skilled nursing - my innerview inc · 7 common areas are arranged to encourage residents to...

Skilled Nursing Resident Drill Down Surveys

© 7/6/10, My InnerView | ALL RIGHTS RESERVED | No part of this work, including survey items or design, may be reproduced, displayed,distributed, modified or transmitted in any form or by any means without the express written permission of My InnerView.

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ITEM NUMBER/LABEL ORIGINAL SURVEY STATEMENT

23 Overall satisfaction How would you rate your overall satisfaction with this facility?24 Recommendation to others What is your recommendation of this facility to others?

Rate this facility on ...1 Choices/preferences Meeting your choices and preferences2 Respectfulness of staff The respect shown to you by staff3 Respect for privacy Meeting your need for privacy4 Resident-to-resident friendships Offering you opportunities for friendships with other residents5 Resident-to-staff friendships Offering you opportunities for friendships with staff6 Meaningfulness of activities Offering you meaningful activities7 Religious/spiritual opportunities Meeting your religious and spiritual needs

17 Safety of facility How safe it is for you18 Security of personal belongings The security of your personal belongings21 Quality of dining experience How enjoyable your dining experience is

Rate this facility on ...8 RN/LVN/LPN care The quality of care provided by the nurses (RNs/LVNs/LPNs)9 CNA/NA care The quality of care provided by the nursing assistants (CNAs/NAs)

10 Rehabilitation therapy The quality of rehabilitation therapy (occupational, physical, speech)11 Adequate staff to meet needs Providing an adequate number of nursing staff to meet care needs12 Attention to resident grooming Meeting your grooming needs13 Commitment to family updates Keeping you and your family informed about you14 Competency of staff The competency of staff15 Care (concern) of staff The staff's care and concern for you

Rate this facility on ...16 Responsiveness of management Management's responsiveness to your suggestions and concerns19 Cleanliness of premises The cleanliness of your room and surroundings20 Quality of meals The quality of the meals22 Quality of laundry services The quality of laundry services

25 Length of stay How long have you lived at this facility?26 Person visiting most Who visits you most often?27 How often visited How often does this person visit you?28 Homes visited How many nursing homes did you (or your family) visit

before choosing this facility?29 Reason for choosing What is the most important reason you (or your family)

chose this facility?30 Gender of resident What is your gender?31 Age of resident What is your age?32 Assistance with survey How is this survey being completed?

Skilled nursing resident satisfaction survey reference

GLOBAL SATISFACTION DOMAIN

QUALITY OF LIFE DOMAIN

QUALITY OF CARE DOMAIN

QUALITY OF SERVICE DOMAIN

DEMOGRAPHICS AND BACKGROUND INFORMATION

© 1/7/09, My InnerView • Reproduction or duplication requires written permission from My InnerView (715) 848-2713

%Facility_Full%

Recently, we asked our residents and family members tocomplete a satisfaction survey. Respondents saidthat we have an opportunity to improve our performance inmeeting your choices and preferences.

To better understand what we could do to meet your needs,we are asking you to complete this brief survey. Your inputwill assist us in finding the best solutions possible.

1 Staff make effort to learn about your personal habits and way of life (for example: past experiences, needs, wishes, preferences).

EXCELLENT GOOD FAIR POOR

Instructions: Please fill in the circle thatbest corresponds to how you would rate thisfacility in the following areas. Mark only onecircle for each statement. If a statementdoes not apply to your situation, rate thefacility based on your opinion in general.

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© May 2010, My InnerView SN/R/1

Form DDSN/R/1- %Facility_ID% %Survey_Run_ID% %Surveyee_ID%

3 Staff know many of your personal preferences, routines, likes and dislikes.

4 Staff usually try to accommodate your personal preferences, routines, likes and dislikes.

5 You can decide when to sleep or wake up.

2 Care plans consider your personal habits and way of life.

6 You can choose when and how often to bathe, shower or be given a bed bath.

9 You can personalize your living environment.

7 You can choose when, where and with whom to have meals.

8 You are given opportunity to choose what to wear.

10 Overall, you are satisfied with the way your personal choices are met.

THANK YOU FOR YOUR FEEDBACK!

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Recently, we asked our residents and family members tocomplete a satisfaction survey. Respondents said that wehave an opportunity to improve the respectfulness ofour staff.


1 Staff are appropriately quiet and respectful when doing their work.



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3 Staff are sensitive when handling your personal and intimate items.

5 Staff take your complaints seriously.

9 Staff do not discuss your private information in the presence of others.


2 Staff respond with genuine concern when you seek attention.

4 Staff honor your confidences.

6 Staff do not “talk down” or patronize you.

7 Staff address you by your name of choice.

8 Staff respect your personal space.

10 Overall, staff show genuine respect and treat you with dignity.

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7 Steps are taken to prevent intrusion by other residents.

