Family & Resident Satisfaction Survey

Please answer the questions below by checking the box that best indicates your opinion. If you don’t know then please check the “Do not know” box. If the question doesn’t apply to the resident then please check the “Does not apply” box. There is space provided for your comments at the end of each section.

Question Title

* 1. Admissions - Please only fill out this section if your friend or family member moved into Three Links Care Centre after January 2018 - If your friend or family member was admitted prior to January 2018 please check "Does not apply"

	1-Always	2-Sometimes	3-Hardly ever	4-Never	5-Do not know	6-Does not apply
Did staff provide you with adequate information about services available at Three Links?	Did staff provide you with adequate information about services available at Three Links? 1-Always	Did staff provide you with adequate information about services available at Three Links? 2-Sometimes	Did staff provide you with adequate information about services available at Three Links? 3-Hardly ever	Did staff provide you with adequate information about services available at Three Links? 4-Never	Did staff provide you with adequate information about services available at Three Links? 5-Do not know	Did staff provide you with adequate information about services available at Three Links? 6-Does not apply
Did staff provide you with adequate information about any additional charges?	Did staff provide you with adequate information about any additional charges? 1-Always	Did staff provide you with adequate information about any additional charges? 2-Sometimes	Did staff provide you with adequate information about any additional charges? 3-Hardly ever	Did staff provide you with adequate information about any additional charges? 4-Never	Did staff provide you with adequate information about any additional charges? 5-Do not know	Did staff provide you with adequate information about any additional charges? 6-Does not apply
Did staff adequately address your questions about how to pay for care?	Did staff adequately address your questions about how to pay for care? 1-Always	Did staff adequately address your questions about how to pay for care? 2-Sometimes	Did staff adequately address your questions about how to pay for care? 3-Hardly ever	Did staff adequately address your questions about how to pay for care? 4-Never	Did staff adequately address your questions about how to pay for care? 5-Do not know	Did staff adequately address your questions about how to pay for care? 6-Does not apply
Overall were you satisfied with the admissions process?	Overall were you satisfied with the admissions process? 1-Always	Overall were you satisfied with the admissions process? 2-Sometimes	Overall were you satisfied with the admissions process? 3-Hardly ever	Overall were you satisfied with the admissions process? 4-Never	Overall were you satisfied with the admissions process? 5-Do not know	Overall were you satisfied with the admissions process? 6-Does not apply

Is there anything else you'd like to tell us about the admissions process?

Question Title

* 2. Activities

	1-Always	2-Sometimes	3-Hardly ever	4-Never	5-Do not know	6-Does not apply
Does the resident have enough to do at Three Links?	Does the resident have enough to do at Three Links? 1-Always	Does the resident have enough to do at Three Links? 2-Sometimes	Does the resident have enough to do at Three Links? 3-Hardly ever	Does the resident have enough to do at Three Links? 4-Never	Does the resident have enough to do at Three Links? 5-Do not know	Does the resident have enough to do at Three Links? 6-Does not apply
Are the activities enjoyable for the resident?	Are the activities enjoyable for the resident? 1-Always	Are the activities enjoyable for the resident? 2-Sometimes	Are the activities enjoyable for the resident? 3-Hardly ever	Are the activities enjoyable for the resident? 4-Never	Are the activities enjoyable for the resident? 5-Do not know	Are the activities enjoyable for the resident? 6-Does not apply
Do you feel the activities provided at Three Links add to the resident’s quality of life?	Do you feel the activities provided at Three Links add to the resident’s quality of life? 1-Always	Do you feel the activities provided at Three Links add to the resident’s quality of life? 2-Sometimes	Do you feel the activities provided at Three Links add to the resident’s quality of life? 3-Hardly ever	Do you feel the activities provided at Three Links add to the resident’s quality of life? 4-Never	Do you feel the activities provided at Three Links add to the resident’s quality of life? 5-Do not know	Do you feel the activities provided at Three Links add to the resident’s quality of life? 6-Does not apply
Does the activities staff treat the resident with respect?	Does the activities staff treat the resident with respect? 1-Always	Does the activities staff treat the resident with respect? 2-Sometimes	Does the activities staff treat the resident with respect? 3-Hardly ever	Does the activities staff treat the resident with respect? 4-Never	Does the activities staff treat the resident with respect? 5-Do not know	Does the activities staff treat the resident with respect? 6-Does not apply
Overall, are you satisfied with the activities provided at Three Links?	Overall, are you satisfied with the activities provided at Three Links? 1-Always	Overall, are you satisfied with the activities provided at Three Links? 2-Sometimes	Overall, are you satisfied with the activities provided at Three Links? 3-Hardly ever	Overall, are you satisfied with the activities provided at Three Links? 4-Never	Overall, are you satisfied with the activities provided at Three Links? 5-Do not know	Overall, are you satisfied with the activities provided at Three Links? 6-Does not apply

Is there anything else you would like to tell us about the activities at Three Links?

