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Homecare-Questionaire

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Homecare-Questionaire Powered By Docstoc
					Homecare Questionnaire What is the name of your current homecare provider or agency? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Please tick one response for each question and comment where appropriate:Always Usually Are you ever asked to go without homecare support? Any comments? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. Do your care workers arrive and leave at the agreed time? Any comments? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. Do you feel you have a homecare service you can rely on? Any comments?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .................................................. Do you have sufficient notice if your homecare service is not going to be available? Any comments? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. Are your needs for a particular gender honoured? Any comments? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. Are you treated with respect and dignity by your carer? Any comments? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. Does your carer switch their mobile phone off when they are supporting you? Any comments? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..................................................
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Sometimes

Never

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Always Do you find your care plan is followed rigidly? Any comments? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. Does your care plan take into consideration your home circumstances and family needs? Any comments? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. If the carer doesn’t arrive within 15 minutes, are the on call services able to respond quickly to your needs? Any comments? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. Is the support you receive personalised enough to allow for variation? Any comments? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. Are your belongings treated in a way that you would chose and are they replaced in position? Any comments? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. Do you feel your belongings are secure? Any comments? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .................................................. Are you treated as an individual? Any comments? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..................................................

Usually

Sometimes

Never

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Always Do you receive a rota? Any comments? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ................. ................................ Do you receive continuity of carers? Any comments? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. Do you receive services in a way that observes your cultural needs? Any comments? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Do you receive services in a way that observes your religion? Any comments? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . How much notice do you have to give to have flexibility built into your package? Any comments? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. How often does someone ask you if your services meet your needs or whether they could be improved? Any comments? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. Do you know who to speak to if you are not happy with your homecare service? Any comments? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..

Usually

Sometimes

Never

Yes

No

Yes

No

Same day

Two days

A week

Never

3 monthly

6monthly

Annually

Never

Yes

No

Is there anything else you would like to tell us about home care services? .............................................................................................. ..............................................................................................
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About You Please tick the appropriate response:Gender Female  Male  25 – 34  35 – 44  45 – 54 55 – 64 65-74  75+

Age 18 – 24 

Ethnic origin White  British  Irish  Other White Background Mixed  White & Black  White & Black African  White & Asian  Other Mixed Background Postcode . . . . . . . . . . . . . . . . . . .

Black or Black British  Caribbean  African  Other Black Background

Asian or Asian British  Indian  Pakistani  Bangledeshi  Other Asian Background

Other Ethnic Group  Chinese  Any other Ethnic Group . . . . . . . . . . . . . . . . . . . . . .

Please state your disability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

We may wish to contact you to discuss your responses on your experiences of homecare services. If you are happy for us to do this, please give your name, address and contact number below:Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ....................................................................................... Contact telephone number . . . . . . . . . . . . . . . . . . . . .

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Tags: Homec, are-Q
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views:27
posted:11/29/2009
language:English
pages:4
Description: Homecare-Questionaire