Nursing Home Resident/Family Satisfaction Survey

This survey collects anonymous feedback of your satisfaction residing in this nursing home. Your responses will help improve our culture and overall satisfaction with care and services.  Thanking for taking the time to complete the survey!
Your survey responses will…
·  Help your opinions be heard.
·  Help make leadership aware of areas that need improvement.
·  All responses are confidential and anonymous.
 
You can call our toll free number (855)938-4226 for any questions you may have.

PLEASE CHECK BOX FOR RESIDENT OR FAMILY THEN CLICK YOUR RESPONSES TO EACH QUESTION

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1. Please enter date

Date

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2. Please give us: the name of the resident, the name of nursing home the resident resides and your contact information to generate a coupon code for your 2nomi life story photobook. (This information is needed so we can keep track of how many residents of each nursing home are receiving a photobook. Your contact information will only be used to generate and send a coupon code to you.)

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3. Resident or Family Representative

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4. Staff makes an effort to learn about you/resident’s personal habits, way of life, past experiences, needs and preferences.

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5. Staff are respectful of your/resident’s wisdom, beliefs and life experiences.

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6. Staff take the time to listen to you/resident to understand needs.

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7. Knowing your/residents history and achievements, staff engage in meaningful conversation.

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8. Nursing assistants are well informed about care needs, personal preferences, psychosocial needs, likes and dislikes.

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9. Staff have a genuine care and concern for resident’s and relate warmly to them.

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10. Staff greet you/resident by your name of choice.

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11. Events and activities are planned to encourage resident’s and staff to attend together.

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12. Routinely, the same staff members care for you/resident.

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13. Staff take action when problems are identified and/or concerns are voiced.

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14. You/resident are encouraged to participate in activities with other residents with similar interests.

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15. Staff know how to calm a resident who is upset

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16. Staff respond with genuine concern when you/resident seek attention.

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17. You and your family are encouraged to participate in care planning.

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18. Care plans consider personal habits, life history, religious and cultural beliefs and way of life.

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19. You/resident can choose when and how often to bathe, shower or be given a bed bath.

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20. During care giving, staff are careful to avoid losing personal items (i.e., glasses, dentures, razors, cosmetics).

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21. Family members are notified when an important item is lost or damaged.

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22. Staff protect privacy and modesty when giving a bath (or shower) and personal care.

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23. Staff helps with dining without compromising dignity.

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24. Intellectual activities and growth are fostered (i.e., books in large print, internet access, lectures, etc.).

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25. You/resident have opportunities for self-expression, religious and spiritual expressions and hobbies.

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26. Family members are informed in a timely manner about things like a change in condition, emergency or hospitalization

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27. Managers show by example that they place the highest value on the quality of care and service

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28. Staff do not handle or rearrange your/resident’s belongings unless requested to do so.

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29. Overall, staff show genuine concern and care for you and your family members.

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