YOUR CENTRE
How happy are you with?
How comfortable your centre is
How warm and cosy your centre is
Your opportunities to interact with other individuals/residents and visitors
Your access to a garden or outdoor area?
Is there anything about your home, house, gardens that you really like or that you would like to change?
YOUR BEDROOM
How happy are you with?
The amount of space you have for your personal things
The security of your belongings?
Your laundry room or place to wash your clothes?
Is there anything about your bedroom or your laundry arrangements that you especially like or that you would like to change?
FOOD & MEAL TIMES
How happy are you with the...
Times the meals are served
Amount of time you get to eat your meal
Access to drinks and snacks outside of mealtimes
Cooking and eating facilities?
The way in which you are involved in decision making about your food
The way in which you are encouraged to learn new skills and become more independent with shopping and cooking
Is there anything about your food or the times that meals are served that you especially like or that you would like to change?
YOUR VISITORS
How happy are you with?
The arrangements for visitors
The welcome your visitors get from team members?
Is there anything about the arrangements for your visitors that you particularly like or that you would like to change?
YOUR RIGHTS
How happy are you with the amount of choice you have about?
The activities you take part in
Your weekly & daily planner
The care and support you receive
The amount of privacy you have
How your respect and dignity is protected
Are you happy with the things we have done for your health and safety
In general, are you happy with the amount of choice and control you have in daily life? Is there anything you would like to change?
YOUR ACTIVITIES
How happy are you with?
Your relationships with other individuals/residents
Your involvement in deciding on the activities in your centre
How often you leave your house
Your participation in the wider community outside of your centre?
What activities do you enjoy most in your centre?
What activities do you enjoy outside of your centre (for example, in the community)?
Are there any other activities that you’d like to take part in or are there any activities you would like to take part in more often?
Do you have you a care and support plan?
Would you like to include anything new in your plan?
TEAM MEMBERS
How happy are you that team members?
Know you and your likes and dislikes?
How happy are you with the supports you get from team members? ... when you are …
How happy are you with the supports you get from team members? … when you are …
Taking part in social or recreational activities inside your centre.
Taking part in activities outside your centre?
Encourage you to learn new skills.
Is there anything else you would like to say about the team members or Staff in your centre?
Who would you speak to if you were unhappy about something in your home?
Have you ever made a complaint about something in your centre?
Were you happy with the way your complaint was dealt with?
What was it about the way your complaint was dealt with that made you happy or unhappy?
If other, please specify:
How long have you or the individual/resident lived in the centre?
Name of person completing this form (Optional):
Is there anything else you want to tell us about your experience of the centre?
Would you like a Designated Safeguarding or Complaints Officer to contact you to discuss anything in this questionnaire?