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Home › Service User Satisfaction Questionnaire ›

Service User Satisfaction Questionnaire

To assist Clyde Homecare to continue to provide and improve our service to you the client, it would be helpful if you, a family member or a friend could complete this questionnaire.

It is optional if you wish to give your name. It would be helpful if you would as it will enable our staff to deal with any issues you may have identified.

Name:

Area:

Care staff

The carer turns up on time: *

Always

Sometimes

Rarely

If the carer is going to be late I am always informed: *

Always

Sometimes

Rarely

The carer wears a uniform: *

Always

Sometimes

Rarely

The carer is neat and tidy: *

Always

Sometimes

Rarely

The carer shows their ID badge: *

Always

Sometimes

Rarely

The carer addresses me courteously: *

Always

Sometimes

Rarely

The carer treats me with respect: *

Always

Sometimes

Rarely

The carer respects my privacy: *

Always

Sometimes

Rarely

The carer respects my wishes: *

Always

Sometimes

Rarely

The carer is aware of my care needs: *

Always

Sometimes

Rarely

Care Service Monitoring

I am contacted on a regular basis by the office staff: *

Yes

No

I am visited on a regular basis by the Homecare Manager or Supervisor: *

Yes

No

When I contact the office I am treated with courtesy: *

Always

Sometimes

Rarely

When I contact the office with an issue I feel I am listened to: *

Always

Sometimes

Rarely

When I have raised an issue it was dealt with promptly: *

Always

Sometimes

Rarely

Complaints

Do you know how to make a complaint?: *

Yes

No

Do you know how to contact staff out of office hours?: *

Yes

No

Do you have a copy of the complaints policy?: *

Yes

No

Do you have a complaints form in your care folder?: *

Yes

No

Complaints

Have you made a complaint?: *

Yes

No

Do you feel your complaint was listened to?: *

Yes

No

Were you contacted by phone to confirm your complaint was being dealt with?: *

Yes

No

Did you feel your complaint was dealt with effectively?: *

Yes

No

Documents

I have a care folder: *

Yes

No

I have a signed Care Plan: *

Yes

No

I have a care visit record sheet in my care folder: *

Yes

No

I have an Accident Form in my care folder: *

Yes

No

Service consultation

Would you or your family be willing to talk to our carers about the needs and expectations of a service user?: *

Yes

No

Comments on service:

Questionnaire completed by: *

Service user

Family carer

Friend

Advocate

Carer

Would you be willing to have your feedback displayed on our website?: *

Yes, please quote me

Yes, but keep my identity anonymous

No thanks

On behalf of Clyde Healthcare Ltd I wish to thank you for taking the time to fill in this form.

Yours sincerely
For Clyde Healthcare Ltd

Kathy McBride
Managing Director

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