Representative and visitor feedback online tool

Your feedback is important to us!

Our staff access this simple observation tool to assist our quality audits and regularly complete it in various areas of the home. We are now making it available for residents, representatives and visitors to complete so we receive helpful external feedback. Please feel free to spend 5-10 minutes to complete this form on your mobile ‘phone or tablet, or home computer.

*These fields must be completed

Many thanks.

Name of observer *

First

Last

Date / Time *

Date

Time

Which home are you observing? *

Findon
Hope Valley

How many positive interactions did you observe?

Selected Value: 0

How many neutral interactions did you observe? (copy)

Selected Value: 0

How many negative interactions did you observe? (copy) (copy)

Selected Value: 0

Rate your observation on the following statements *

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
Staff demonstrated kindness, dignity & respect:	Strongly DisagreeStaff demonstrated kindness, dignity & respect: Strongly Disagree	DisagreeStaff demonstrated kindness, dignity & respect: Disagree	NeutralStaff demonstrated kindness, dignity & respect: Neutral	AgreeStaff demonstrated kindness, dignity & respect: Agree	Strongly AgreeStaff demonstrated kindness, dignity & respect: Strongly Agree
Staff engaged in a positive & friendly way with residents:	Strongly DisagreeStaff engaged in a positive & friendly way with residents: Strongly Disagree	DisagreeStaff engaged in a positive & friendly way with residents: Disagree	NeutralStaff engaged in a positive & friendly way with residents: Neutral	AgreeStaff engaged in a positive & friendly way with residents: Agree	Strongly AgreeStaff engaged in a positive & friendly way with residents: Strongly Agree
Appropriate language and communication was used at all times:	Strongly DisagreeAppropriate language and communication was used at all times: Strongly Disagree	DisagreeAppropriate language and communication was used at all times: Disagree	NeutralAppropriate language and communication was used at all times: Neutral	AgreeAppropriate language and communication was used at all times: Agree	Strongly AgreeAppropriate language and communication was used at all times: Strongly Agree
Residents were offered choice:	Strongly DisagreeResidents were offered choice: Strongly Disagree	DisagreeResidents were offered choice: Disagree	NeutralResidents were offered choice: Neutral	AgreeResidents were offered choice: Agree	Strongly AgreeResidents were offered choice: Strongly Agree
Residents were well groomed:	Strongly DisagreeResidents were well groomed: Strongly Disagree	DisagreeResidents were well groomed: Disagree	NeutralResidents were well groomed: Neutral	AgreeResidents were well groomed: Agree	Strongly AgreeResidents were well groomed: Strongly Agree
The room ambience was pleasant & the temperature was optimal:	Strongly DisagreeThe room ambience was pleasant & the temperature was optimal: Strongly Disagree	DisagreeThe room ambience was pleasant & the temperature was optimal: Disagree	NeutralThe room ambience was pleasant & the temperature was optimal: Neutral	AgreeThe room ambience was pleasant & the temperature was optimal: Agree	Strongly AgreeThe room ambience was pleasant & the temperature was optimal: Strongly Agree
Background noise levels were appropriate to the area:	Strongly DisagreeBackground noise levels were appropriate to the area: Strongly Disagree	DisagreeBackground noise levels were appropriate to the area: Disagree	NeutralBackground noise levels were appropriate to the area: Neutral	AgreeBackground noise levels were appropriate to the area: Agree	Strongly AgreeBackground noise levels were appropriate to the area: Strongly Agree
TVs and other media were set at an appropriate level for the residents:	Strongly DisagreeTVs and other media were set at an appropriate level for the residents: Strongly Disagree	DisagreeTVs and other media were set at an appropriate level for the residents: Disagree	NeutralTVs and other media were set at an appropriate level for the residents: Neutral	AgreeTVs and other media were set at an appropriate level for the residents: Agree	Strongly AgreeTVs and other media were set at an appropriate level for the residents: Strongly Agree
Staff noise was appropriate & staff did not use loud voices:	Strongly DisagreeStaff noise was appropriate & staff did not use loud voices: Strongly Disagree	DisagreeStaff noise was appropriate & staff did not use loud voices: Disagree	NeutralStaff noise was appropriate & staff did not use loud voices: Neutral	AgreeStaff noise was appropriate & staff did not use loud voices: Agree	Strongly AgreeStaff noise was appropriate & staff did not use loud voices: Strongly Agree
There was no clutter or feeling that residents were in a workplace:	Strongly DisagreeThere was no clutter or feeling that residents were in a workplace: Strongly Disagree	DisagreeThere was no clutter or feeling that residents were in a workplace: Disagree	NeutralThere was no clutter or feeling that residents were in a workplace: Neutral	AgreeThere was no clutter or feeling that residents were in a workplace: Agree	Strongly AgreeThere was no clutter or feeling that residents were in a workplace: Strongly Agree
Residents requests were met promptly & helpfully:	Strongly DisagreeResidents requests were met promptly & helpfully: Strongly Disagree	DisagreeResidents requests were met promptly & helpfully: Disagree	NeutralResidents requests were met promptly & helpfully: Neutral	AgreeResidents requests were met promptly & helpfully: Agree	Strongly AgreeResidents requests were met promptly & helpfully: Strongly Agree
The environment was homely:	Strongly DisagreeThe environment was homely: Strongly Disagree	DisagreeThe environment was homely: Disagree	NeutralThe environment was homely: Neutral	AgreeThe environment was homely: Agree	Strongly AgreeThe environment was homely: Strongly Agree
The care & services seemed well run & organised:	Strongly DisagreeThe care & services seemed well run & organised: Strongly Disagree	DisagreeThe care & services seemed well run & organised: Disagree	NeutralThe care & services seemed well run & organised: Neutral	AgreeThe care & services seemed well run & organised: Agree	Strongly AgreeThe care & services seemed well run & organised: Strongly Agree
Staff were modelling Resident Focused Care:	Strongly DisagreeStaff were modelling Resident Focused Care: Strongly Disagree	DisagreeStaff were modelling Resident Focused Care: Disagree	NeutralStaff were modelling Resident Focused Care: Neutral	AgreeStaff were modelling Resident Focused Care: Agree	Strongly AgreeStaff were modelling Resident Focused Care: Strongly Agree
There were adequate staff available:	Strongly DisagreeThere were adequate staff available: Strongly Disagree	DisagreeThere were adequate staff available: Disagree	NeutralThere were adequate staff available: Neutral	AgreeThere were adequate staff available: Agree	Strongly AgreeThere were adequate staff available: Strongly Agree
Staff looked & acted professionally:	Strongly DisagreeStaff looked & acted professionally: Strongly Disagree	DisagreeStaff looked & acted professionally: Disagree	NeutralStaff looked & acted professionally: Neutral	AgreeStaff looked & acted professionally: Agree	Strongly AgreeStaff looked & acted professionally: Strongly Agree
Staff engaged with residents at every opportunity:	Strongly DisagreeStaff engaged with residents at every opportunity: Strongly Disagree	DisagreeStaff engaged with residents at every opportunity: Disagree	NeutralStaff engaged with residents at every opportunity: Neutral	AgreeStaff engaged with residents at every opportunity: Agree	Strongly AgreeStaff engaged with residents at every opportunity: Strongly Agree

Comments and recommendations for feedback/continuous improvement

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