%Facility_Full%

Recently, we asked our residents and family members tocomplete a satisfaction survey. Respondents said that wehave an opportunity to improve our respect for privacy.


1 Staff do not discuss your health, financial or social condition inappropriately or in presence of others.



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2 Staff protect privacy and modesty when giving you a bath (or shower) and personal care.

3 You can visit with family members and friends in private.

5 You can make telephone calls in private.

4 You can visit with other residents in private.

6 Staff do not handle or rearrange your belongings unless requested to do so.

9 Staff are respectful of your personal space.

8 Staff knock or request permission before entering your room.

10 Overall, your need for privacy is met.


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7 Common areas are arranged to encourage residents to socialize.

%Facility_Full%

Recently, we asked our residents and family members tocomplete a satisfaction survey. Respondents said that wehave an opportunity to improve resident friendships withother residents.


1 Facility settings are conducive for you to visit, socialize and dine with other residents.



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2 You may choose with whom to eat.

3 Staff try to accommodate your preference in selecting and changing roommates.

5 You were introduced to other residents soon after admission.

4 Staff try to introduce residents to others with similar interests.

6 Ethnic, cultural, national and religious events are celebrated.

9 You are encouraged to participate in activities with other residents with similar interests.

8 Social activities are arranged to encourage residents to mingle and interact with each other.

10 Overall, opportunities are offered to foster mutual friendships among residents.


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7 On a routine basis, the same staff members care for you.

%Facility_Full%

Recently, we asked our residents and family members tocomplete a satisfaction survey. Respondents said that wehave an opportunity to improve your friendships with staff.


1 Staff interact with you in friendly and caring manner.



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2 Knowing your history and achievements, staff engage you in meaningful conversation.

3 Staff take time to visit and chat with you.

5 Events and activities are planned to encourage residents and staff to attend together.

6 There is a sense of community among staff, residents and families.

9 Staff relate warmly to residents.

8 Staff have a genuine care and concern for residents.


4 Staff greet you by your name of choice.

10 Overall, residents and staff genuinely care about each other.

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9 Staff escort you, if needed, to and from activities and events.

7 You have opportunity to engage in activities outside facility.

%Facility_Full%

Recently, we asked our residents and family members tocomplete a satisfaction survey. Respondents said that wehave an opportunity to improve our performance in providingmeaningful activities.


1 Activities are offered to meet your preferences.



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2 Activities are offered in the evening.

3 Activities are offered on the weekend.

5 You have opportunity to experience the outdoors.

6 You have opportunity for self expression (for example: cultivating a garden, cooking, painting, playing an instrument).


4 Intellectual activities and growth are fostered (for example: with books in large print, internet access, lectures).

8 Recreational equipment and supplies meet your needs.

10 Overall, activities are meaningful and enjoyable.

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9 Religious services are held in a quiet and conducive environment.

7 You have opportunity and assistance, if needed, to attend church services outside the facility.

%Facility_Full%

Recently, we asked our residents and family members tocomplete a satisfaction survey. Respondents said that wehave an opportunity to improve our performance inmeeting your religious and spiritual needs.


1 You can participate in religious and church services of choice.



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2 You have access to minister, rabbi or priest of choice.

3 You can get spiritual help when needed.

4 Staff are attuned to your religious needs.

5 You have opportunity to share personal religious and spiritual beliefs.

6 You have opportunity and appropriate setting to pray or practice your religion in private.


8 Staff are aware of and sensitive to the rituals of various religions.

10 Overall, your religious and spiritual needs are known and met.

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9 Nurses provide you with compassionate care.

7 Nurses know you well enough to be able to answer questions from family members.

%Facility_Full%

Recently, we asked our residents and family members tocomplete a satisfaction survey. Respondents said that wehave an opportunity to improve care provided by thenurses (RNs/LVNs/LPNs).


1 Nursing care is given with skill.



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2 Nurses encourage family to participate in the plan of care.

3 Nurses are knowledgeable regarding your health needs.

4 Nurses follow physician’s orders when delivering care.

5 Nurses inform your family members of any change in your condition.

6 Nurses give guidance to nursing assistants and other caregivers.

8 Nurses assess your discomfort and pain and take appropriate measures to provide relief.

10 Overall, nurses are well trained, competent and skilled.


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9 You can get the care and assistance you need without having to wait a long time.

%Facility_Full%

Recently, we asked our residents and family members tocomplete a satisfaction survey. Respondents said that wehave an opportunity to improve care provided by nursingassistants (CNAs/NAs).


1 Nursing assistants are well informed about your personal preferences, routines, likes and dislikes.



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2 Nursing assistants are well informed about your condition.

