Customer Service Questionnaire
Our primary goal at Valley Care Management is to provide our residents and families with the best service possible. Please take a few minutes to complete the following survey. Your comments and feedback will help us identify areas we are excelling in as well as areas that we can improve upon.
* Required
Evaluation of Care and Service
Staff is available in a timely manner
Disagree
1
2
3
4
Agree
Clear selection
Staff greets you and offers to help you
Disagree
1
2
3
4
Agree
Clear selection
Staff is friendly and cheerful
Disagree
1
2
3
4
Agree
Clear selection
Administrative Staff Answers your questions
Disagree
1
2
3
4
Agree
Clear selection
Administrative Staff follows through on commitments
Disagree
1
2
3
4
Agree
Clear selection
Overall, how would you rate staff customer service
Poor
Fair
Good
Excellent
Choose One
Poor
Fair
Good
Excellent
Choose One
Clear selection
Evaluation of the Building and Grounds
Building is overall clean
Disagree
1
2
3
4
Agree
Clear selection
Individual rooms are cleaned on a regular basis
Disagree
1
2
3
4
Agree
Clear selection
Outside grass and landscaping are well groomed
Disagree
1
2
3
4
Agree
Clear selection
Overall, how would you rate the building and grounds
Poor
Fair
Good
Excellent
Choose One
Poor
Fair
Good
Excellent
Choose One
Clear selection
Evaluation of Meals
My Loved one enjoys the food
Disagree
1
2
3
4
Agree
Clear selection
The variety of food options is satisfying
Disagree
1
2
3
4
Agree
Clear selection
The special diet required by my loved one seems to be followed appropriately
Disagree
1
2
3
4
Agree
Clear selection
Overall, how would you rate the food
Poor
Fair
Good
Excellent
Choose One
Poor
Fair
Good
Excellent
Choose One
Clear selection
Evaluation of Activities
A balanced variety of activities are offered
Disagree
1
2
3
4
Agree
Clear selection
Activities are offered frequently during the day to meet my loved one's needs
Disagree
1
2
3
4
Agree
Clear selection
Journeys does well in engaging the outside community for programs
Disagree
1
2
3
4
Agree
Clear selection
Overall, how would you rate the activities offered at Journeys
Poor
Fair
Good
Excellent
Choose One
Poor
Fair
Good
Excellent
Choose One
Clear selection
Final Questions
How would you describe your loved one's experience:
Your answer
What changes do you suggest to make others' experiences as good or better than your experience?
Your answer
If your loved one was admitted within the last year, please share any feedback regarding the admission process:
Your answer
Where did you first hear about us?
Choose
Friend/Family
Employee
Newspaper
Radio
Television
Internet
Other
Would you refer us to your friends/family?
Yes
No
Clear selection
If No, Why?
Your answer
Additional Comments
Your answer
Your Name (Optional)
Your answer
Email Address (This is used to validate this survey)
*
Your answer
All responses are kept confidential
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