Family & Guardian Questionnaire

This questionnaire is designed to help us assess the quality of our services and to identify areas in which we need to improve.

 
Home/Location where your family member lives:
   

Living Environment
Is the home/apartment well-maintained?
Is the home/apartment clean?
Is the home/apartment safe?
Rate your family member’s relationship
with housemates.
Is the home/apartment a good place to live?
Is the home pleasant and nicely decorated?

Comments relating to the living environment:

Resident Life
Are your family member’s rights respected?
Is your family member treated with dignity?
Is RSI attentive to medical issues?
Are you satisfied with the social/
recreational opportunities provided by RSI?
Is your family member’s diet appropriate?
Does your family member have the right
amount of control over his/her money?
Does RSI provide your family member with
the correct amount of control over his/her life?
Does your family member participate in the
activities of the home/apartments?
Are the house rules fair?
Are the household chores appropriate?
Is your family member’s clothing properly
cared for?
Are other personal possessions properly
cared for?
How satisfied are you with day services
(work, school, day programs)?

Comments relating to resident life

Staff Members
How well do staff members communicate
with you?
How responsive are staff members to your
requests?
How attentive are staff members to your
family member’s needs?
Are staff members pleasant, approachable,
and polite to you and your family member?
How well do staff members teach new
skills?
How would you rate staff members overall?

Comments relating to staff members

Management
   
Is RSI moving in the right direction?
How would you rate your relationship with RSI?

In what area(s) would you like to see RSI focus in the future?
Would you prefer to network with:
Would you be interested in joining a Family Group? 
Would you be interested in hosting or leading a Family Group? 

Comments relating to management:
If you would like to receive feedback regarding your responses, please provide us with your name:

Thank you for your feedback!