MICs Group of Health Services

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1. Who is filling out this survey?

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2. Name of Facility

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3. Were you served in the official language in which you are most comfortable?

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4. If you received services in French, were you satisfied with the services provided?

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5. You and your loved one received a warm welcome and had everything explained to you when you first came

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6. You and your loved ones are always welcomed and treated with kindness and respect.

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7. You and your loved ones are encouraged to participate in discussions about your care.

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8. Staff respect your day to day routines and habits without rushing you.

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9. The home offers a variety of food that is flavourful.

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10. The home offers a variety of food that is culturally appropriate.

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11. Your room is clean

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12. Your personal items are respected.

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13. Staff regularly wash their hands and there is information available to encourage others to properly wash their hands.

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14. You and your visitors are informed about infection and how to control them.

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15. All areas, including common areas are clean

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16. All areas, including common areas are welcoming

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17. Staff smile and laugh during their day.

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18. Your information is shared with only the right people, at the right time and in a way that is easy to understand.

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19. You have been informed of who to bring compliments, comments and or complaints to for resolution.

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20. Staff offer activities to you and your loved ones that are based on physical and cognitive ability, wishes and desires

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21. You and your loved ones are encouraged to participate in activities that are based on physical and cognitive ability, wishes and desires

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22. As necessary, the home asks service providers to assist in your care

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23. You and your loved ones can speak to staff when you need to

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24. You and your loved ones can speak to physicians when you need to

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25. At all times you and your loved ones feel safe.

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26. Continence care products are appropriate and of good quality.

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27. Team members wear their name tags

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28. Team members identify themselves when providing services.

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29. Comments:

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