Question Title

* 3. Choice

	1-Always	2-Sometimes	3-Hardly ever	4-Never	5-Do not know	6-Does not apply
Can the resident go to bed whenever he or she likes?	Can the resident go to bed whenever he or she likes? 1-Always	Can the resident go to bed whenever he or she likes? 2-Sometimes	Can the resident go to bed whenever he or she likes? 3-Hardly ever	Can the resident go to bed whenever he or she likes? 4-Never	Can the resident go to bed whenever he or she likes? 5-Do not know	Can the resident go to bed whenever he or she likes? 6-Does not apply
Can the resident choose the clothes that he or she wears?	Can the resident choose the clothes that he or she wears? 1-Always	Can the resident choose the clothes that he or she wears? 2-Sometimes	Can the resident choose the clothes that he or she wears? 3-Hardly ever	Can the resident choose the clothes that he or she wears? 4-Never	Can the resident choose the clothes that he or she wears? 5-Do not know	Can the resident choose the clothes that he or she wears? 6-Does not apply
Is the resident able to make his or her room feel home-like?	Is the resident able to make his or her room feel home-like? 1-Always	Is the resident able to make his or her room feel home-like? 2-Sometimes	Is the resident able to make his or her room feel home-like? 3-Hardly ever	Is the resident able to make his or her room feel home-like? 4-Never	Is the resident able to make his or her room feel home-like? 5-Do not know	Is the resident able to make his or her room feel home-like? 6-Does not apply
Does the staff leave the resident alone if he or she does not want to do anything?	Does the staff leave the resident alone if he or she does not want to do anything? 1-Always	Does the staff leave the resident alone if he or she does not want to do anything? 2-Sometimes	Does the staff leave the resident alone if he or she does not want to do anything? 3-Hardly ever	Does the staff leave the resident alone if he or she does not want to do anything? 4-Never	Does the staff leave the resident alone if he or she does not want to do anything? 5-Do not know	Does the staff leave the resident alone if he or she does not want to do anything? 6-Does not apply
Does the staff allow the resident to do the things that he or she wants to do for himself/herself?	Does the staff allow the resident to do the things that he or she wants to do for himself/herself? 1-Always	Does the staff allow the resident to do the things that he or she wants to do for himself/herself? 2-Sometimes	Does the staff allow the resident to do the things that he or she wants to do for himself/herself? 3-Hardly ever	Does the staff allow the resident to do the things that he or she wants to do for himself/herself? 4-Never	Does the staff allow the resident to do the things that he or she wants to do for himself/herself? 5-Do not know	Does the staff allow the resident to do the things that he or she wants to do for himself/herself? 6-Does not apply
Does the staff know the resident’s likes and dislikes?	Does the staff know the resident’s likes and dislikes? 1-Always	Does the staff know the resident’s likes and dislikes? 2-Sometimes	Does the staff know the resident’s likes and dislikes? 3-Hardly ever	Does the staff know the resident’s likes and dislikes? 4-Never	Does the staff know the resident’s likes and dislikes? 5-Do not know	Does the staff know the resident’s likes and dislikes? 6-Does not apply

Is there anything else you would like to tell us about resident choice at Three Links?

