ChildBridge Center for Residential Living and Center for Education Satisfaction Survey

Thank you for taking the time to complete the following survey. Little City Foundation is always striving for feedback from the individuals and families we serve in order to improve our program and services to better meet your needs. Results will be shared with leadership in a final aggregate report. The information you provide will remain anonymous unless you request that it be provided to program leadership in the general comment section.

Today's Date:

ChildBridge Program that you are affiliated with.

	ChildBridge Center for Group Home Living
	ChildBridge Center for Education

Please answer all of the questions below by marking the response that matches your level of agreement or disagreement with the statement. If the statement does not pertain to the services provided please mark N/A.

COMMUNICATION/DECISION MAKING

	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree	Not Applicable
I am included in the decision making process for my family member/youth.	I am included in the decision making process for my family member/youth. Strongly Agree	I am included in the decision making process for my family member/youth. Agree	I am included in the decision making process for my family member/youth. Neutral	I am included in the decision making process for my family member/youth. Disagree	I am included in the decision making process for my family member/youth. Strongly Disagree	I am included in the decision making process for my family member/youth. Not Applicable
My family member/youth’s Case Manager/Coordinator keeps me informed about issues or concerns.	My family member/youth’s Case Manager/Coordinator keeps me informed about issues or concerns. Strongly Agree	My family member/youth’s Case Manager/Coordinator keeps me informed about issues or concerns. Agree	My family member/youth’s Case Manager/Coordinator keeps me informed about issues or concerns. Neutral	My family member/youth’s Case Manager/Coordinator keeps me informed about issues or concerns. Disagree	My family member/youth’s Case Manager/Coordinator keeps me informed about issues or concerns. Strongly Disagree	My family member/youth’s Case Manager/Coordinator keeps me informed about issues or concerns. Not Applicable
I am aware of the agency's grievance procedure.	I am aware of the agency's grievance procedure. Strongly Agree	I am aware of the agency's grievance procedure. Agree	I am aware of the agency's grievance procedure. Neutral	I am aware of the agency's grievance procedure. Disagree	I am aware of the agency's grievance procedure. Strongly Disagree	I am aware of the agency's grievance procedure. Not Applicable
My concerns are addressed in a timely manner by the case manager.	My concerns are addressed in a timely manner by the case manager. Strongly Agree	My concerns are addressed in a timely manner by the case manager. Agree	My concerns are addressed in a timely manner by the case manager. Neutral	My concerns are addressed in a timely manner by the case manager. Disagree	My concerns are addressed in a timely manner by the case manager. Strongly Disagree	My concerns are addressed in a timely manner by the case manager. Not Applicable
Concerns and grievances not able to be solved at the case manager level are handled professionally and efficiently by the supervisor/manager level.	Concerns and grievances not able to be solved at the case manager level are handled professionally and efficiently by the supervisor/manager level. Strongly Agree	Concerns and grievances not able to be solved at the case manager level are handled professionally and efficiently by the supervisor/manager level. Agree	Concerns and grievances not able to be solved at the case manager level are handled professionally and efficiently by the supervisor/manager level. Neutral	Concerns and grievances not able to be solved at the case manager level are handled professionally and efficiently by the supervisor/manager level. Disagree	Concerns and grievances not able to be solved at the case manager level are handled professionally and efficiently by the supervisor/manager level. Strongly Disagree	Concerns and grievances not able to be solved at the case manager level are handled professionally and efficiently by the supervisor/manager level. Not Applicable

HOME ENVIRONMENT

	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree	Not Applicable
The home where the child lives is safe.	The home where the child lives is safe. Strongly Agree	The home where the child lives is safe. Agree	The home where the child lives is safe. Neutral	The home where the child lives is safe. Disagree	The home where the child lives is safe. Strongly Disagree	The home where the child lives is safe. Not Applicable
The home where the child lives is kept clean.	The home where the child lives is kept clean. Strongly Agree	The home where the child lives is kept clean. Agree	The home where the child lives is kept clean. Neutral	The home where the child lives is kept clean. Disagree	The home where the child lives is kept clean. Strongly Disagree	The home where the child lives is kept clean. Not Applicable
The child has access to his/her personal possessions.	The child has access to his/her personal possessions. Strongly Agree	The child has access to his/her personal possessions. Agree	The child has access to his/her personal possessions. Neutral	The child has access to his/her personal possessions. Disagree	The child has access to his/her personal possessions. Strongly Disagree	The child has access to his/her personal possessions. Not Applicable

