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QA Form (We Care)
0.00
Client First Name
*
Client Last Name
*
Date of Birth
*
Service User Type
*
Adult
Child
Private
Other
Service User Type (Other)
*
Service User Location
*
Manchester
Stockport
Rochdale
Trafford
Other
Service User Location (Other)
*
Are the Carers Wearing the correct PPE?
*
Yes
No
Mostly
Are the Carers Well Presented?
*
Yes
No
Needs Improvement
Are the staff arriving within 30 mins of your agreed time?
*
Yes
No
Mostly
Expand on this
Are the Carers/Office letting you know about changes to your call times?
*
Yes
No
Are the carers?
Do you feel rushed?
*
Yes
No
Sometimes
Expand on this
Do you feel the LogBooks are accurate I.E Time & Notes?
*
Yes
No
Mostly
Needs Improving
Expand on this
Do you know who your Social worker is?
*
Yes
No, provide details
If known, does your Social worker or any one from there team get in contact with you. Help with any tasks etc?
*
Yes
No
Has there been any changes e.g. meals eaten , salt assessments , meal preparation?
*
Yes
No
Expand on this
Do you know how to contact Social Services?
Yes
No, provide details
Do you know your care teams Names?
*
Yes
No
Some
Do you feel comfortable with your carers?
*
1
2
3
4
5
1 lowest, 5 highest
Do the carers treat you with respect and dignity?
*
1
2
3
4
5
1 lowest, 5 highest
Are there any changes in Personal care?
*
Yes
No
Expand on this
Do you know how to raise a complaint against a staff member?
*
Yes
No
Need to provide details
Are your calls answered when you ring the office, And are they responsive to your needs?
*
Yes
No
Mostly
Needs Improving
what do we care do well?
*
how can we care do better?
*
conclusion / tasks
Name of person completing the form
Date
*
Submit
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