Resident Satisfaction Survey

– Step 1 of 5

Gender

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:

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

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

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

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