3 You receive necessary assistance with grooming, dressing and personal hygiene.

7 You are clean and well groomed.

4 You receive necessary assistance with eating.

5 Nursing assistants care for you with kindness and concern.

6 Nursing assistants are patient when working with you.

8 Nursing assistants understand your individual needs.

10 Overall, nursing assistants provide good care to you.


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9 Family members are kept informed of changes in therapy plan.

%Facility_Full%

Recently, we asked our residents and family members tocomplete a satisfaction survey. Respondents said that wehave an opportunity to improve our performance in providingrehabilitation therapy.


1 Therapy program accommodates your wishes and preferences.



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2 You have opportunity to participate in planning your therapy program.

3 Therapy program has been explained to you and your family members.

4 Therapy area is clean and well maintained.

5 Therapists are respectful toward you.

6 Your therapy goals are clearly communicated to you and your family members.

8 You are kept informed of changes in therapy plan.

7 Therapists’ plan of care incorporates your wishes.

10 Overall, therapy program meets your needs.


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9 Family members can easily identify staff by their attire, name tags and other means of identification.

%Facility_Full%

Recently, we asked our residents and family members tocomplete a satisfaction survey. Respondents said that wehave an opportunity to improve our performance in staffing.


1 Staff have adequate equipment and supplies to provide care.



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2 Adequate staff are available on weekends.

3 Adequate staff are available during the week.

4 Adequate staff are available on all shifts.

5 Call lights are answered in a reasonable amount of time.

6 Staff convey in word and action that staffing levels are adequate for them to do their job well.

7 Family concerns get prompt attention.

8 Telephone calls from family members are answered promptly.

10 Overall, there are adequate staff to meet your needs.


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%Facility_Full%

Recently, we asked our residents and family members tocomplete a satisfaction survey. Respondents said that wehave an opportunity to improve our performance inresident grooming.


1 You are bathed or showered at the times you desire.



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2 You are shaved (or have facial hair removed) as desired.

3 The beauty parlor and/or barber services meet your needs.

5 You are dressed in a manner appropriate to the condition or situation (for example: going to therapy, on an outing or to the dining room).

6 Staff do a good job assisting you with oral hygiene.

4 Your clothing is clean and in good repair.

7 Your fingernails are clean and trimmed.

8 Your toenails are clean and trimmed.

9 Your hair is clean and combed.

10 Overall, you are clean and well groomed.

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7 Nurses are available to answer questions about you.

9 Facility maintains accurate and updated family contact information.

%Facility_Full%

Recently, we asked our residents and family members tocomplete a satisfaction survey. Respondents said that wehave an opportunity to improve our performance inkeeping you and your family informed.


1 During admission, you and your family members were made aware of what to expect from the facility.



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2 Family members are informed in a timely manner about things that matter to you (for example: change in your condition, an emergency or hospitalization).

3 Family members’ calls to the facility are returned in a timely manner.

5 Staff help you and your family members with questions about bills for services received.

6 You and your family members are kept informed of changes in facility policy, fee schedules, facility events, etc.

4 Billing is clear and understandable.

8 You and your family members are invited to participate in care plans.

10 Overall, family members are kept involved in and informed about your care.


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9 Staff know your physical diagnoses.

%Facility_Full%

Recently, we asked our residents and family members tocomplete a satisfaction survey. Respondents said that wehave an opportunity to improve the competency of staff.


1 Staff have the necessary skills to do a good job.



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2 Staff are capable of handling emergency situations.

3 Staff are skilled to handle your physical needs.

4 Staff are skilled to handle your medical needs.

5 Staff know how to calm a resident who is upset.

6 Staff know how to care for a resident with dementia.

7 Staff are able to accurately respond to care-related questions.

8 Staff take action when problems are identified.

10 Overall, staff provide you with competent care.


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9 Staff take the time to listen to you to understand your needs.

%Facility_Full%

Recently, we asked our residents and family members tocomplete a satisfaction survey. Respondents said that wehave an opportunity to improve staff’s care and concernfor residents.


1 Staff respond to call lights with a friendly and willing attitude.



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2 The highest priority for staff is taking care of their residents.

3 Caregivers are available when needed.

4 The facility has very devoted caregivers.

5 Staff spend time with you.

6 Staff show a personal concern for you.

7 Staff go out of their way to be kind to you.

8 Staff are respectful of your wisdom and life experiences.

10 Overall, staff show genuine care and concern for you.


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9 Concerns are addressed in a timely manner.

%Facility_Full%

Recently, we asked our residents and family members tocomplete a satisfaction survey. Respondents said that wehave an opportunity to improve the responsiveness ofmanagement.


1 Administrator is accessible to you.



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2 Director of nursing is accessible to you.

