2025 LTC Nutrition Services Client Experience Questionnaire Client Experience Questionnaire Please assist us in completing this survey regarding our food service. Your comments will guide us in improving our food service. When answering these questions, think about your mealtime experience in general and not one meal in particular. We do not collect personal information unless you request a follow-up. *If the question does not apply, please leave blank Question Title * Facility Location Baldur PCH Baldur Transition Unit Bayside (Killarney) PCH Benito PCH Benito Transitional Unit Birch Lodge (Hamiota) PCH Birtle Transitional Unit Bren-Del-Win Lodge (Deloraine) PCH Carberry PCH Country Meadows (Neepawa) PCH Crocus Court (Roblin) PCH Dauphin PCH Davidson Memorial (Cartwright) PCH Delwynda Court (Deloraine) PCH Dinsdale (Brandon) PCH Dr. Gendreau (Ste. Rose) PCH Elkwood Mannor (Elkhorn) PCH Erickson PCH Erickson Transitional Unit Evergreen Place (Boissevain) PCH Fairview (Brandon) PCH Gilbert Plains PCH Glenboro PCH Grandview PCH Hartney PCH McCreary/Alonsa PCH McCreary/Alonsa Transitional Unit Melita PCH Minnedosa PCH Morley House (Shoal Lake) PCH Reston Transitional Unit Rideau Park (Brandon) PCH Riverdale (Rivers) PCH Rossburn PCH Rossburn Transitional Unit Russell PCH Sandy Lake PCH Sherwood (Virden) PCH Shoal Lake/Strathclair PCH Souris PCH St. Paul's (Dauphin) PCH Sunnyside (Birtle) PCH Swan Valley Lodge Swan Valley PCH Tiger Hills Manor (Treherne) PCH Wawanesa PCH Wawanesa Transitional Unit Westman Nursing Home (Virden) PCH Westview Lodge (Boisevain) PCH Willowview (Reston) PCH Winnipegosis PCH Winnipegosis Transitional Unit Question Title * Survey Completed by: Resident Family (on behalf of Patient/Resident) Other Question Title * Please choose the best answer for each:In general... Always Most of the Time Sometimes Never Not Applicable 1. I enjoy the food and beverages I am served. 1. I enjoy the food and beverages I am served. Always 1. I enjoy the food and beverages I am served. Most of the Time 1. I enjoy the food and beverages I am served. Sometimes 1. I enjoy the food and beverages I am served. Never 1. I enjoy the food and beverages I am served. Not Applicable 2. My food tastes good. 2. My food tastes good. Always 2. My food tastes good. Most of the Time 2. My food tastes good. Sometimes 2. My food tastes good. Never 2. My food tastes good. Not Applicable 3. My food looks good. 3. My food looks good. Always 3. My food looks good. Most of the Time 3. My food looks good. Sometimes 3. My food looks good. Never 3. My food looks good. Not Applicable 4. Hot foods are served hot enough. 4. Hot foods are served hot enough. Always 4. Hot foods are served hot enough. Most of the Time 4. Hot foods are served hot enough. Sometimes 4. Hot foods are served hot enough. Never 4. Hot foods are served hot enough. Not Applicable 5. Cold foods are served cold enough. 5. Cold foods are served cold enough. Always 5. Cold foods are served cold enough. Most of the Time 5. Cold foods are served cold enough. Sometimes 5. Cold foods are served cold enough. Never 5. Cold foods are served cold enough. Not Applicable Question Title * Please choose the best answer for each:In general….. Always Most of the Time Sometimes Never Not Applicable 6. I am happy with the amount of food I receive. 6. I am happy with the amount of food I receive. Always 6. I am happy with the amount of food I receive. Most of the Time 6. I am happy with the amount of food I receive. Sometimes 6. I am happy with the amount of food I receive. Never 6. I am happy with the amount of food I receive. Not Applicable If only sometimes/never, why? Question Title * Please choose the best answer for each:In general….. Always Most of the Time Sometimes Never Not Applicable 7. I am given enough time to finish my meals. 7. I am given enough time to finish my meals. Always 7. I am given enough time to finish my meals. Most of the Time 7. I am given enough time to finish my meals. Sometimes 7. I am given enough time to finish my meals. Never 7. I am given enough time to finish my meals. Not Applicable 8. If I do not like the meal served, I am offered another choice. 