Satisfaction Survey for People Supported 2021

By completing this survey, you will help us see what we are doing well, where we need to improve, and look at any other suggestions you have to help us give you the best possible service experience. This survey should take about 15 minutes to complete. Thank you for taking the time to fill out this survey, your input is very important.

Please complete either by yourself or with the assistance of a family member or someone that knows you best, but not your paid support team.

This survey has a option where the questions and answers are read out loud to you. Just click on the box with the arrow. Allow time for it to play as there is a few seconds delay.

Deadline date is by the end of the day on Friday, May 28th, 2021.

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* 1. I am completing this survey on my own.

Yes

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* 2. If No, who is filling out this survey with you? (Relationship ie. friend, family member)

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* 3. What type of support do you receive? (Check all that apply)

In home respite (example: a support worker comes to your house to support you and takes you out into your community)

Out of home respite (example: you stay at a community living home for the weekend or other periods of time)

Community activities (example: bowling going to church, volunteering)

Planning Supports (example: getting together to identify your goals, dreams, supports needed, planning for your future and completing applications and meeting together with your family)

Independent Support Services (example: living in your own apartment/home with or without a roommate and receiving only support as needed)

Accommodation Support (24-hour support in your home)

Employment Supports/Career Compass (example: assistance to help you prepare for finding a job)

Host Family

Virtual Day Supports

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* 4. I make my own decisions.

YES

SOMETIMES

Satisfaction Survey for People Supported 2021

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* 1. I am completing this survey on my own.

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* 2. If No, who is filling out this survey with you? (Relationship ie. friend, family member)

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* 3. What type of support do you receive? (Check all that apply)

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* 4. I make my own decisions.

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* 5. I enjoy where I live.

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* 6. I decide what I do in my home.

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* 7. I decide what to do in my community.

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* 8. When rules/restrictions are not in place due to COVID, I go out and do things in the community as often as I want?

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* 9. Staff listens to what I have to say.

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* 10. Staff respect my privacy.

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* 11. Staff treat me well.

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* 12. Staff help me reach my goals.

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* 13. I enjoy the staff who work with me.

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* 14. When rules/restrictions are not in place due to COVID, I see my family when I want to.

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* 15. When rules/restrictions are not in place due to COVID, I see my friends when I want to.

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* 16. I feel safe.

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* 17. I am happy with supports and services I receive through Community Living Essex County.

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* 18. What do you like most about the support you receive?

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* 19. What do you not like about the support you receive?

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* 20. How can we improve support to you?

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* 21. Any other comments, questions, or concerns?