3 Administrator truly listens to your concerns.

4 Director of nursing truly listens to your concerns.

5 Administrator makes an effort to address your concerns.

6 Managers show by example that they place the highest value on the quality of care and service.

7 Administrator returns family members’ phone calls in a timely manner.

8 Staff members convey to management the issues or concerns you express.

10 Overall, managers show genuine concern and care for you and your family members.


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%Facility_Full%

Recently, we asked our residents and family members tocomplete a satisfaction survey. Respondents said that wehave an opportunity to improve the safety of the facility.


1 Equipment (for example: elevators, beds, tubs, wheelchairs) is properly maintained and in safe working condition.



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2 You and your family members have been educated about the facility’s emergency and disaster plan.

3 Interior layout and furnishings of the home (for example: lighting, floors, furniture, doors) are conducive to minimizing accidents and injuries.

4 Exterior of facility (for example: walkways, gardens, parking lot, entrances) contribute to a safe environment.


9 The building and grounds are monitored to ensure security of the premises.

5 Systems are in place to minimize the risk of residents wandering.

6 Systems are in place to minimize the risk of residents falling.

10 Overall, the facility has taken steps to ensure your safety.

7 Needed repairs are made in a timely manner.

8 Steps are taken to minimize your exposure to mental, physical and verbal abuse.

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%Facility_Full%

Recently, we asked our residents and family members tocomplete a satisfaction survey. Respondents said that wehave an opportunity to improve the security of personalbelongings.


1 Locked storage is available to you.



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2 Your belongings are rarely lost.

3 Staff respond in a timely manner to concerns about missing items.

4 Reports of missing items are adequately investigated.


9 Family members are notified when an important item is lost or damaged.

5 Staff ask before rearranging or handling your personal belongings.

6 Steps are taken to prevent confused residents from taking what belongs to others.

7 During care giving, staff are careful to avoid losing your personal items (for example: dentures, razors, cosmetics).

8 Staff take care to avoid breaking or damaging your personal items.

10 Overall, the facility ensures that your personal items are secure.

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9 The grounds are well groomed and maintained.

%Facility_Full%

Recently, we asked our residents and family members tocomplete a satisfaction survey. Respondents said that wehave an opportunity to improve the cleanliness ofresidents’ rooms and surroundings.


1 Furniture in your room is clean and well maintained.



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2 Your bathroom is clean and well maintained.

3 Room accessories (for example: draperies, bedspreads) are clean and in good condition.

4 The floor in your room is clean and odor free.


5 Floors in the common living areas are clean and odor free.

6 Furnishings in the common living areas are clean and well maintained.

7 Repairs to items in common use are promptly made.

10 Overall, rooms and common areas are clean, well maintained and attractive.

8 Common living areas are free of offensive odors and noise.

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9 Your food preferences are recognized and honored.

10 Overall, the quality of food is satisfactory.


%Facility_Full%

Recently, we asked our residents and family members tocomplete a satisfaction survey. Respondents said that wehave an opportunity to improve the quality of meals.


1 Food is tasty.



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2 Menus offer variety in meals.

3 Food is appetizing even when dietary restrictions are addressed.

4 Food is sufficient to meet your needs.

5 Food is presented in an attractive manner.

6 Alternative food choices are offered when the meal served does not appeal to you.

7 Snacks are available to you upon request.

8 Food is served at a proper temperature (cold, warm, hot).

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%Facility_Full%

Recently, we asked our residents and family members tocomplete a satisfaction survey. Respondents said that wehave an opportunity to improve the quality of the diningexperience.


1 Food is presented in an appetizing manner.



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2 Tables are set in an appealing manner.

3 Meals are offered in an inviting social setting.

4 Dining room arrangements help those in wheelchairs to eat in a dignified manner.

5 You receive necessary assistance with eating.

6 Atmosphere in dining room is peaceful.

7 Staff helps you with feeding without compromising your dignity.

8 You have choice in seating arrangement.

9 You can choose mealtime.

10 Overall, dining is a pleasant experience.

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9 Family members are informed when your clothing needs to be mended or replaced.

%Facility_Full%

Recently, we asked our residents and family members tocomplete a satisfaction survey. Respondents said that wehave an opportunity to improve the quality of laundryservices.


1 Personal laundry is rarely lost.



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2 Supply of fresh linen is adequate for your care.

3 Laundry is returned in a timely fashion.

4 Your clothing is rarely damaged, shrunk, torn or stained.

8 You do not get clothing and personal items belonging to another resident.

5 Your clothing is returned unwrinkled and ready to be worn.

6 Staff handle your clothing and apparel with proper care.

7 Staff are sensitive in handling your personal and intimate clothing.

10 Overall, the quality of laundry services is satisfactory.


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skilled nursing - my innerview inc · 7 common areas are arranged to encourage residents to...

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