8. If I do not like the meal served, I am offered another choice. Always 8. If I do not like the meal served, I am offered another choice. Most of the Time 8. If I do not like the meal served, I am offered another choice. Sometimes 8. If I do not like the meal served, I am offered another choice. Never 8. If I do not like the meal served, I am offered another choice. Not Applicable 9. I receive enough help at meal times. 9. I receive enough help at meal times. Always 9. I receive enough help at meal times. Most of the Time 9. I receive enough help at meal times. Sometimes 9. I receive enough help at meal times. Never 9. I receive enough help at meal times. Not Applicable 10. I enjoy where I eat my meals. 10. I enjoy where I eat my meals. Always 10. I enjoy where I eat my meals. Most of the Time 10. I enjoy where I eat my meals. Sometimes 10. I enjoy where I eat my meals. Never 10. I enjoy where I eat my meals. Not Applicable 11. My table setting is clean/neat. 11. My table setting is clean/neat. Always 11. My table setting is clean/neat. Most of the Time 11. My table setting is clean/neat. Sometimes 11. My table setting is clean/neat. Never 11. My table setting is clean/neat. Not Applicable Question Title * Please choose the best answer for each:In general….. Always Most of the Time Sometimes Never Not Applicable 12. My personal, cultural or religious food preferences are met. 12. My personal, cultural or religious food preferences are met. Always 12. My personal, cultural or religious food preferences are met. Most of the Time 12. My personal, cultural or religious food preferences are met. Sometimes 12. My personal, cultural or religious food preferences are met. Never 12. My personal, cultural or religious food preferences are met. Not Applicable If only sometimes/never, why? Question Title * Please choose the best answer for each:In general….. Always Most of the Time Sometimes Never Not Applicable 13. The staff who serve my meals are pleasant/friendly. 13. The staff who serve my meals are pleasant/friendly. Always 13. The staff who serve my meals are pleasant/friendly. Most of the Time 13. The staff who serve my meals are pleasant/friendly. Sometimes 13. The staff who serve my meals are pleasant/friendly. Never 13. The staff who serve my meals are pleasant/friendly. Not Applicable Question Title * 14. Do you have any comments or suggestions that might help us improve our service, such as meal ideas? Do any particular meals need to be improved? Demographics: (of the patient/resident) Question Title * Gender: Male Female Gender Diverse Prefer not to answer Question Title * Ethnicity (race): Caucasian (White) Indigenous (First Nations, Inuit, Metis) Black Asian (South, East) Chinese Filipino Japanese Korean Latin American Middle Eastern Prefer not to answer Other (please specify) Question Title * Age: 40 years or under 41-44 years 45-49 years 50-54 years 55-59 years 60-64 years 65-69 years 70-74 years 75-79 years 80-84 years 85-89 years 90 years or older Patient Advisor Volunteers Needed!! Someone just like you helped to design this survey!We want to partner with existing patients or family members who might be interested in helping us review, design or provide feedback to our Food/Nutrition Services. By leaving your name, phone number and email address below, you are indicating your interest in partnering with Prairie Mountain Health (PMH) and are consenting to be contacted by Patient Relations. Patient Relations will be in contact with you when an opportunity becomes available. Question Title * Volunteer Contact Information: Volunteer Full Name: Home Community: Phone Number: Email Address: Forward additional Concerns or Compliments regarding your care to Patient Relations.Patient Relations: email patientrelations@pmh-mb.ca or call 1-800-735-6596Questions or concerns related to this survey can be sent to ceq@pmh-mb.caThank you for your participation! Done