Question Title

* 4. Direct Care

	1-Always	2-Sometimes	3-Hardly ever	4-Never	5-Do not know	6-Does not apply
Does the resident look well groomed and cared for?	Does the resident look well groomed and cared for? 1-Always	Does the resident look well groomed and cared for? 2-Sometimes	Does the resident look well groomed and cared for? 3-Hardly ever	Does the resident look well groomed and cared for? 4-Never	Does the resident look well groomed and cared for? 5-Do not know	Does the resident look well groomed and cared for? 6-Does not apply
Does a staff person check on the resident to see if he or she is comfortable? (ask if he or she needs a drink, blanket, change of position, etc)	Does a staff person check on the resident to see if he or she is comfortable? (ask if he or she needs a drink, blanket, change of position, etc) 1-Always	Does a staff person check on the resident to see if he or she is comfortable? (ask if he or she needs a drink, blanket, change of position, etc) 2-Sometimes	Does a staff person check on the resident to see if he or she is comfortable? (ask if he or she needs a drink, blanket, change of position, etc) 3-Hardly ever	Does a staff person check on the resident to see if he or she is comfortable? (ask if he or she needs a drink, blanket, change of position, etc) 4-Never	Does a staff person check on the resident to see if he or she is comfortable? (ask if he or she needs a drink, blanket, change of position, etc) 5-Do not know	Does a staff person check on the resident to see if he or she is comfortable? (ask if he or she needs a drink, blanket, change of position, etc) 6-Does not apply
Is a staff person available to help the resident if he or she needs help? (i.e.: help getting dressed, help getting things, etc.)	Is a staff person available to help the resident if he or she needs help? (i.e.: help getting dressed, help getting things, etc.) 1-Always	Is a staff person available to help the resident if he or she needs help? (i.e.: help getting dressed, help getting things, etc.) 2-Sometimes	Is a staff person available to help the resident if he or she needs help? (i.e.: help getting dressed, help getting things, etc.) 3-Hardly ever	Is a staff person available to help the resident if he or she needs help? (i.e.: help getting dressed, help getting things, etc.) 4-Never	Is a staff person available to help the resident if he or she needs help? (i.e.: help getting dressed, help getting things, etc.) 5-Do not know	Is a staff person available to help the resident if he or she needs help? (i.e.: help getting dressed, help getting things, etc.) 6-Does not apply
Is staff gentle when they take care of the resident?	Is staff gentle when they take care of the resident? 1-Always	Is staff gentle when they take care of the resident? 2-Sometimes	Is staff gentle when they take care of the resident? 3-Hardly ever	Is staff gentle when they take care of the resident? 4-Never	Is staff gentle when they take care of the resident? 5-Do not know	Is staff gentle when they take care of the resident? 6-Does not apply
Does staff treat the resident with respect?	Does staff treat the resident with respect? 1-Always	Does staff treat the resident with respect? 2-Sometimes	Does staff treat the resident with respect? 3-Hardly ever	Does staff treat the resident with respect? 4-Never	Does staff treat the resident with respect? 5-Do not know	Does staff treat the resident with respect? 6-Does not apply
Does staff keep you informed about your family member and involved in his or her care planning?	Does staff keep you informed about your family member and involved in his or her care planning? 1-Always	Does staff keep you informed about your family member and involved in his or her care planning? 2-Sometimes	Does staff keep you informed about your family member and involved in his or her care planning? 3-Hardly ever	Does staff keep you informed about your family member and involved in his or her care planning? 4-Never	Does staff keep you informed about your family member and involved in his or her care planning? 5-Do not know	Does staff keep you informed about your family member and involved in his or her care planning? 6-Does not apply
Overall, are you satisfied with how our staff takes care of the resident?	Overall, are you satisfied with how our staff takes care of the resident? 1-Always	Overall, are you satisfied with how our staff takes care of the resident? 2-Sometimes	Overall, are you satisfied with how our staff takes care of the resident? 3-Hardly ever	Overall, are you satisfied with how our staff takes care of the resident? 4-Never	Overall, are you satisfied with how our staff takes care of the resident? 5-Do not know	Overall, are you satisfied with how our staff takes care of the resident? 6-Does not apply

Is there anything else you would like to tell us about the direct care at Three Links?

