Client and Family Feedback
To ensure we provide a good quality of service that meet your needs, we would be obliged if you would complete this questionnaire. By asking how our workers support you and whether you feel we meet your needs, we are able to look at ways of improving and/or maintaining the standard of care we deliver. Please be assured that any information provided will be kept in strictest confidence, unless we have your consent to discuss these with the worker concerned. Please tick the appropriate response according to how you think your worker rates and give your comments. Many thanks for your time.
Date:
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Month
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Day
Year
Date
Client Initials:
Postcode:
Client/Parent Signiture
1) Are you happy with the communication between yourselves and the staff who work in your home?
Please Select
Yes
No
Sometimes
Please elaborate and give details:
2) Do the staff who work in your home treat you/the client with compassion, respect, dignity and make you feel safe?
Please Select
Yes
No
Sometimes
Please elaborate and give details:
3) Do the staff who work in your home provide the support that you/the client require in line with the care plan and associated documents (risk assessments, professional guidelines etc) and how you wish for the support to be delivered?
Please Select
Yes
No
Sometimes
Please elaborate and give details:
4) Are you happy with the communication and support you receive from the office staff?
Please Select
Yes
No
Sometimes
Please elaborate and give details:
5) Overall, how satisfied are you with the support you receive from Unity Care Solutions?
Please Select
Very satisfied
Satisfied
Unsatisfied
Very unsatisfied
Please elaborate and give details:
Is there anything else you would like to add?
Thank you for your time.
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