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People Supported Satisfaction Survey
Please provide us with your opinion of the services you are receiving (please check off all that apply).
Family Support
Group Living
SIL
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Respite
Name:
*
Address:
*
I completed this survey myself
Yes
No
Sometimes
N/a
I am living where I want to live.
Yes
No
Sometimes
N/a
I am happy where I am living.*
Yes
No
Sometimes
N/a
I am living with the right number of people.
Yes
No
Sometimes
N/a
I have the privacy I wish.*
Yes
No
Sometimes
N/a
I choose my daily routines such as meals, laundry, having a bath etc.
Yes
No
Sometimes
N/a
There is nothing that I cannot do in my home; the doors are not locked, and things are accessible.
Yes
No
Sometimes
N/a
I choose what I do during the day.
Yes
No
Sometimes
N/a
I choose what I do on the weekends.
Yes
No
Sometimes
N/a
My support asks me for my permission before they share my personal information with others.
Yes
No
Sometimes
N/a
My support knocks before they come into my home or my bedroom.
Yes
No
Sometimes
N/a
My support asks me for my permission before they help me.
Yes
No
Sometimes
N/a
I receive health care on a regular basis.
Yes
No
Sometimes
N/a
I receive dental care on a regular basis.
Yes
No
Sometimes
N/a
I have enough supports and services to help me do what I want to do.
Yes
No
Sometimes
N/a
I am able to get to the places I want to go, when I want to go.
Yes
No
Sometimes
N/a
In my community I have the help I need to meet people and do things.
Yes
No
Sometimes
N/a
I can spend my money the way I want.
Yes
No
Sometimes
N/a
There is some place I can go, to be by myself, when I want to.
Yes
No
Sometimes
N/a
I am able to call friends/family when I choose.
Yes
No
Sometimes
N/a
I have the opportunity to belong to clubs, social groups or volunteer as much as I wish.
Yes
No
Sometimes
N/a
I see my friends as much and as often as I wish.
Yes
No
Sometimes
N/a
How would you describe the supports/services that you are getting from WDDS.
Yes
No
Sometimes
N/a
I answer my own phone.
Yes
No
Sometimes
N/a
I am asked what I would like to do and get help to do it.
Yes
No
Sometimes
N/a
. My support staff are aware of the places that I want to go and help me with getting the necessary transportation.
Yes
No
Sometimes
N/a
I can exercise my rights.
Yes
No
Sometimes
N/a
I know my rights.*
Yes
No
Sometimes
N/a
When I have a concern or question, I know who to call.
Yes
No
Sometimes
N/a
I feel safe in my home and/or places I am supported.
Yes
No
Sometimes
N/a
Do you know what supports/services WDDS offers?
Yes
No
Sometimes
N/a
I choose what I do in the evening.
Yes
No
Sometimes
N/a
I feel safe when I go out into the community.
Yes
No
Sometimes
N/a
I have participated in a fire drill this month.
Yes
No
Sometimes
N/a
Amount
Yes
No
Somestimes
N/a
Quality
Better than last year
Worse than last year
About the same as last year
Are you happy with the supports/services you are getting?
Yes
No
Can you give us some comments on what you like or don’t like and write it below:
*
Overall, are you satisfied with your life?
Yes
No
Can you give us some comments:
*
If you have any other thoughts, ideas, or concerns that you want to share, please write them down here:
*
