HCBS Survey
PLEASE RESPOND BASED ON YOUR EXPERIENCE BEFORE MARCH 2020 (PRE-COVID). If you are not a service participant answer based on your observations of Futures Explored's programs and services.

If you are unable to answer question (or it is not relevant to you), please select N/A.
Name: *
Relationship to Futures Explored *
Required
If you are an employee, care provider, family member, or board member, please answer to the best of your ability based on your observations or knowledge of Futures Explored's programs and services.
Program (that you attend or are connected with). *
Where do you live? (County or City only) *
Do you have the opportunity to participate in community outings and activities (i.e. outings, volunteerism, working)?
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If you answered "yes" above, please describe the community outings or activities you have participated in before March 2020 :
If you answered no, what best describes why you aren't able to participate in community activities during the program day.
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Do you have the opportunity to interact with non-program participants and non-support staff?
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Are you given opportunities to search for jobs or work in jobs?
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Are you given opportunities to search for a new job if you wanted?
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Add comments (Optional)
Do you have access to transportation that is easy for you to use and that you can use when you want to? Transportation options can include: Public transportation, Uber/Lyft, rides from family and friends, driving your own car, riding your bike, etc.
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During program time, are you able to access your personal items and money as much and you want to?
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Does your IPP from the Regional Center reflect your choices for what programs and services you want to receive?
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Does your support staff explain information such as your rights and responsibilities in a way you can understand?
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Do you know what to do if you felt mistreated at program or by your support staff?
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Is your personal information kept private and confidential at program and/or by your support staff? For instance, your personal business isn't discussed where other people can hear OR documents with your personal information are not left out for others to see.
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Do you have privacy while using the bathroom and/or when receiving personal care support?
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Does support staff communicate with you in a way that you are able to easily understand? (Ex: communication device, Braille, large font, sign language, your native language)
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Are you allowed to express your personal style (clothing, hair style, make up, jewelry, etc.) at program or work?
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Do you feel that the people who support you understand your needs and interests?
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Is there someplace at program or work where you can safely store your belongings?
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Are you able to talk on the phone, text, and read mail/email in private while at program or while working with your support staff?
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Are you able to spend time alone or away from the group while at program or work?
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Do you feel supported by Futures Explored to make your own decisions about your life?
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Are you able to choose who supports you?
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Do you know about Futures Explored's Grievance Policy?
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Do you know how to file a Grievance?
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Are you able to change your program schedule or your support service schedule?
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Are you able to voice concerns about program or supports received?
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If you are of retirement age, are you supported to retire?
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