Dear Service User

Here at St. Clare’s Hospice we are keen to ensure that the services we provide meet the needs of our patients and their carers. An individual’s experience with us is very important and we would be extremely grateful if you could spend a little time completing this anonymous questionnaire. Please be open with your responses – they will be vital in our planning for the future. Please return your questionnaire to St Clares Hospice, Primrose Terrace, Jarrow, NE32 5HA

If you feel you would like to discuss anything personally then please don’t hesitate to contact me on the address above:

Regards

Jacki Richardson

Day Unit Sister

Day Care Questionnaire

We would like you to think about you experience in the day unit while a guest here at St Clare’s. How likely are you to recommend our Hospice to friends and family if they need similar care or support

Don’t know
Extremely unlikely 
Unlikely
Neither likely or unlikely
Likely
Extremely likely

Can you tell us why you gave this answer?......

………………………………………………………………………………….

Before you were contacted by a member of the day care team, did you understand why you had been referred for day services

No  Yes  Unsure 

Any comments:

………………………………………………………………………………………………………………………………………………………………………………………………

2a. Did you feel anxious about being contacted by the day team?

(Please tick the box closest to your view)

Not at all anxious Extremely Anxious



1  2  3  4  5 

Can’t remember 

Any Comments

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Can you tell me who your key worker is? (this could be your Macmillanor District Nurse)

……………………………………………………………………………………………………………………………………………………………………………………

4a. Were you given an information booklet on day care services prior to agreeing to attending

No  Yes  Can’t remember 

Comment

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4b.Was the booklet helpful?

No  Yes  Can’t remember  Did not look at the booklet 

If you ticked ‘No’, please give more details.

……………………..……………………………………………………………………..

Do you have any suggestions for other information that should be

Included in the booklet?

Comment

......

……………………..…………………………………………………………………

Have staff involved in your care introduced themselves?

Never  Some of the time  Most of the time  Always 

Comment

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How satisfied were you with your involvement in planning your care?

Very dissatisfied  Not satisfied  Satisfied  Very satisfied 

If you were not satisfied, do you have any suggestions as to how we could

involve you more?

……….……………………..………………………………………………………

Have you been offered / completed a SPARC tool assessment on

admission to day hospice

Yes No 

8. Did you have the opportunity to ask questions when you wanted to?

YES  No 

9.Did you feel staff made an effort to meet your individualneeds and

wishes?

Never  Some of the time  Most of the time  Always 

Comment

………………………………………………………………………………………..

……………………………………………………………………………………….

10. Did you feel you were treated with respect?

Never  Some of the time  Most of the time  Always 

Comment

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11. Did you feel your privacy and dignity needs were met?

Never  Some of the time  Most of the time  Always 

12. Please rate the following by circling your response.

Poor Excellent

How clean the hospice was / 1 2 3 4 5
The quality of the catering / 1 2 3 4 5
The general environment and surroundings / 1 2 3 4 5

Do you have any more comments on the above?

……………………..…………………………………………………………………….

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13 What have you been most satisfied with during your time at the day hospice?

……………………..……………………………………………………………………..

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14. Is there anything we could do better or you would like to add to improve the overall services available to day care guests

Date completed……………………

Patient name (optional) ………………………

Thank you for taking the time to complete and return this survey

Regards

Jacki Richardson

Day Care Sister