PROGRAM SERVICES

	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree	Not Applicable
LCF staff meets the personal care needs of my family member/youth with dignity and respect.	LCF staff meets the personal care needs of my family member/youth with dignity and respect. Strongly Agree	LCF staff meets the personal care needs of my family member/youth with dignity and respect. Agree	LCF staff meets the personal care needs of my family member/youth with dignity and respect. Neutral	LCF staff meets the personal care needs of my family member/youth with dignity and respect. Disagree	LCF staff meets the personal care needs of my family member/youth with dignity and respect. Strongly Disagree	LCF staff meets the personal care needs of my family member/youth with dignity and respect. Not Applicable
I observe positive and engaging interactions between staff and residents when I visit the home.	I observe positive and engaging interactions between staff and residents when I visit the home. Strongly Agree	I observe positive and engaging interactions between staff and residents when I visit the home. Agree	I observe positive and engaging interactions between staff and residents when I visit the home. Neutral	I observe positive and engaging interactions between staff and residents when I visit the home. Disagree	I observe positive and engaging interactions between staff and residents when I visit the home. Strongly Disagree	I observe positive and engaging interactions between staff and residents when I visit the home. Not Applicable
Activities provided in the home promote learning for my family member/youth.	Activities provided in the home promote learning for my family member/youth. Strongly Agree	Activities provided in the home promote learning for my family member/youth. Agree	Activities provided in the home promote learning for my family member/youth. Neutral	Activities provided in the home promote learning for my family member/youth. Disagree	Activities provided in the home promote learning for my family member/youth. Strongly Disagree	Activities provided in the home promote learning for my family member/youth. Not Applicable
My family member/youth has opportunities to access his/her local community.	My family member/youth has opportunities to access his/her local community. Strongly Agree	My family member/youth has opportunities to access his/her local community. Agree	My family member/youth has opportunities to access his/her local community. Neutral	My family member/youth has opportunities to access his/her local community. Disagree	My family member/youth has opportunities to access his/her local community. Strongly Disagree	My family member/youth has opportunities to access his/her local community. Not Applicable
The programs/services provided in the home are appropriate for my family member/youth.	The programs/services provided in the home are appropriate for my family member/youth. Strongly Agree	The programs/services provided in the home are appropriate for my family member/youth. Agree	The programs/services provided in the home are appropriate for my family member/youth. Neutral	The programs/services provided in the home are appropriate for my family member/youth. Disagree	The programs/services provided in the home are appropriate for my family member/youth. Strongly Disagree	The programs/services provided in the home are appropriate for my family member/youth. Not Applicable
The programs/services provided in the home have resulted in an increase in daily living skills functioning.	The programs/services provided in the home have resulted in an increase in daily living skills functioning. Strongly Agree	The programs/services provided in the home have resulted in an increase in daily living skills functioning. Agree	The programs/services provided in the home have resulted in an increase in daily living skills functioning. Neutral	The programs/services provided in the home have resulted in an increase in daily living skills functioning. Disagree	The programs/services provided in the home have resulted in an increase in daily living skills functioning. Strongly Disagree	The programs/services provided in the home have resulted in an increase in daily living skills functioning. Not Applicable
The programs/services provided have resulted in an increase in more positive behavioral responses.	The programs/services provided have resulted in an increase in more positive behavioral responses. Strongly Agree	The programs/services provided have resulted in an increase in more positive behavioral responses. Agree	The programs/services provided have resulted in an increase in more positive behavioral responses. Neutral	The programs/services provided have resulted in an increase in more positive behavioral responses. Disagree	The programs/services provided have resulted in an increase in more positive behavioral responses. Strongly Disagree	The programs/services provided have resulted in an increase in more positive behavioral responses. Not Applicable
I am greeted appropriately and professionally by staff when I am in the home.	I am greeted appropriately and professionally by staff when I am in the home. Strongly Agree	I am greeted appropriately and professionally by staff when I am in the home. Agree	I am greeted appropriately and professionally by staff when I am in the home. Neutral	I am greeted appropriately and professionally by staff when I am in the home. Disagree	I am greeted appropriately and professionally by staff when I am in the home. Strongly Disagree	I am greeted appropriately and professionally by staff when I am in the home. Not Applicable

