Valley View Home Resident Post Discharge Satisfaction Survey
Resident Care
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Please Rate the level of service in each area. Your input is important to us.

1.

Please rate the experience you have had with our Certified Nurses Aides.

Extremely Dissatisfied [1]Very Dissatisfied [2]Somewhat Dissatisfied [3]Somewhat Satisfied [4]Very Satisfied [5]Extremely Satsfied [6]
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2.

Please rate the service you received from our Nurses.

Extremely Dissatisfied [1]Very Dissatisfied [2]Somewhat Dissatisfied [3]Somewhat Satisfied [4]Very Satisfied [5]Extremely Satisfied [6]
1

3.

If applicable please rate the services you received from our Physical Therapy and Occupational Therapy dept.

Extremely Dissatisfied [1]Very Dissatisfied [2]Somewhat Dissatisfied [3]Somewhat Satisfied [4]Very Satisfied [5]Extremely Satisfied [6]
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4.

Please rate how well we involved you in your plan of care? (Were you invited to care plan conferences and/or kept abreast of your condition or needs?)

Extremely Dissatisfied [1]Very Dissatisfied [2]Somewhat Dissatisfied [3]Somewhat Satisfied [4]Very Satisfied [5]Extremely Satisfied [6]
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5.

Please rate our Activity Department Performance and how you felt they met your needs.

Extremely Dissatisfied [1]Very Dissatisfied [2]Somewhat Dissatisfied [3]Somewhat Satisfied [4]Very Satisfied [5]Extremely Satisfied [6]
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6.

Please rate how you feel our Social Service Department met your needs. (This includes handling lost items, grievances, social service needs or questions you may have had.)

Extremely Dissatisfied [1]Very Dissatisfied [2]Somewhat Dissatisfied [3]Somewhat Satisfied [4]Very Satisfied [5]Extremely Satisfied [6]
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