Survey for Adult Service Users

 

Were you involved in the decision to use this Agency?

Yes
No

 

Have you received a copy of your Care Plan?

Yes
No

 

Does your Care Plan match what you want from the service and is your Care Plan flexible?

Always
Usually
Sometimes
Never

 

How often does your home carer visit you?

Less Than Twice A Day
Twice A Day
Once A Day
Three Or More Times A Day

 

Do the home carers do the things that are detailed in your Care Plan?

Always
Usually
Sometimes
Never

 

Do the home carers stay for the agreed length of time?

Always
Usually
Sometimes
Never

 

Do the home carers listen to and act on what you say?

Always
Usually
Sometimes
Never

 

Do the home carers assist you with your medication?

Always
Usually
Sometimes
Never

 

Do you know how to make a complaint if you are not happy with the service that you receive?

Yes
No

 

Does the service take into account and respect the different needs you may have (i.e. In relation to age, gender etc)

Always
Usualy
Sometimes
Never

 

How do you think the Agency can improve?

 

What do you feel the Agency does well?

 

Any other comments.

 

Re-type the word for Verification