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Feedback

Who is completing this form?

Who is completing this form?

How long have you been involved with our service?

How long have you been involved with our service?

How satisfied are you with the domiciliary support service overall?

How satisfied are you with the domiciliary support service overall?

Would you recommend our service to others?

Would you recommend our service to others?

Please rate the professionalism of the support staff

Please rate the professionalism of the support staff

Do you feel the support provided meets your (or the service user’s) individual needs?

Do you feel the support provided meets your (or the service user’s) individual needs?

How well do staff communicate with you/about the person receiving care?

How well do staff communicate with you/about the person receiving care?

Do staff treat you (or the service user) with dignity and respect?

Do staff treat you (or the service user) with dignity and respect?

Do you feel the support staff are well-trained and competent?

Do you feel the support staff are well-trained and competent?

Are tasks and care activities completed as agreed in the care plan?

Are tasks and care activities completed as agreed in the care plan?

Do you feel safe (or feel the person receiving care is safe) with the support workers?

Do you feel safe (or feel the person receiving care is safe) with the support workers?

Do staff promote the service user’s independence and wellbeing?

Do staff promote the service user’s independence and wellbeing?

What do you value most about the service?

Is there anything we could improve?

Do you have any concerns or complaints you’d like to raise?

Would you like to be contacted to discuss your feedback?

Would you like to be contacted to discuss your feedback?