 1, Column 3
Always
Row 1, Column 4
N/a
Row 1, Column 5
Never
Row 2, Column 0
Rarely
Row 2, Column 1
Sometimes
Row 2, Column 2
Often
Row 2, Column 3
Always
Row 2, Column 4
N/a
Row 2, Column 5
Never
Row 3, Column 0
Rarely
Row 3, Column 1
Sometimes
Row 3, Column 2
Often
Row 3, Column 3
Always
Row 3, Column 4
N/a
Row 3, Column 5
Never
Row 4, Column 0
Rarely
Row 4, Column 1
Sometimes
Row 4, Column 2
Often
Row 4, Column 3
Always
Row 4, Column 4
N/a
Row 4, Column 5
Never
Row 5, Column 0
Rarely
Row 5, Column 1
Sometimes
Row 5, Column 2
Often
Row 5, Column 3
Always
Row 5, Column 4
N/a
Row 5, Column 5
Never
Row 6, Column 0
Rarely
Row 6, Column 1
Sometimes
Row 6, Column 2
Often
Row 6, Column 3
Always
Row 6, Column 4
N/a
Row 6, Column 5
Never
Row 7, Column 0
Rarely
Row 7, Column 1
Sometimes
Row 7, Column 2
Often
Row 7, Column 3
Always
Row 7, Column 4
N/a
Row 7, Column 5
Never
Row 8, Column 0
Rarely
Row 8, Column 1
Sometimes
Row 8, Column 2
Often
Row 8, Column 3
Always
Row 8, Column 4
N/a
Row 8, Column 5
Never
Row 9, Column 0
Rarely
Row 9, Column 1
Sometimes
Row 9, Column 2
Often
Row 9, Column 3
Always
Row 9, Column 4
N/a
Row 9, Column 5
Never
Row 10, Column 0
Rarely
Row 10, Column 1
Sometimes
Row 10, Column 2
Often
Row 10, Column 3
Always
Row 10, Column 4
N/a
Row 10, Column 5
Never
Row 11, Column 0
Rarely
Row 11, Column 1
Sometimes
Row 11, Column 2
Often
Row 11, Column 3
Always
Row 11, Column 4
N/a
Row 11, Column 5
Never
Row 12, Column 0
Rarely
Row 12, Column 1
Sometimes
Row 12, Column 2
Often
Row 12, Column 3
Always
Row 12, Column 4
N/a
Row 12, Column 5
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9
Is there another agency providing NDIS-funded support for you?
Yes
No
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10
How likely are you to replace the current services you use with another provider?
Would you rather have support workers from AmeCare or a different support agency?
0
1
2
3
4
5
0 = I want to stop my AmeCare supports
5 = I want to keep my AmeCare supports
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11
What do you like most about AmeCare?
What are 3 things you have enjoyed doing with AmeCare employees?
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12
What do you like least about AmeCare?
What are 3 things that you would change or improve about our service?
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13
What suggestions do you have about ways that we can improve?
How can AmeCare improve our service delivery?
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14
Is there anything you would change about the way we work or provide support?
This question is about if AmeCare needs to update any policies and/or procedures.
Huge
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Normal
Small
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quote
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Ok
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15
Do you wish to remain anonymous?
*
This field is required.
Yes
No
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16
Are you happy for us to contact you about your responses?
*
This field is required.
Yes
No
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17
Your Name
*
This field is required.
First Name
Last Name
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18
Your preferred contact details
*
This field is required.
Email
Phone
Your Contact Details
Row 0, Column 0
Row 0, Column 1
Your Contact Details
Email
Row 0, Column 0
Phone
Row 0, Column 1
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19
Thank you for taking the time to let us know your experiences. Do you have any other comments?
Are there any specific experiences you would like us to know about?
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Client Feedback: Your experience with AmeCare
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