Family Satisfaction Survey

In an ongoing effort to provide the best care possible for the residents we serve, Petersen Health Care is asking you to participate in an Family Satisfaction Survey (you do not need to include your name). Your opinion is important to us and we appreciate hearing from you regarding your perception of the work environment, communication, services and quality of care we offer.

Petersen Health Care is dedicated to providing the highest quality of care and life for our residents. Further, we want all families to bring their rich backgrounds, knowledge, and experiences to the table in trying to construct the ideal long-term care environment. Thank you for your assistance with this survey. We read each & every response.

We believe anonymity is important, names are not asked for nor included with the survey.

Location*

Thinking about your overall experience as a family member of a resident at this community, how would you rate the following characteristics of this community?

1. The quality of the medical and nursing care.

2. The living environment.

3. The service provided to my family member.

4. The quality of my family member’s life here.

5. The staff of the community.

Thinking about the atmosphere and the environment at this community, please indicate your agreement or disagreement with the following statements:

6. This community is odor free.

7. This community is clean and neat.

8. Furniture and equipment are in good condition.

9. My family member is safe here.

10. My family member’s personal itemsare safe here.

Thinking about services provided to your family at this community, please indicate your agreement or disagreement with the following statements:

11. My family member can get help when needed.

12. This community offers an appropriate variety of activities.

13. My family member’s laundry is done properly.

Thinking about the quality of your family member’s life at this community, please indicate your agreement or disagreement with the following statements:

14. When I visit, my family member is clean and well groomed.

15. My family member’s toileting needs are met.

16. My family member’s privacy is respected.

17. The dining experience is pleasant.

Thinking about the staff at this community, please indicate your agreement or disagreement with the following statements:

18. The staff interact with my family member regularly.

19. The staff treat my family member with dignity and respect.

20. The staff are friendly and courteous.

Thinking about your personal interactions with staff and administration, please indicate your agreement or disagreement with the following statements?

21. Concerns I have about the care of my family member are addressed promptly.

22. I receive regular communication from staff regarding my familymember’s condition.

23. The staff is pleasant when I call the community.

24. The business office is helpful and responsive.

25. The Administration is available when needed.

26. Gender?

Male
Female

27. Age?

28. Tell us what we do best here.

29. Tell us what improvements would make things better for you here.

30. Please add any additional comments you would like us to hear.

Confirmation*

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Comments

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