Survey Form Friends Relatives and Advocate Date(Required) DD slash MM slash YYYY Name Relationship with citizen (You are not required to complete the above information. You may complete either name or relationship to Citizen, or neither if you wish to remain anonymous)1. Is the service Safe?1(a). Any equipment I see that the agency uses is well maintainedInadequate (1 Score)Requires Improvement (2 Score)Good (3 Score)Outstanding (4 Score)1(b). There is enough staff to ensure the person important to me receives a reliable service that is not rushed. Staff have the right mix of skills to make sure they are kept safeInadequate (1 Score)Requires Improvement (2 Score)Good (3 Score)Outstanding (4 Score)1(c). I feel confident their belongings are safe and secureInadequate (1 Score)Requires Improvement (2 Score)Good (3 Score)Outstanding (4 Score)1(d). I know how to raise concerns about issues I may observeInadequate (1 Score)Requires Improvement (2 Score)Good (3 Score)Outstanding (4 Score)1(e). Staff give medicine according to the Care Plan and it is stored correctly and safelyInadequate (1 Score)Requires Improvement (2 Score)Good (3 Score)Outstanding (4 Score)1(f). The person important to me is kept safe and protected by staff, but also, they have as much freedom as possible to do the things they want to doInadequate (1 Score)Requires Improvement (2 Score)Good (3 Score)Outstanding (4 Score)1(g). Staff protect their dignity and human rights and respect them as an individualInadequate (1 Score)Requires Improvement (2 Score)Good (3 Score)Outstanding (4 Score)1(h). The person important to me is protected from being bullied, harassed, harmed and abusedInadequate (1 Score)Requires Improvement (2 Score)Good (3 Score)Outstanding (4 Score)1(i). Staff deal with incidents and accidents quickly and openlyInadequate (1 Score)Requires Improvement (2 Score)Good (3 Score)Outstanding (4 Score)2. Is the service Effective?2(a). Staff have the right knowledge, qualifications, and skills to carry out their role in providing the person who is important to me with the right careInadequate (1 Score)Requires Improvement (2 Score)Good (3 Score)Outstanding (4 Score)2(b). If I have financial guardianship, I have been informed about the costs of the service including any extra costsInadequate (1 Score)Requires Improvement (2 Score)Good (3 Score)Outstanding (4 Score)2(c). When needed, I am involved in decisions about their careInadequate (1 Score)Requires Improvement (2 Score)Good (3 Score)Outstanding (4 Score)2(d). Staff make sure the person important to me gets the right food and drink, and that they have enough of itInadequate (1 Score)Requires Improvement (2 Score)Good (3 Score)Outstanding (4 Score)2(e). I am regularly asked for my views about the service the person important to me receives, and my feedback is consistently goodInadequate (1 Score)Requires Improvement (2 Score)Good (3 Score)Outstanding (4 Score)3. Is the service Caring?3(a). I can visit the person important to me whenever they would like and I am welcomed by Wyville Home Care ServicesInadequate (1 Score)Requires Improvement (2 Score)Good (3 Score)Outstanding (4 Score)3(b). If they have communication challenges, I was consulted on their likes and dislikesInadequate (1 Score)Requires Improvement (2 Score)Good (3 Score)Outstanding (4 Score)3(c). I am encouraged to express my views about the service they receiveInadequate (1 Score)Requires Improvement (2 Score)Good (3 Score)Outstanding (4 Score)3(d). Staff communicate with the person important to me according to their needs and wishesInadequate (1 Score)Requires Improvement (2 Score)Good (3 Score)Outstanding (4 Score)3(e). Staff communicate with me in the way I need them toInadequate (1 Score)Requires Improvement (2 Score)Good (3 Score)Outstanding (4 Score)3(f). The person I visit is supported to get the help they need when they need it, such as an advocate (people who can speak on their behalf)Inadequate (1 Score)Requires Improvement (2 Score)Good (3 Score)Outstanding (4 Score)3(g). The staff team is caring and staff work well togetherInadequate (1 Score)Requires Improvement (2 Score)Good (3 Score)Outstanding (4 Score)3(h). Staff treat me with dignity, respect, kindness and compassion as well as the person important to meInadequate (1 Score)Requires Improvement (2 Score)Good (3 Score)Outstanding (4 Score)4. Is the service Responsive?4(a). The treatment and support of the person who is important to me is set out in writing and tells staff what is needed to support them bestInadequate (1 Score)Requires Improvement (2 Score)Good (3 Score)Outstanding (4 Score)4(b). Where I have an activated lasting Power of Attorney, I am fully involved in decisions about their current and future careInadequate (1 Score)Requires Improvement (2 Score)Good (3 Score)Outstanding (4 Score)4(c). They are helped by staff to keep up their hobbies and get involved in the community if they want toInadequate (1 Score)Requires Improvement (2 Score)Good (3 Score)Outstanding (4 Score)4(d). They are helped by staff to not feel lonely and staff help them keep in contact with me and other family and friendsInadequate (1 Score)Requires Improvement (2 Score)Good (3 Score)Outstanding (4 Score)4(e). When they need to visit the hospital, staff plan this well with them to make sure it goes as smoothly as possibleInadequate (1 Score)Requires Improvement (2 Score)Good (3 Score)Outstanding (4 Score)4(f). If I have any concerns and complaints, staff always take them seriously, investigate them thoroughly and respond to them in good timeInadequate (1 Score)Requires Improvement (2 Score)Good (3 Score)Outstanding (4 Score)5. Is the service Well-led?5(a). I know who the manager is and anyone else in chargeInadequate (1 Score)Requires Improvement (2 Score)Good (3 Score)Outstanding (4 Score)5(b). Staff and managers work effectively with others who may be involved in caring for the person important to me, such as my local councilInadequate (1 Score)Requires Improvement (2 Score)Good (3 Score)Outstanding (4 Score)5(c). The managers know what they need to do and are always honest, including when things go wrongInadequate (1 Score)Requires Improvement (2 Score)Good (3 Score)Outstanding (4 Score)5(d). I am asked for my views on the wider service and I feel included in how things will be different. The management communicates clearly to everyone, thinking about the way we will understand the message bestInadequate (1 Score)Requires Improvement (2 Score)Good (3 Score)Outstanding (4 Score)Respecting My PrivacyIf you wish, you do not have to declare your identity on this survey and you may return it anonymouslyA member of staff helped me to complete this surveyYesNoI have been told that I can return this survey anonymouslyYesNoI am satisfied that I can return this survey anonymously if I want toYesNoI have been shown how to return this survey anonymouslyYesNo6. What does the service do well? 7. What could the service do better? 8. Would you like to add anything to your comments?