Question Title

* 5. Meals and Dining

	1-Always	2-Sometimes	3-Hardly ever	4-Never	5-Do not know	6-Does not apply
Does the resident think the food is tasty?	Does the resident think the food is tasty? 1-Always	Does the resident think the food is tasty? 2-Sometimes	Does the resident think the food is tasty? 3-Hardly ever	Does the resident think the food is tasty? 4-Never	Does the resident think the food is tasty? 5-Do not know	Does the resident think the food is tasty? 6-Does not apply
Are foods served at the correct temperature? (hot foods are hot, cold foods are cold)	Are foods served at the correct temperature? (hot foods are hot, cold foods are cold) 1-Always	Are foods served at the correct temperature? (hot foods are hot, cold foods are cold) 2-Sometimes	Are foods served at the correct temperature? (hot foods are hot, cold foods are cold) 3-Hardly ever	Are foods served at the correct temperature? (hot foods are hot, cold foods are cold) 4-Never	Are foods served at the correct temperature? (hot foods are hot, cold foods are cold) 5-Do not know	Are foods served at the correct temperature? (hot foods are hot, cold foods are cold) 6-Does not apply
Does the resident have the opportunity to try a variety of foods?	Does the resident have the opportunity to try a variety of foods? 1-Always	Does the resident have the opportunity to try a variety of foods? 2-Sometimes	Does the resident have the opportunity to try a variety of foods? 3-Hardly ever	Does the resident have the opportunity to try a variety of foods? 4-Never	Does the resident have the opportunity to try a variety of foods? 5-Do not know	Does the resident have the opportunity to try a variety of foods? 6-Does not apply
Are there times when the resident does not get enough to eat?	Are there times when the resident does not get enough to eat? 1-Always	Are there times when the resident does not get enough to eat? 2-Sometimes	Are there times when the resident does not get enough to eat? 3-Hardly ever	Are there times when the resident does not get enough to eat? 4-Never	Are there times when the resident does not get enough to eat? 5-Do not know	Are there times when the resident does not get enough to eat? 6-Does not apply
Does the resident receive the help that he or she requires to eat?	Does the resident receive the help that he or she requires to eat? 1-Always	Does the resident receive the help that he or she requires to eat? 2-Sometimes	Does the resident receive the help that he or she requires to eat? 3-Hardly ever	Does the resident receive the help that he or she requires to eat? 4-Never	Does the resident receive the help that he or she requires to eat? 5-Do not know	Does the resident receive the help that he or she requires to eat? 6-Does not apply

Is there anything else you would like to tell us about the meals and dining experience at Three Links?

Question Title

* 6. Environment

	1-Always	2-Sometimes	3-Hardly ever	4-Never	5-Do not know	6-Does not apply
Do the resident’s clothes get lost or damaged in the laundry?	Do the resident’s clothes get lost or damaged in the laundry? 1-Always	Do the resident’s clothes get lost or damaged in the laundry? 2-Sometimes	Do the resident’s clothes get lost or damaged in the laundry? 3-Hardly ever	Do the resident’s clothes get lost or damaged in the laundry? 4-Never	Do the resident’s clothes get lost or damaged in the laundry? 5-Do not know	Do the resident’s clothes get lost or damaged in the laundry? 6-Does not apply
Are there enough comfortable places for the resident to sit outdoors?	Are there enough comfortable places for the resident to sit outdoors? 1-Always	Are there enough comfortable places for the resident to sit outdoors? 2-Sometimes	Are there enough comfortable places for the resident to sit outdoors? 3-Hardly ever	Are there enough comfortable places for the resident to sit outdoors? 4-Never	Are there enough comfortable places for the resident to sit outdoors? 5-Do not know	Are there enough comfortable places for the resident to sit outdoors? 6-Does not apply
Are you satisfied with the resident’s room?	Are you satisfied with the resident’s room? 1-Always	Are you satisfied with the resident’s room? 2-Sometimes	Are you satisfied with the resident’s room? 3-Hardly ever	Are you satisfied with the resident’s room? 4-Never	Are you satisfied with the resident’s room? 5-Do not know	Are you satisfied with the resident’s room? 6-Does not apply
Does Three Links seem home-like?	Does Three Links seem home-like? 1-Always	Does Three Links seem home-like? 2-Sometimes	Does Three Links seem home-like? 3-Hardly ever	Does Three Links seem home-like? 4-Never	Does Three Links seem home-like? 5-Do not know	Does Three Links seem home-like? 6-Does not apply
Does Three Links appear clean and tidy?	Does Three Links appear clean and tidy? 1-Always	Does Three Links appear clean and tidy? 2-Sometimes	Does Three Links appear clean and tidy? 3-Hardly ever	Does Three Links appear clean and tidy? 4-Never	Does Three Links appear clean and tidy? 5-Do not know	Does Three Links appear clean and tidy? 6-Does not apply
Are you satisfied with the safety and security at Three Links?	Are you satisfied with the safety and security at Three Links? 1-Always	Are you satisfied with the safety and security at Three Links? 2-Sometimes	Are you satisfied with the safety and security at Three Links? 3-Hardly ever	Are you satisfied with the safety and security at Three Links? 4-Never	Are you satisfied with the safety and security at Three Links? 5-Do not know	Are you satisfied with the safety and security at Three Links? 6-Does not apply

Is there anything else you would like to tell us about the environment at Three Links?

