Home FEEDBACK FORM FEEDBACK FORM FEEDBACK FORM Asher Excellent Ltd homecare services Feedback Form Thank you for choosing Asher Excellent Ltd homecare services for your home care needs. We are committed to continuously enhancing the quality of our services, and your feedback through this brief survey would be greatly appreciated. 1. Which service(s) from Asher Excellent Ltd homecare services are you currently using, or have you used in the past? Hourly Care Livein Care Other (Please specify below) 2. Gender Identity: How do you identify your gender? Male Female Prefer not to say 3. Age: What is your age? 0-15 16-24 25-34 35-44 45-54 55-64 65-74 75-84 85+ 4. Ethnicity: What is your ethnic background? White Mixed/Multiple Ethnic groups Asian/Asian Black Black/African/Caribbean/Black British Other Prefer not to say 5. How did you hear about Asher Excellent Ltd Homecare services Homecare Services? 6. The CQC defines "Safe" as: “people are protected from abuse and avoidable harm.” Yes No Do you consider the services provided by Asher Excellent Ltd homecare services Homecare Services to be safe? Comments (Optional): 7. The CQC defines "Effective" as: “people’s care, treatment and support achieve good outcomes, promote a good quality of life and are evidence based where possible.” Yes No Do you consider the service provided by Asher Excellent Ltd homecare services to be effective? Comments (Optional): 8. The CQC defines "Caring" as: “staff involve people and treat people with compassion, kindness, dignity, and respect.” Yes No Do you consider the service provided by Asher Excellent Ltd homecare services to be caring? Comments (Optional): 9. The CQC defines "Responsive" as: “services are organised so that they meet people’s needs.” Yes No Do you consider the service provided by Asher Excellent Ltd homecare services to be responsive? Comments (Optional): 10. The CQC defines "Well-led" as: “the leadership, management, and governance of the organisation assure the delivery of high-quality person-centred care, support learning and innovation, and promote an open and fair culture.” Yes No Do you consider the service provided by Asher Excellent Ltd homecare services to be well led Comments (Optional): 11. Was the first assessment procedure understandable and informative? Yes No N/A 12. Were the carers aware of your choices and needs for care? Yes No Partially 13. On a scale of 1 to 5, please indicate how well you and the team communicate: Very Poor Poor Neutral Good Excellent 14. Did the carers regularly arrive on time for their arranged visits? Always Mostly Sometimes Rarely Never N/A 15. Did the caretakers treat you with dignity and pay attention to your needs? Yes, always Mostly Sometimes Rarely No, never 16. Please provide a score of 1 to 5 for the carers' professionalism and competence: Very Poor Poor Neutral Good Excellent 17. Were the carers following the prearranged care plan? Yes, always Mostly Sometimes Rarely No, never 18. Did you think your confidentiality and privacy were upheld? Yes No 19. Did the team help you with your questions or issues and respond to you promptly? Always Mostly Sometimes Rarely Never 20. Do you think others should use Asher Excellent Ltd homecare services Very Likely Likely Neutral Unlikely Very Unlikely 21. Based on your observations, how would you grade our overall performance? Excellent Very Good Adequate Needs Improvement Poor 22. Did we fulfil our promise to you? Yes No 23. If a colleague asked, "Would you recommend Asher Excellent Ltd homecare services?" Yes No Comments (Optional): 24. Do you have any further comments? 25. If you wish for your comments to be kept private or public, kindly indicate so by checking the following box: Yes No Optional) Completed by: Send Message
