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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 takes the time to learn about you/resident’s habits, past experiences, medical and psychosocial needs, and preferences.

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5. Staff engage in meaningful and uplifting conversations based on an understanding of resident’s wisdom, beliefs, history, and achievements.

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6. You/your family participate in care plans that consider your personal habits, life history, religious/cultural beliefs.

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7. Staff is careful with your belongings and notify you/your family if something is misplaced or missing.

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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 the resident and relate warmly to them and their family members.

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10. Staff greet resident/you by their/your name of choice, staff understand and accommodate needs and personal preferences.

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11. Events and activities are planned based on the resident’s history and preferences to encourage resident’s participation.

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12. Staff know how to calm a resident who is upset through an understanding of unmet needs, conflicts, or emotional triggers.

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13. Staff respond with genuine compassion and take action when problems are identified and/or concerns are voiced.

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14. Resident has opportunities for self-expression, religious and spiritual expressions, intellectual activities and favorite hobbies.

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