Annual Quality Assurance Form

Date *

How did you hear about us?

Friend or colleague

Radio / TV

Social Media

Other

Do you feel involved in the decisions that are made regarding your care?

Do you feel your needs are met as requested?

Do you feel you are kept informed about the service you are receiving?

Does your carer arrive at the time you are expecting ? *

If not are you informed by the office of the change in time?

Does the carer complete the tasks they are expected to do?

Are the carers well presented?

Do you feel the carers are well trained?

Do you feel your privacy and dignity is respected when assistance is given?

If you contact the office is your call answered promptly and with courtesy?

Is the person in the office familiar with your care and able to answer your queries?

If you are told we will ring you back do we?

Have you ever had cause to use the Complaints Procedure? If so was your complaint handled promptly and was the outcome acceptable?

.Do you know where to find our written Complaints Procedure?

Have you received a copy of our Service User Guide?

Did you find the information easy to read and understand?

Have you had reason to access the on-call emergency service line?

Was the called handled efficiently?

Any other comments?

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