PARTICIPANT SATISFACTION SURVEY

Dear Participant,

I would like to thank you for choosing our service to provide you supports. As part of our commitment to continually provide quality services we conduct satisfaction surveys on a regular basis and to assist us in

identifying areas that might need improvements. We value your feedbacks and comments.

Please go through each question and tick the appropriate box that indicates your response

Thank you for your time to complete this satisfaction survey.

Sincerely,

Dal

Chief Executive Officer (CEO)

1 - Staff respects my legal and human rights.

2 - Staff communicates with me about the provision of supports in response to my needs.

3 - Information is provided in the language, mode of communication and terms that I understand.

4 - I am supported to engage with my family, friends and chosen community as directed by me.

5 - I am supported to practice my culture, values and beliefs.

6 - Staff treats me with dignity and respect.

7 - Staff respects my privacy and confidentiality.

8 - It was explained to me of why my personal information is collected, how it is stored, how and when it is used for.

9 - Active decision-making and individual choice is supported by the service.

10 - I am supported on dignity of risk taking (i.e. supported to make informed choices about the benefits and risks of the options under consideration).

11 - My autonomy is respected, including their right to intimacy and sexual expressions.

12 - Sufficient time was provided to me to consider and review the risk taking options and seek advice if required, at any stage of support provision, including assessment, planning, provision, review and exit.

13 - I am supported to access advocacy service at any time I request for.

14 - There has been no incidents of abuse, violence, neglect, exploitation or discrimination towards me in this service.

15 - Staff is competent in what they do.

16 - I feel safe in this home.

17 - Staff listens to my feedback or complaint and act upon them within a reasonable timeframe that I am satisfied with.

18 - I was provided with information on how to make a comment or complaint internally and externally.

19 - The service provides information for me on how incident is managed within the service.

20 - My required supports are planned to meet my specific needs and preferences.

21 -Arrangements are in place to ensure support is provided to me without interruption.

22 -Where changes or interruptions are unavoidable, alternative arrangements are explained and agreed with me.

23 - Any access / entry criteria (including any associated costs) are clearly explained to me.

24 - I was supported to understand under what circumstances supports can be withdrawn.

25 - I understand I could choose who my worker be and if it is not practical there is alternative arrangement explained to me.

26 - My medication is managed efficiently.

27 - My clinical care is managed efficiently.

28 - Staff supports in managing my behaviour.

Additional comments you would like us to know:

If you would like us to contact you personally to discuss any of your responses and/ or other concerns that you might have please write your name down and tick the box indicating this.

Thank you for taking time completing the survey.

Yes, I would like someone to contact me to discuss my responses to the survey.

Participant/ guardian's full name (optional)

inclusionCHOICEtrustFRIENDSHIP

02 9454 7754

PARTICIPANT SATISFACTION SURVEY