The staff of this facility wants to provide you with the best care possible. Your response to this survey will be kept confidential, but it will help us to know how to better serve you and other residents in the facility.
 
 

Question Title

* 1. The Convalescent Center provides you with care that meets your need.

Question Title

* 2. The nursing staff willingly and pleasantly provide care to you.

Question Title

* 3. The aides willingly and pleasantly provide care to you.

Question Title

* 4. Your call light is answered in a timely manner.

Question Title

* 5. The staff knows your mental and physical needs.

Question Title

* 6. Are you ever afraid?

Question Title

* 7. The care you receive is the same on all shifts.

Question Title

* 8. You are treated respectfully.

Question Title

* 9. Your visitors are welcomed to this facility.

Question Title

* 10. Your personal property, such as clothing, jewelry, radios and clocks are safe from theft or loss.

Question Title

* 11. At meal times your hot food items are served hot.

Question Title

* 12. At meal times your cold food items are served cold.

Question Title

* 13. How would you rate meals?

Question Title

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

Question Title

* 15. You understand your diet.

Question Title

* 16. You are satisfied with the medical care your doctor provides.

Question Title

* 17. Your physician listens to you.

Question Title

* 18. Pain is managed to your satisfaction?

Question Title

* 19. The furniture in your room is comfortable and arranged according to your choice.

Question Title

* 20. Your room is clean and odor free.

Question Title

* 21. Do you have the things you want with you, such as photos, books, keepsakes and furniture?

Question Title

* 22. Your privacy is respected.

Question Title

* 23. You understand your rights and responsibilities as a resident of this facility.

Question Title

* 24. If you desire, is there someone available to talk with you about your religious or spiritual feelings?

Question Title

* 25. What do you like best about this facility?

Question Title

* 26. What would you like to see improved?

Question Title

* 27. I would recommend this facility to others.

Question Title

* 28. Do you know where the state survey is located in our facility? 

Activity Survey

Question Title

* 29. Do you attend activities offered?

Question Title

* 30. Are you getting supplies in your room for independent use (such as word sesarch, tapes, DVD's, books, craft supplies)?

Question Title

* 31. What is your favorite activity?

Question Title

* 32. Are there enough activities provided?

Question Title

* 33. Do you enjoy the activities that are offered in this facility?

Question Title

* 34. Are there enough outside activities?

Question Title

* 35. Do you get your mail in a timely manner?

If you have additional information or concerns please feel free to contact :
Valerie Jeffres
Long Term Care Administrator 

816-629-2742
vjeffres@esmc.org

T