It is very important to us at Excelsior Springs Hospital to provide the best care possible to the residents in our Long Term Care Facility. Please assist us in evaluating the care provided from your perspective. Your response to this survey will be kept confidential. Thank you for taking the time to complete this survey. 
 
 

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* 1. In general, how would you rate the overall care received from the nursing staff?

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* 2. How would you rate your loved one's physician?

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* 3. Do you feel the facility adequately controls the resident's pain?

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* 4. Has Social Services responded timely and appropriately to your requests?

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* 5. Did you know Social Services can assist with applying for Medicaid?

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* 6. Is the management team responsive to complaints/concerns?

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* 7. Do you know who to contact if you have a concern regarding care of a resident?

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* 8. How would you rate the condition of your loved one's room?

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* 9. Do you think the resident's room is comfortable, homelike and reflects what the resident would like?

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* 10. How would you rate the overall facility appearance?

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* 11. Is the direct care staff friendly and professional?

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* 12. Do you think the direct care staff receives enough training/education?

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* 13. Does the staff honor your loved one's choices/preferences?

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* 14. Do you fell you are notified timely of significant changes in regards to your loved one? 

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* 15. Did you know that you can request a care plan meeting to be held at a time that accommodates your schedule?

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* 16. Do you think the meals are appetizing and nourishing? 

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* 17. Do you feel the meal size is appropriate?

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* 18. Are you aware, diet permitting, that residents can receive snacks such as cookies, ice cream and popcorn free of charge?

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* 19. Does the facility provide meaningful activities that engage residents?

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* 20. Are you aware the contact information for the ombudsman is posted across from the nurse's station?

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* 21. Are you aware that copies of the last 3 years state inspections are located by the nurses' station?

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* 22. Do you have suggestions on how we can make improvements to our facility, our care, etc.?

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* 23. What do you like best about our Long Term Care Facility?

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* 24. Would you recommend our facility to others?

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* 25. Optional:

Thank you for your time!
Please return the form in the envelope provided. 


Valerie Jeffres
Long Term Care Administrator 
1700 Rainbow Blvd.
Excelsior Springs, MO 64024

816-629-3572
vjeffres@esmc.org 

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