Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.DateNameFirstLastYou are not required to complete the above information. You may complete your name or leave this blank if you wish to remain anonymous.1. Is the Service Safe? *Any equipment that the agency uses is well maintained *InadequateRequires ImprovementGoodOutstandingI feel confident that my belongings are safe and secure *InadequateRequires ImprovementGoodOutstandingI am involved in reviewing my medicines and supported to be as independent as possible *InadequateRequires ImprovementGoodOutstandingStaff give me my medicine according to the Care Plan and it is stored correctly and safely *InadequateRequires ImprovementGoodOutstandingI am involved in reviewing my medicines and supported to be as independent as possible *InadequateRequires ImprovementGoodOutstandingStaff have helped me know how to stay safe and how to raise any concerns *InadequateRequires ImprovementGoodOutstandingI feel safe and protected by staff, but also have as much freedom as possible to do the things I want to do *InadequateRequires ImprovementGoodOutstandingStaff protect my dignity and human rights and respect me as an individual *InadequateRequires ImprovementGoodOutstandingI feel protected from being bullied, harassed, harmed and abused *InadequateRequires ImprovementGoodOutstandingIf the person caring for me needs to change at short notice, I am told so that I know who to expect *InadequateRequires ImprovementGoodOutstandingStaff deal with incidents and accidents quickly and openly *InadequateRequires ImprovementGoodOutstanding2. Is the service Effective? *I am introduced to any staff who are going to provide my care *InadequateRequires ImprovementGoodOutstandingStaff have the right knowledge, qualifications and skills to carry out their role in providing me with the right care *InadequateRequires ImprovementGoodOutstandingI am always asked to give my consent (permission) to my care, treatment and support in a way I understand *InadequateRequires ImprovementGoodOutstandingWhen needed, my family and friends are also involved in decisions about my care *InadequateRequires ImprovementGoodOutstandingStaff take steps at the right time to make sure I stay in good health *InadequateRequires ImprovementGoodOutstandingStaff make sure I get the right food and drink I need and that I have enough of it *InadequateRequires ImprovementGoodOutstandingI am regularly asked for my views about the service I receive and my feedback is consistently good *InadequateRequires ImprovementGoodOutstanding3.Is the service Caring? *Staff know about my background, likes, hopes and needs *InadequateRequires ImprovementGoodOutstandingI am encouraged to express my views and I feel listened to *InadequateRequires ImprovementGoodOutstandingI have access to advocates (people who can speak on my behalf) *InadequateRequires ImprovementGoodOutstandingStaff treat me with dignity and respect. They have time to develop trusting relationships with me and are concerned for my wellbeing *InadequateRequires ImprovementGoodOutstanding4. Is the service Responsive? *My care, treatment and support are set out in writing and this tells staff what is needed to support me best *InadequateRequires ImprovementGoodOutstandingI am fully involved in decisions about my current and future care *InadequateRequires ImprovementGoodOutstandingII can choose who supports me and this includes being able to choose the gender of the person supporting me *InadequateRequires ImprovementGoodOutstandingMy Care Plan is changed as my needs change, and all those who need to know, such as other services, are kept up to date *InadequateRequires ImprovementGoodOutstandingMy Care Plan includes information about the whole of my life, including my goals, abilities and how I want to manage my health *InadequateRequires ImprovementGoodOutstandingIf I need to visit hospital or use another service, staff plan this with me to make sure it goes as smoothly as possible *InadequateRequires ImprovementGoodOutstandingIf I have any concerns and complaints, staff always take them seriously, investigate them thoroughly and respond to them in good time *InadequateRequires ImprovementGoodOutstanding5.Is the service Well-led? *Staff know what is expected of them and are happy in their work *InadequateRequires ImprovementGoodOutstandingStaff and managers work effectively with others who may be involved in caring for me, such as my local council *InadequateRequires ImprovementGoodOutstandingI am asked for my views on the wider service and I feel included in how things will be different *InadequateRequires ImprovementGoodOutstandingI am asked for my views on the wider service and I feel included in how things will be different (copy) *InadequateRequires ImprovementGoodOutstandingI am asked for my views on the wider service and I feel included in how things will be different (copy) (copy) *InadequateRequires ImprovementGoodOutstandingThe managers know what they need to do and are always honest, including when things go wrong *InadequateRequires ImprovementGoodOutstandingRespecting My Privacy *A member of staff helped me to complete this survey *YESNOI have been told that I can return this survey anonymously *YESNOI have been shown how to return this survey anonymously *YESNOI am satisfied that I can return this survey anonymously if I want to *YESNOCommentsSubmit