Healthwatch Staffordshire has put together this list of questions to help us understand the experiences of people living in a Care Home (residential or nursing). The survey is open to residents, their families and/or friends.
We would like to invite you to take our survey. You may answer the survey anonymously, or you can give us your contact details at the end if you would like to discuss anything further. We will not use your details for any other purposes.
The views collected by the survey may be included in one of our Reports or used in our own statistics. Your name will not be attached to specific comments in our reporting, unless you ask us to do so.
This question requires an answer
1. What is the name of your home/accommodation? *
2. Which of the following applies to you?
3. What type of home is this?
4. Do your carers treat you with respect and dignity?
5. Have you read and signed your support plan?
6. If you were unhappy about your care, could you tell someone? Who would you tell?
7. Do you think the people who look after you would fix any complaints you had?
8. Have your carers helped you stay active/engaged? How?
9. Have your carers helped you stay in contact with friends/family? How?
10. Do you get to choose your food?
11. Do your carers ask your permission before helping you?
12. Do your have enough interesting things to do?
13. Do your carers give you the information you need to help you make choices?
14. Are there always snacks and drinks available when you want them?
16. Do you think there are enough staff?
17. Have your carers told you what to do if you feel unsafe or at risk?
18. Is there anything you don't like about your carers?
19. What is your favourite thing about your carers/living here?
20. If you could change one thing about your care, what would it be?
Questions 21 to 28 are about the resident and are optional. If you answer them it will help us check that we have reached a range of ages, disability needs, gender, race, ethnicity and religions. We would like to make sure that everyone has their say.
21. What is the resident's name?
22. How long have you been living here?
23. Have you lived in another care home?
24. What care need is the primary reason for being supported in a care home (if nursing care is required you may choose more than one)?
25. Please tell us the resident's age
26. Please tell us the resident's gender
27. Please select the resident's ethnicity
28. What is the resident's religion or belief?
29. Would you like us to contact you about your responses ?
30. If you have answered Yes to questions 29 then please leave us your name and either a phone number or email address which we can use to contact you.
You can contact Healthwatch independently of this survey if you would like to give us any feedback on your experience of Health and Social Care Services in Staffordshire. Our freephone number is 0800 051 8371 and our email address is enquiries@healthwatchstaffordshire.co.uk.
If you are completing a paper questionnaire you can return it to the staff at your care home or by post to Healthwatch Staffordshire, c/o Support Staffordshire, Floor 3, Civic Centre, Riverside, Stafford ST16 3AQ
Thank you for your help.