Relatives and Residents Questionnaire

Please give your rating between 0 and 5, where 5 is “outstanding”, and 0 is “poor”

SECTION A
Overall how do you rate the home where you or your relative lives in terms of the following attributes:

the outside appearance of the home? *

the gardens? *

the front entrance? *

the halls and corridors? *

the main lounge and dining area? *

your bedroom? *

your bathroom facilities? *

safety in the event of an emergency such as a fire? *

cleanliness? *

smell? *

the laundry service? *

SECTION B
How do you rate The Willows in terms of the following attributes:

its overall atmosphere? *

the welcome visitors are given? *

the standard of residential care you / the resident receives? *

the standard of your / the resident's health care? *

the social and recreational activities available to residents? *

the food, tea, coffee and snacks served to residents? *

special events such as resident birthdays, Christmas, etc? *

special occasions such as open days for residents' relatives, the tri-annual parties, etc *

the other residents as companions for you / your relative? *

contacting family by telephone? *

leaving messages for the resident with home staff? *

being informed by home staff as to problems or progress relating to you / the resident? *

the hygiene, grooming and personal presentation relating to you / the resident? *

meeting your / the resident's individual needs and preferences? *

SECTION C
Turning to the staff who work at the home, in terms of their appearance, friendliness, manners, caring skills and so on, how do you rate the following personnel:

home manager? *

senior staff? *

care assistants? *

housekeeping and other maintenance staff? *

SECTION D
How do you rate the following attributes of the home:

the attentiveness and responsiveness of staff to matters of concern to you or your relative? *

the procedure for making complaints? *

Would you recommend the home to other people?

WE WOULD WELCOME ANY COMMENTS OR SUGGESTIONS YOU MAY WISH TO MAKE. PLEASE WRITE THESE IN THE AREA BELOW

Your Name

Date *

Month *

Day *

Year *

N.B. This will be treated in the strictest confidence.
Thank you for taking the time to complete this questionnaire