HEALTH AND WELLNESS

	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
The health and wellness needs of my family member/youth are being met.	The health and wellness needs of my family member/youth are being met. Strongly Agree	The health and wellness needs of my family member/youth are being met. Agree	The health and wellness needs of my family member/youth are being met. Neutral	The health and wellness needs of my family member/youth are being met. Disagree	The health and wellness needs of my family member/youth are being met. Strongly Disagree
I am kept informed about medical concerns for my family member/youth.	I am kept informed about medical concerns for my family member/youth. Strongly Agree	I am kept informed about medical concerns for my family member/youth. Agree	I am kept informed about medical concerns for my family member/youth. Neutral	I am kept informed about medical concerns for my family member/youth. Disagree	I am kept informed about medical concerns for my family member/youth. Strongly Disagree
My family member/youth has access to the activities at the recreation center.	My family member/youth has access to the activities at the recreation center. Strongly Agree	My family member/youth has access to the activities at the recreation center. Agree	My family member/youth has access to the activities at the recreation center. Neutral	My family member/youth has access to the activities at the recreation center. Disagree	My family member/youth has access to the activities at the recreation center. Strongly Disagree
My family member/youth has access to clinical services when needed.	My family member/youth has access to clinical services when needed. Strongly Agree	My family member/youth has access to clinical services when needed. Agree	My family member/youth has access to clinical services when needed. Neutral	My family member/youth has access to clinical services when needed. Disagree	My family member/youth has access to clinical services when needed. Strongly Disagree

OTHER SERVICES

	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree	Not Applicable
The Director for the program addresses my concerns in a timely manner.	The Director for the program addresses my concerns in a timely manner. Strongly Agree	The Director for the program addresses my concerns in a timely manner. Agree	The Director for the program addresses my concerns in a timely manner. Neutral	The Director for the program addresses my concerns in a timely manner. Disagree	The Director for the program addresses my concerns in a timely manner. Strongly Disagree	The Director for the program addresses my concerns in a timely manner. Not Applicable
I would recommend Little City to a family member or a friend.	I would recommend Little City to a family member or a friend. Strongly Agree	I would recommend Little City to a family member or a friend. Agree	I would recommend Little City to a family member or a friend. Neutral	I would recommend Little City to a family member or a friend. Disagree	I would recommend Little City to a family member or a friend. Strongly Disagree	I would recommend Little City to a family member or a friend. Not Applicable
Overall I am satisfied with the services provided by Little City.	Overall I am satisfied with the services provided by Little City. Strongly Agree	Overall I am satisfied with the services provided by Little City. Agree	Overall I am satisfied with the services provided by Little City. Neutral	Overall I am satisfied with the services provided by Little City. Disagree	Overall I am satisfied with the services provided by Little City. Strongly Disagree	Overall I am satisfied with the services provided by Little City. Not Applicable

A FEW LAST QUESTIONS

What one thing does LCF do really well?

What one thing would you like to see LCF change?

Is there any particular Little City Foundation staff member who you would like to recognize for his/her outstanding efforts in supporting you and your family? If so, please share some details about your experience.

Your suggestions are welcomed. Please take a minute to comment on areas of satisfaction or dissatisfaction with your experience with Little City.

Location where your family member/youth lives

Name of Family member/youth in our program (Optional)

Your name (Optional)

Your email address (Optional)