Professional Survey Form

Date(Required)

DD slash MM slash YYYY

Name

Position

Email

(You are not required to complete the above information. You may complete either name, position, email, or neither if you wish to remain anonymous)

1. Do you feel that the care service carries out a thorough assessment of the service users and that care is planned according to the information gathered?

Always	Usually	Sometimes	Never

2. Do you feel that the care service monitors, meets and reviews the social and health care needs of the service users?

Always	Usually	Sometimes	Never

3. Do you feel that the care service seeks and acts on advice to meet service users' social and care needs and to promote well-being?

Always	Usually	Sometimes	Never

4. Do you feel that the care service respects the service users' right to privacy and dignity?

Always	Usually	Sometimes	Never

5. Do you feel that the care service offers service users the opportunity to live the life they choose, as far as possible?

Always	Usually	Sometimes	Never

6. Do you feel that the manager and the staff of the care service have the necessary skills and attitude to meet the needs of the service users?

Always	Usually	Sometimes	Never

7. Do you feel that the care service responded appropriately if you or anyone using the service have ever raised any concerns?

Always	Usually	Sometimes	Never

8. Are you made to feel welcome when you visit the care service?

Always	Usually	Sometimes	Never

9. Do you feel that the manager responded your queries in timely manners?

Always	Usually	Sometimes	Never

10. Do you have any concerns that you would like to raise with me personally?

Always	Usually	Sometimes	Never

11. Do you have any concerns that you would like to raise with me personally?

Yes

No

Concern

12. What does the service do well?

13. What could the service do better?

14. Would you like to add anything to your comments?