FQ02 HIQA Resident Pre Inspection Questionnaire

1. Do you like living here? Tick as appropriate.

Yes

No

Most of the time

Sometimes

Can you tell us why?

2. Is there anything you do not like about living here?

Can you tell us about it?

3. What do you like doing during the evenings and/or at weekends?

Can you tell us about it?

4. Is there anything in your house that you would like to see changed/improved or done differently?

5. Who would you talk to or tell if you had a concern/ worry or complaint?

6. Do you feel safe here?

Can you tell us why?

7. Can you family and friends visit you here?

8. Do you take part in the plans and decisions that are made about your life?

Can you tell us about that?

9. Do you feel well cared for here? Tell us about it.

10. Do you know what your rights are living in the centre?

Can you tell us about your rights?

11. Is there anything you would like to tell us about the centre that we have not asked you? Yes No

Comments:

Thank you for taking the time to fill in the questionnaire. Your views are important to us. A public report will be written following the inspection. You may prefer to speak to an inspector instead of, or as well as filling in the questionnaire. The centre staff will inform you of the date for inspection of your centre.

Please note that if your identity has to be disclosed for any reason, theHealth Information and Quality Authority will discuss this with you first.

On completion of this form

You can post it to your regional Health Information and Quality Authority office or if you wish, place it in an envelop and give it to inspectors when they are in your centre or ask staff to give it to the inspectors. The address of your regional office is highlighted below:

If you live in:

Cavan

Clare

Donegal

Dublin

Galway

Kildare

Laois

Leitrim

Longford

Louth

Mayo

Meath

Monaghan

Offaly

Roscommon

Sligo

Tipperary North

Westmeath

Wicklow

If you live in:

Carlow

Cork

Kerry

Kilkenny

Limerick

Tipperary South

Waterford

Wexford