Shared Lives Service Users Feedback Questionaire - Page 1 of 3 - Cumberland Council - Citizen Space

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Shared Lives Service User Feedback Questionaire

We would like to ask you some questions about how you have found your care. We want to find out what is working well and what could be improved.

1. What type of Support do you have from Shared Lives?

(Required) Long Term Day Support Respite

2. Your Name (can be anonymous if you prefer)

3. Your carers’ name (can be left blank if you prefer)

4. How are you feeling today?

5. Does your Carer make you happy?

Yes No

Is there anything you would like to tell us about this?

6. Do you do fun things with your carer?

Yes No

Is there anything you would like to tell us about this?

7. Do you spend time with your friends and family?

Yes No

Is there anything you would like to tell us about this?

8. Do you like your bedroom?

Yes No I do not stay overnight at my carers house

Is there anything you would like to tell us about this?

9. Is your bedroom decorated how you like it?

Yes No Not applicable

Is there anything you would like to tell us about this?

10. Do you choose what you want to eat and drink?

(Required) Yes No

Is there anything you would like to tell us about this?

11. Do you feel safe with your Carer?

Yes No

Is there anything you would like to tell us about this?

12. Does your respite carer make you happy?

Yes No I don't have a respite carer

Suggestions:

13. Do you see your Shared Lives Supervisor regularly?

Yes No

Is there anything you would like to tell us about this?

14. Do they listen and help you?

Yes No

Is there anything you would like to tell us about this?

15. Do you access any other Shared Lives Services?

Yes No

Is there anything you would like to tell us about this?

16. Would you like to access any other Shared Lives Services?

Yes No

17. If yes please tell us which ones-

Long Term Day Support Respite

18. If you would like to tell us anything else please add it in the box below: