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Resident Satisfaction Survey
Resident Satisfaction Survey
Please enable JavaScript in your browser to complete this form.
–
Step
1
of 5
Gender
Male
Female
Transgender
Current Age
10-17
18-21
Race
White
African American
Hispanic
Asian
Native American
Indian
Other
Race
How long have you lived at HOC?
Less than 3 months
3, 4, or 5 months
6, 7, or 8 months
9, 10, or 11 months
1 year to 2 years
Greater than 2 years
This survey was completed with help from:
Help from No One
Help from staff member
Help with friend
Help from Family Member
Next
Access/Admission/Orientation
1. I was accepted at HOC and did intake in a reasonable amount of time.
*
Strongly Disagree
Disagree
Agree
Strongly Agree
Don't know; does not apply
Strongly Disagree
Disagree
Agree
Strongly Agree
Don't know; does not apply
2. The staff who did my intake was knowledgeable and professional.
*
Strongly Disagree
Disagree
Agree
Strongly Agree
Don't know; does not apply
Item #1 Strongly Disagree
Item #1 Disagree
Item #1 Agree
Item #1 Strongly Agree
Item #1 Don't know; does not apply
3. The Mission, Values, and Goals of the HOC Program were explained to me.
*
Strongly Disagree
Disagree
Agree
Strongly Agree
Don't know; does not apply
Item #1 Strongly Disagree
Item #1 Disagree
Item #1 Agree
Item #1 Strongly Agree
Item #1 Don't know; does not apply
Input from Residents
1. People who work at HOC seem interested in my progress and services provided.
*
Strongly Disagree
Disagree
Agree
Strongly Agree
Don't know; does not apply
Item #1 Strongly Disagree
Item #1 Disagree
Item #1 Agree
Item #1 Strongly Agree
Item #1 Don't know; does not apply
2. I am encouraged to give my opinion about my treatment, the staff, as well as the program and services.
*
Strongly Disagree
Disagree
Agree
Strongly Agree
Don't know; does not apply
Item #1 Strongly Disagree
Item #1 Disagree
Item #1 Agree
Item #1 Strongly Agree
Item #1 Don't know; does not apply
3. There are several different ways I can give feedback about the HOC program
*
Strongly Disagree
Disagree
Agree
Strongly Agree
Don't know; does not apply
Item #1 Strongly Disagree
Item #1 Disagree
Item #1 Agree
Item #1 Strongly Agree
Item #1 Don't know; does not apply
Rights and Responsibilities
1. I am treated with dignity and respect at HOC.
*
Strongly Disagree
Disagree
Agree
Strongly Agree
Don't know; does not apply
Item #1 Strongly Disagree
Item #1 Disagree
Item #1 Agree
Item #1 Strongly Agree
Item #1 Don't know; does not apply
2. My rights and responsibilities were clearly explained to me during intake and I was offered a copy for my records.
*
Strongly Disagree
Disagree
Agree
Strongly Agree
Don't know; does not apply
Item #1 Strongly Disagree
Item #1 Disagree
Item #1 Agree
Item #1 Strongly Agree
Item #1 Don't know; does not apply
3. If something happens that I don’t like or I feel like my rights have been violated, I know how to file a complaint.
*
Strongly Disagree
Disagree
Agree
Strongly Agree
Don't know; does not apply
Item #1 Strongly Disagree
Item #1 Disagree
Item #1 Agree
Item #1 Strongly Agree
Item #1 Don't know; does not apply
5. My rights for privacy and confidentiality were explained to me.
*
Strongly Disagree
Disagree
Agree
Strongly Agree
Don't know; does not apply
Item #1 Strongly Disagree
Item #1 Disagree
Item #1 Agree
Item #1 Strongly Agree
Item #1 Don't know; does not apply
Next
The Assessment Process
1. My needs were identified and discussed with an educated and respectful staff member.
*
Strongly Disagree
Disagree
Agree
Strongly Agree
Don't know; does not apply
Item #1 Strongly Disagree
Item #1 Disagree
Item #1 Agree
Item #1 Strongly Agree
Item #1 Don't know; does not apply
2. I felt heard, listened to, and safe when disclosing my reasons for being in residential care.
*
Strongly Disagree
Disagree
Agree
Strongly Agree
Don't know; does not apply
Item #1 Strongly Disagree
Item #1 Disagree
Item #1 Agree
Item #1 Strongly Agree
Item #1 Don't know; does not apply
3. I understand why I am asked questions about my history, goals, and preferences.
*
Strongly Disagree
Disagree
Agree
Strongly Agree
Don't know; does not apply
Item #1 Strongly Disagree
Item #1 Disagree
Item #1 Agree
Item #1 Strongly Agree
Item #1 Don't know; does not apply
4. I felt respected when sharing my history and developing a plan for services.
*
Strongly Disagree
Disagree
Agree
Strongly Agree
Don't know; does not apply
Item #1 Strongly Disagree
Item #1 Disagree
Item #1 Agree
Item #1 Strongly Agree
Item #1 Don't know; does not apply
Treatment Planning
1. I participated in the development of my treatment plan.
*
Strongly Disagree
Disagree
Agree
Strongly Agree
Don't know; does not apply
Item #1 Strongly Disagree
Item #1 Disagree
Item #1 Agree
Item #1 Strongly Agree
Item #1 Don't know; does not apply
2. I have a copy of my treatment plan or was offered a copy.
*
Strongly Disagree
Disagree
Agree
Strongly Agree
Don't know; does not apply
Item #1 Strongly Disagree
Item #1 Disagree
Item #1 Agree
Item #1 Strongly Agree
Item #1 Don't know; does not apply
3. My treatment plan is changed or updated when things change or at my request.
*
Strongly Disagree
Disagree
Agree
Strongly Agree
Don't know; does not apply
Item #1 Strongly Disagree
Item #1 Disagree
Item #1 Agree
Item #1 Strongly Agree
Item #1 Don't know; does not apply
Quality of Care
1. The staff seem educated and experienced when providing care.
*
Strongly Disagree
Disagree
Agree
Strongly Agree
Don't know; does not apply
Item #1 Strongly Disagree
Item #1 Disagree
Item #1 Agree
Item #1 Strongly Agree
Item #1 Don't know; does not apply
2. The environment and energy of the facility felt welcoming, professional, private, and safe.
*
Strongly Disagree
Disagree
Agree
Strongly Agree
Don't know; does not apply
Item #1 Strongly Disagree
Item #1 Disagree
Item #1 Agree
Item #1 Strongly Agree
Item #1 Don't know; does not apply
3. I am encouraged to include family and/or my other support systems when engaging in services.
*
Strongly Disagree
Disagree
Agree
Strongly Agree
Don't know; does not apply
Item #1 Strongly Disagree
Item #1 Disagree
Item #1 Agree
Item #1 Strongly Agree
Item #1 Don't know; does not apply
Next
Quality of Life
1. My overall Quality of Life has improved since beginning services at HOC.
*
Strongly Disagree
Disagree
Agree
Strongly Agree
Don't know; does not apply
Item #1 Strongly Disagree
Item #1 Disagree
Item #1 Agree
Item #1 Strongly Agree
Item #1 Don't know; does not apply
2. I am doing better in school, work, and/or other daily activities.
*
Strongly Disagree
Disagree
Agree
Strongly Agree
Don't know; does not apply
Item #1 Strongly Disagree
Item #1 Disagree
Item #1 Agree
Item #1 Strongly Agree
Item #1 Don't know; does not apply
3. My personal relationships, family relationships, and/or support system dynamic has improved since coming to HOC.
*
Strongly Disagree
Disagree
Agree
Strongly Agree
Don't know; does not apply
Item #1 Strongly Disagree
Item #1 Disagree
Item #1 Agree
Item #1 Strongly Agree
Item #1 Don't know; does not apply
4. My social interaction is healthier and I feel more confident with my life situations.
*
Strongly Disagree
Disagree
Agree
Strongly Agree
Don't know; does not apply
Item #1 Strongly Disagree
Item #1 Disagree
Item #1 Agree
Item #1 Strongly Agree
Item #1 Don't know; does not apply
5. I am more self-aware and better at managing my Mental Health needs.
*
Strongly Disagree
Disagree
Agree
Strongly Agree
Don't know; does not apply
Item #1 Strongly Disagree
Item #1 Disagree
Item #1 Agree
Item #1 Strongly Agree
Item #1 Don't know; does not apply
Cultural Competency
1. My religious or spiritual beliefs and/or practices are respected at HOC.
*
Strongly Disagree
Disagree
Agree
Strongly Agree
Don't know; does not apply
Item #1 Strongly Disagree
Item #1 Disagree
Item #1 Agree
Item #1 Strongly Agree
Item #1 Don't know; does not apply
2. The staff has a professional understanding of my educational, social, and family background.
*
Strongly Disagree
Disagree
Agree
Strongly Agree
Don't know; does not apply
Item #1 Strongly Disagree
Item #1 Disagree
Item #1 Agree
Item #1 Strongly Agree
Item #1 Don't know; does not apply
3. I can easily understand the staff when they are speaking to me.
*
Strongly Disagree
Disagree
Agree
Strongly Agree
Don't know; does not apply
Item #1 Strongly Disagree
Item #1 Disagree
Item #1 Agree
Item #1 Strongly Agree
Item #1 Don't know; does not apply
4. The HOC staff seemed self-aware, displayed an open attitude including knowledge and skills, and appeared open toward others.
*
Strongly Disagree
Disagree
Agree
Strongly Agree
Don't know; does not apply
Item #1 Strongly Disagree
Item #1 Disagree
Item #1 Agree
Item #1 Strongly Agree
Item #1 Don't know; does not apply
Accessibility and Technology
1. When I requested accommodations, I was taken seriously and my needs were met.
*
Strongly Disagree
Disagree
Agree
Strongly Agree
Don't know; does not apply
Item #1 Strongly Disagree
Item #1 Disagree
Item #1 Agree
Item #1 Strongly Agree
Item #1 Don't know; does not apply
2. A variety of technology was available to meet my needs.
*
Strongly Disagree
Disagree
Agree
Strongly Agree
Don't know; does not apply
Item #1 Strongly Disagree
Item #1 Disagree
Item #1 Agree
Item #1 Strongly Agree
Item #1 Don't know; does not apply
3. Technology support was available to me if there were technology system issues.
*
Strongly Disagree
Disagree
Agree
Strongly Agree
Don't know; does not apply
Item #1 Strongly Disagree
Item #1 Disagree
Item #1 Agree
Item #1 Strongly Agree
Item #1 Don't know; does not apply
4. Using the Phone System was simple and current with common technology standards.
*
Strongly Disagree
Disagree
Agree
Strongly Agree
Don't know; does not apply
Item #1 Strongly Disagree
Item #1 Disagree
Item #1 Agree
Item #1 Strongly Agree
Item #1 Don't know; does not apply
Health and Safety
1. The organization provides services in a safe setting.
*
Strongly Disagree
Disagree
Agree
Strongly Agree
Don't know; does not apply
Item #1 Strongly Disagree
Item #1 Disagree
Item #1 Agree
Item #1 Strongly Agree
Item #1 Don't know; does not apply
2. Services are provided in a clean and sanitary facility.
*
Strongly Disagree
Disagree
Agree
Strongly Agree
Don't know; does not apply
Item #1 Strongly Disagree
Item #1 Disagree
Item #1 Agree
Item #1 Strongly Agree
Item #1 Don't know; does not apply
3. I feel safe in the neighborhood and parking areas around the business location.
*
Strongly Disagree
Disagree
Agree
Strongly Agree
Don't know; does not apply
Item #1 Strongly Disagree
Item #1 Disagree
Item #1 Agree
Item #1 Strongly Agree
Item #1 Don't know; does not apply
4. In the event of an emergency, I know how to respond or feel that staff will assist me in responding in order to keep me safe.
*
Strongly Disagree
Disagree
Agree
Strongly Agree
Don't know; does not apply
Item #1 Strongly Disagree
Item #1 Disagree
Item #1 Agree
Item #1 Strongly Agree
Item #1 Don't know; does not apply
Next
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