Question Title

* 7. Additional Questions

	1-Always	2-Sometimes	3-Hardly ever	4-Never	5-Do not know	6-Does not apply
Do you feel welcome when you enter Three Links?	Do you feel welcome when you enter Three Links? 1-Always	Do you feel welcome when you enter Three Links? 2-Sometimes	Do you feel welcome when you enter Three Links? 3-Hardly ever	Do you feel welcome when you enter Three Links? 4-Never	Do you feel welcome when you enter Three Links? 5-Do not know	Do you feel welcome when you enter Three Links? 6-Does not apply
Do you know who to approach when you have a concern or problem?	Do you know who to approach when you have a concern or problem? 1-Always	Do you know who to approach when you have a concern or problem? 2-Sometimes	Do you know who to approach when you have a concern or problem? 3-Hardly ever	Do you know who to approach when you have a concern or problem? 4-Never	Do you know who to approach when you have a concern or problem? 5-Do not know	Do you know who to approach when you have a concern or problem? 6-Does not apply
Do you feel listened to when you have a concern or problem?	Do you feel listened to when you have a concern or problem? 1-Always	Do you feel listened to when you have a concern or problem? 2-Sometimes	Do you feel listened to when you have a concern or problem? 3-Hardly ever	Do you feel listened to when you have a concern or problem? 4-Never	Do you feel listened to when you have a concern or problem? 5-Do not know	Do you feel listened to when you have a concern or problem? 6-Does not apply
Do staff make an effort to resolve your concerns or problems in a timely manner?	Do staff make an effort to resolve your concerns or problems in a timely manner? 1-Always	Do staff make an effort to resolve your concerns or problems in a timely manner? 2-Sometimes	Do staff make an effort to resolve your concerns or problems in a timely manner? 3-Hardly ever	Do staff make an effort to resolve your concerns or problems in a timely manner? 4-Never	Do staff make an effort to resolve your concerns or problems in a timely manner? 5-Do not know	Do staff make an effort to resolve your concerns or problems in a timely manner? 6-Does not apply

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* 8. Would you recommend Three Links Care Center to a family member or friend?

Yes

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* 9. Overall, are you satisfied with the quality of care that the resident receives at Three Links?

Yes

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* 10. Additional Services - Has the resident or family member accessed any of the additional services provided at Three Links such as:

	Yes	No
Social work	Social work Yes	Social work No
Dietician	Dietician Yes	Dietician No
Spiritual care	Spiritual care Yes	Spiritual care No
Music therapy	Music therapy Yes	Music therapy No
Volunteer services	Volunteer services Yes	Volunteer services No
Art therapy	Art therapy Yes	Art therapy No
Rehab assistant	Rehab assistant Yes	Rehab assistant No

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* 11. Is there anything we have not asked that you would like to tell us about?

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* 12. What would you like to see done at Three Links that would improve your family member’s quality of life?

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* 13. Are you aware of the Family Advisory Committee? Would you be interested in participating as a committee member?

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* 14. Thank you for taking the time to fill out this survey. The results will be used to improve the quality of care at Three Links Care Centre.

Optional If you would like someone from the facility to contact you to follow up with you regarding the survey please fill out the information below.

Name

Email Address

Phone Number

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* 1. Admissions - Please only fill out this section if your friend or family member moved into Three Links Care Centre after January 2018 - If your friend or family member was admitted prior to January 2018 please check "Does not apply"

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* 2. Activities

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* 3. Choice

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* 4. Direct Care

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* 5. Meals and Dining

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* 6. Environment

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* 7. Additional Questions

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* 8. Would you recommend Three Links Care Center to a family member or friend?

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* 9. Overall, are you satisfied with the quality of care that the resident receives at Three Links?

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* 10. Additional Services - Has the resident or family member accessed any of the additional services provided at Three Links such as:

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* 11. Is there anything we have not asked that you would like to tell us about?

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* 12. What would you like to see done at Three Links that would improve your family member’s quality of life?

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* 13. Are you aware of the Family Advisory Committee? Would you be interested in participating as a committee member?

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* 14. Thank you for taking the time to fill out this survey. The results will be used to improve the quality of care at Three Links Care Centre.***Optional*** If you would like someone from the facility to contact you to follow up with you regarding the survey please fill out the information below.

* 14. Thank you for taking the time to fill out this survey. The results will be used to improve the quality of care at Three Links Care Centre.

Optional If you would like someone from the facility to contact you to follow up with you regarding the survey please fill out the information below.