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24 Hour Home Care
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Stakeholder Questionnaire
Please complete the Questionaire below
Section 1- About You
Name (Optional):
First
Last
In what capacity do you use our service? (Please tick any that apply)
Health Care Professional
Social Care Professional
Advocate
Other, please specify
If Other, please specify
Approximately how long have you been using our services?
Section 2- Our Care Services
Care Planning / Reviewing
Excellent
Good
Average
Poor
Very Poor
Don't Know
Caring attitude of our staff to clients
Excellent
Good
Average
Poor
Very Poor
Don't Know
Meeting clients individual needs
Excellent
Good
Average
Poor
Very Poor
Don't Know
Range and quality of care provided
Excellent
Good
Average
Poor
Very Poor
Don't Know
Access to relevant information
Excellent
Good
Average
Poor
Very Poor
Don't Know
Clients access to medical services
Excellent
Good
Average
Poor
Very Poor
Don't Know
Care visits
Excellent
Good
Average
Poor
Very Poor
Don't Know
Additional Comments:
Section 3 - Our Staff
When contacting / meeting with us are our staff?:
Courteous
Excellent
Good
Average
Poor
Very Poor
Don't Know
Well Presented
Excellent
Good
Average
Poor
Very Poor
Don't Know
Knowledgeable
Excellent
Good
Average
Poor
Very Poor
Don't Know
Friendly
Excellent
Good
Average
Poor
Very Poor
Don't Know
Helpful
Excellent
Good
Average
Poor
Very Poor
Don't Know
Additional Comments:
Section 4- Our Premises
If you have visited our premises, how would you rate the following?:
External Areas
Excellent
Good
Average
Poor
Very Poor
Don't Know
Reception
Excellent
Good
Average
Poor
Very Poor
Don't Know
Cleanliness and House Keeping
Excellent
Good
Average
Poor
Very Poor
Don't Know
Offices / Meeting Room
Excellent
Good
Average
Poor
Very Poor
Don't Know
Additional Comments:
Section 5 – Communication and Involvement
What is your impression of how we do the following:
Communicate with you?
Excellent
Good
Average
Poor
Very Poor
Don't Know
Communicate with clients?
Excellent
Good
Average
Poor
Very Poor
Don't Know
Involve clients with their care package?
Excellent
Good
Average
Poor
Very Poor
Don't Know
Involve you with clients’ care packages?
Excellent
Good
Average
Poor
Very Poor
Don't Know
Additional Comments:
Please use this space to add any further comments which you may find relevant.
