Continuous Quality Improvement Plan
Stakeholder Satisfaction Survey

*Home / Program Evaluated *Please indicate if you are evaluating more than one home / program *Name and Title of Evaluator *Please note that your responses will be received by the quality enhancement coordinator and not the home. The home will receive only the general results of the survey. Please rate the following items based on the factors of professionalism, effectiveness, and person-centered orientation: 1 - Overall quality of services received by persons served Excellent Good Fair Poor Unknown Not Applicable 2 - Quality of the implementation of personal plans Excellent Good Fair Poor Unknown Not Applicable 3 - Quality of health and safety experienced by persons served Excellent Good Fair Poor Unknown Not Applicable 4 - Adequacy of staffing to meet the needs of the persons served Excellent Good Fair Poor Unknown Not Applicable 5 - Assistance with the vocational or educational needs of the persons served Excellent Good Fair Poor Unknown Not Applicable 6 - Skill of the direct care staff Excellent Good Fair Poor Unknown Not Applicable 7 - Skill of management Excellent Good Fair Poor Unknown Not Applicable 8 - Efficiency of program functioning (i.e., effective utilization of resources) Excellent Good Fair Poor Unknown Not Applicable 9 - Timeliness of returned phone calls, documentation, etc. Excellent Good Fair Poor Unknown Not Applicable 10 - Overall physical appearance of the particular setting(s). Excellent Good Fair Poor Unknown Not Applicable 11 - Overall satisfaction of persons served Excellent Good Fair Poor Unknown Not Applicable 12 - Overall empowerment of persons served Excellent Good Fair Poor Unknown Not Applicable 13 - Overall impressions of our adherence to ethics in business & service Excellent Good Fair Poor Unknown Not Applicable clearsend