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Exit Survey
 
 
Is the resident able to be interviewed?
 
Not Interviewable
 
Interviewable
 
Resident refused or is unable to interview
 
 
 
Are you able to participate in making decisions regarding food choices/preferences?
 
No
 
Yes
 
 
 
Is this acceptable to you?
 
No
 
Yes
 
 
 
Do you partcipate in choosing your bedtime?
 
No
 
Yes
 
 
 
Is this acceptable to you?
 
No
 
Yes
 
 
 
Do you particiate in choosing when to get up?
 
No
 
Yes
 
 
 
Is this acceptableto you?
 
No
 
Yes
 
 
 
Do you choose your dressing and bath time?
 
No
 
Yes
 
 
 
Is this acceptable to you?
 
No
 
Yes
 
 
 
Do you feel the staff treats you with respect and dignity? For example, does the staff take time to listen to you and are staff helpful when you request assistance?
 
No
 
Yes