PATIENT SATISFACTION SURVEY

Patient Name: Date:
Interviewer: Admission Date:

Please rate the questions below, in your opinion, from 1 – 5. One is the least satisfactory and five is the most satisfactory. Your feedback is valuable and allows Sudbury Pines to continue to improve while providing the best possible care. At your convenience please fill out the survey below and return it to the admissions office. Thank you for your time.

1. How satisfied were you with the admission process? 1 2 3 4 5
comments:

2. How satisfied are you with the comfort of your room? 1 2 3 4 5
comments:

3. How satisfied are you with Administration/Business Office
 in answering your needs? 1 2 3 4 5
comments:

4. How satisfied are you with the type of
activities that are offered?  1 2 3 4 5
comments:

5. How satisfied are you with the frequency of
activities offered?1 2 3 4 5
comments:

6. Are you satisfied that your spiritual needs are met? 1 2 3 4 5
comments:

7. How satisfied are you with the
care provided by your physician? 1 2 3 4 5
comments:

8. How satisfied are you with the care provided by your
nurse practitioner? 1 2 3 4 5
comments:

9. Are you satisfied with the level of information you received about
your medical condition? 1 2 3 4 5
comments:

10. Are you satisfied with the timeliness with which
your medications are given? 1 2 3 4 5
comments:

11. How satisfied are you with the licensed nursing staff? 1 2 3 4 5
comments:

12. How satisfied are you with your
pain management programs? 1 2 3 4 5
comments:

13. How satisfied are you with the assistance you
have received from your Social Worker? 1 2 3 4 5
comments:

14. How well do you understand your resident rights? 1 2 3 4 5
comments:

15. How satisfied are you with the explanation you
received regarding advance directives? 1 2 3 4 5
comments:

16. How satisfied are you with the
Resident Care Team Meeting? 1 2 3 4 5
comments:

17. How satisfied are you with the level of bedside care
you received from the nursing assistant(s)? 1 2 3 4 5
comments:

18. Do you feel that the nursing assistants treat you with
dignity and respect? 1 2 3 4 5
comments:

19. When you use your call light is it
answered in a timely manner? 1 2 3 4 5
comments:

20. How satisfied are you with the level of care delivered by the physical/occupational/speech therapy staff? 1 2 3 4 5
comments:

21. How satisfied are you with the quality of your meals? 1 2 3 4 5
comments:

22. How satisfied are you with the
temperature of your meals? 1 2 3 4 5
comments:

23. Are your meals delivered in a timely manner? 1 2 3 4 5
comments:

24. Are you satisfied with the variety of meals offered? 1 2 3 4 5
comments:

25. How satisfied are you with the housekeeping
services in the general building? 1 2 3 4 5
comments:

26. Are you satisfied with the cleanliness of
your room, bedside areas, and bathroom? 1 2 3 4 5
comments:

27. How satisfied are you with our
personal laundry services? 1 2 3 4 5
comments:

28. Are you satisfied with the quality of
bed linens, towels, etc., provided by the facility? 1 2 3 4 5
comments:

29. Do you feel that some of the services you
receive are already provided by another source? 1 2 3 4 5
comments:

30. If you indicated there was a problem,
how satisfied are you that the problem was resolved? 1 2 3 4 5
comments:

31. Do you feel that there is some other service
 that you require but are not currently receiving? 1 2 3 4 5
comments:
32. Would you recommend
Sudbury Pines Extended Care Facility to others? 1 2 3 4 5
comments:

33. What improvements could we make to make your stay more comfortable?


34. How did you hear about Sudbury Pines Extended Care Facility?