Support Staff Survey – Valley Residential Services

Support Staff Survey

Valley Residential Services is committed to providing the best services possible for the people we serve. Thank you in advance for your time!

Home(Required)

Resident Initials(Required)

Please fill in the home and the initials (no full names) of the resident you are completing the survey for. A survey should be completed for each resident to whom you provide supports.

1. Availability of management staff(Required)

Please explain why you chose this rating(Required)

2. Home staff demonstrate ability to implement written programs(Required)

Please explain why you chose this rating(Required)

3. Information (data) is available upon visiting the home(Required)

Please explain why you chose this rating(Required)

4. Physical appearance of the residents (neat, clean, appropriately dressed)(Required)

Please explain why you chose this rating(Required)

5. Resident's daily notes are informative, documentation clear and understandable(Required)

Please explain why you chose this rating(Required)

6. Home fulfills reasonable requests and recommendations in a timely manner(Required)

Please explain why you chose this rating(Required)

7. I am invited by management to in-service at staff meetings(Required)

Please explain why you chose this rating(Required)

8. Physical appearance of the home (neat, clean, free of offensive odors)(Required)

Please explain why you chose this rating(Required)

9. I am made to feel comfortable when I visit the home(Required)

Please explain why you chose this option(Required)

10. The home provides a safe environment(Required)

Please explain why you chose this rating(Required)

11. The home promotes Home and Community Based Services (HCBS) Standards and Gentle Teaching(Required)

Please explain why you chose this rating(Required)

12. The home addresses resident's specific cultural needs(Required)

Please explain why you chose this rating(Required)

13. The home accommodates choices in daily living (including daily routine, meals, outings)(Required)

Please explain why you chose this rating(Required)

14. Additional recommendations/comments:

Optional

Name of person completing survey

Optional

Contact Information

Optional. If you would like a copy of our Annual Outcomes Management Report, please fill out your name and email address in the space provided. The report is an overview of the services we’ve provided and our goals for the future. Thank you.