Quality Assurance Questionnaire
  • I am a...*
  • Format: (000) 000-0000.

  • Catering & Food (required)

  • How satisfied are you with the quality of food provided?
  • How satisfied are you with the variety of food provided?
  • How satisfied are you with the amount of food provided?
  • How satisfied are you with the efforts made to satisfy your individual requirements (including any religious and cultural requirements)?
  • How satisfied are you with the way in which menus are planned?
  • How satisfied are you with the way in which food is presented? (eg to make it attractive or easy to eat)
  • How satisfied are you with the starting times for meals?
  • How satisfied are you with the time taken over meals? (eg too rushed or too slow)
  • How satisfied are you with seating and table arrangements?
  • How satisfied are you with the general atmosphere at mealtimes?
  • How satisfied are you with additional snacks and drinks provided?

  • Personal Care & Support (required)

  • How satisfied are you with how the staff look after you?
  • How satisfied are you with staff availability - do they come to help you when you? (eg when you ring for help)
  • How satisfied are you with how they carry out their work?
  • How satisfied are you with their attitudes and general manner?
  • How satisfied are you with the nursing and medical care that you receive?
  • How satisfied are you with any additional services or treatment arranged? (eg chiropodist, hairdresser)

  • Daily Living (required)

  • How satisfied are you with the arrangements you have for getting up and going to bed?
  • How satisfied are you with the arrangements for your personal care? (eg forwashing, bathing, going to the toilet etc)
  • How satisfied are you with the arrangements for cleaning and tidying your room or flat?
  • How satisfied are you with the social activities provided or arranged?
  • How satisfied are you with efforts to help you keep up with your personal interests and hobbies?
  • How satisfied are you with how residents in general get on with each other?
  • How satisfied are you with how residents and staff get on with each other?

  • Premises (required)

  • How satisfied are you with the home’s decorations and furnishings?
  • How satisfied are you with the facilities and amenities?
  • How satisfied are you with the accessibility of lounges, dining room and other public areas?
  • How satisfied are you with the general cleanliness and tidiness of the building and grounds?
  • How satisfied are you with how well repairs and general maintenance are carried out?

  • Management (required)

  • How satisfied are you with the the availability of the home’s manager to discuss any problems when you need to?
  • How satisfied are you with the way they get things done when asked?
  • How satisfied are you with the management’s efforts to create a good atmosphere?
  • Should be Empty: