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LIEBERMAN CENTER FAMILY COUNCIL
FAMILY MEMBER SATISFACTION SURVEY
Responses are confidential and reviewed only by LCFC for use in formulating concerns/recommendations to Lieberman Center administration. Respondent’s names and resident names are optional but please provide your resident’s floor. Contact information for you is needed if you would like LCFC to communicate with you about specific concerns.
__________________________________ ______________________________________
Your Name Telephone and/or e-mail
____________________________ _____
Resident’s Name Floor
 
 
 
Resident out of bed and dressed by reasonable time (10 a.m.)?
 
Very Satisfied
 
Satisfied
 
Dissatisfied
 
Very Dissatisfied
 
Unknown
 
N/A
 
 
 
Accessibility of call button?
 
Very Satisfied
 
Satisfied
 
Dissatisfied
 
Very Dissatisfied
 
Unknown
 
N/A
 
 
 
Personal hygiene of residents: Nails clean/trimmed
 
Very Satisfied
 
Satisfied
 
Dissatisfied
 
Very Dissatisfied
 
Unknown
 
N/A
 
 
 
Timely response to call button?
 
Very Satisfied
 
Satisfied
 
Dissatisfied
 
Very Dissatisfied
 
Unknown
 
N/A
 
 
 
Personal Hygiene of residents: Bathing?
 
Very Satisfied
 
Satisfied
 
Dissatisfied
 
Very Dissatisfied
 
Unknown
 
N/A
 
 
 
Personal hygiene of residents: Clean clothes?
 
Very Satisfied
 
Satisfied
 
Dissatisfied
 
Very Dissatisfied
 
Unknown
 
N/A
 
 
 
Personal hygiene of residents: Hair groomed?
 
Very Satisfied
 
Satisfied
 
Dissatisfied
 
Very Dissatisfied
 
Unknown
 
N/A
 
 
 
Personal hygiene of residents: Oral hygiene?
 
Very Satisfied
 
Satisfied
 
Dissatisfied
 
Very Dissatisfied
 
Unknown
 
N/A
 
 
 
Hands washed after toileting and before meals?
 
Very Satisfied
 
Satisfied
 
Dissatisfied
 
Very Dissatisfied
 
Unknown
 
N/A
 
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