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Family Survey
Please share your honest feedback to help us improve the care and safety of your loved one.
Name of Client or Resident
Please rate our services.
π« Not applicable
β do not have an opinion
π Poor service
that needs immediate attention
π Average service
that you would expect
π Above average service
that creates a sense of security and contentment for your loved one
π Excellent service
that you would recommend to others
Does your Loved one feel safe at/with Amyβs Eden?
π« No opinion
π Poor
π Fair
π Good
π Excellent
Does your love one feel respected and cared for?
π« No opinion
π Poor
π Fair
π Good
π Excellent
Are you treated with respect and courtesy as a family member?
π« No opinion
π Poor
π Fair
π Good
π Excellent
Is your loved one encouraged by staff to remain as independent as possible?
π« No opinion
π Poor
π Fair
π Good
π Excellent
Do you feel empowered to engage in your loved ones experience and needs?
π« No opinion
π Poor
π Fair
π Good
π Excellent
Does the Staff promote a pleasant βHallmark Movieβ feel atmosphere, free of negative emotional drama?
π« No opinion
π Poor
π Fair
π Good
π Excellent
Do the Staff identify outside resources to assist your loved one?
π« No opinion
π Poor
π Fair
π Good
π Excellent
Does your loved one wish to attend, outings or social events?
π« No opinion
π Poor
π Fair
π Good
π Excellent
Are there a variety of activities offered to stimulate your loved oneβs socialization?
π« No opinion
π Poor
π Fair
π Good
π Excellent
Would you like more communication with your Liaison (staff overseeing needs including healthcare needs)?
Yes
No
Comments on communication with your Liaison
Does your loved one enjoy a rapport and connection with the attendant?
π« No opinion
π Poor
π Fair
π Good
π Excellent
How would you or your loved one rate the quality & preparation of the food?
π« No opinion
π Poor
π Fair
π Good
π Excellent
Does your loved one enjoy the meals, dining services & atmosphere?
π« No opinion
π Poor
π Fair
π Good
π Excellent
Does your loved one participate in offered activities?
π« No opinion
π Poor
π Fair
π Good
π Excellent
Are the Dietary needs met and timely?
π« No opinion
π Poor
π Fair
π Good
π Excellent
Comments on dietary needs
Does your loved one receive needed and timely Physicians services?
π« No opinion
π Poor
π Fair
π Good
π Excellent
Does the staff improve your loved oneβs medication fulfillment?
π« No opinion
π Poor
π Fair
π Good
π Excellent
Does the Staff identify any decline in your loved one In a timely manner ?
π« No opinion
π Poor
π Fair
π Good
π Excellent
Does your loved one receive individualized help to improve their ability to be properly cared for?
π« No opinion
π Poor
π Fair
π Good
π Excellent
Are the Assistants polite, professional and timely?
π« No opinion
π Poor
π Fair
π Good
π Excellent
Does the staff anticipate needs and inform you timely?
π« No opinion
π Poor
π Fair
π Good
π Excellent
Comments on staff
How would you rate the senior living residence during your last visit?
π« No opinion
π Poor
π Fair
π Good
π Excellent
Is your loved oneβs home clean?
π« No opinion
π Poor
π Fair
π Good
π Excellent
Is the Housekeeping timely?
π« No opinion
π Poor
π Fair
π Good
π Excellent
Are the rooms of our facility well kept?
π« No opinion
π Poor
π Fair
π Good
π Excellent
Are the Laundry services efficient and timely?
π« No opinion
π Poor
π Fair
π Good
π Excellent
Is the common area sufficient and clean?
π« No opinion
π Poor
π Fair
π Good
π Excellent
Is the home in good repair?
π« No opinion
π Poor
π Fair
π Good
π Excellent
Is the Maintenance Personnel courtesy, professional and timely?
π« No opinion
π Poor
π Fair
π Good
π Excellent
Are the Amyβs Eden Grounds clean, well-groomed and well lit?
π« No opinion
π Poor
π Fair
π Good
π Excellent
Comments on Grounds cleanliness
Overall did your loved oneβs quality of life improve upon or after admission?
π« No opinion
π Poor
π Fair
π Good
π Excellent
Overall has there been an improvement in your loved oneβs health upon or after admission?
π« No opinion
π Poor
π Fair
π Good
π Excellent
Overall did the staff make the initial admission & transition a positive experience for your family and loved one?
π« No opinion
π Poor
π Fair
π Good
π Excellent
Overall is the Office Staff professional, courtesy and timely?
π« No opinion
π Poor
π Fair
π Good
π Excellent
Overall did your loved oneβs appetite improve and/or gain weight?
Yes
No
Would you recommend our services to another community member?
Yes
No
Can we use some of your comments for testimonials on our website, printed ads or brochures?
Yes
No
Would you enjoy being a family member that new families might want to talk to before they admit their loved one?
Yes
No
Would you enjoy being a family member that new families might want to talk to before they admit their loved one?
Yes
No
Submit the feedback