Assisted Living Resident Drill Down Surveys

Transcription

1 ASSISTED LIVING RESIDENT DRILL DOWN SURVEYS Assisted Living Resident Drill Down Surveys 7/6/10, My InnerView ALL RIGHTS RESERVED No part of this work, including survey items or design, may be reproduced, displayed, distributed, modified or transmitted in any form or by any means without the express written permission of My InnerView.

2 Assisted living resident satisfaction survey reference ITEM NUMBER/LABEL ORIGINAL SURVEY STATEMENT GLOBAL SATISFACTION 33 Overall satisfaction How would you rate your overall satisfaction with this community? 34 Recommendation to others What is your recommendation of this community to others? QUALITY OF LIFE DOMAIN Rate this community on... 1 Choices/preferences Meeting your choices and preferences 2 Respectfulness of staff The respect shown to you by staff 3 Respect for privacy Meeting your need for privacy 4 Resident-to-resident friendships Offering you opportunities for friendships with other residents 5 Resident-to-staff friendships Offering you opportunities for friendships with staff 6 Meaningfulness of activities Offering you meaningful activities 7 Religious/spiritual opportunities Meeting your religious and spiritual needs 16 Safety of facility How safe it is for you 17 Security of personal belongings The security of your personal belongings 24 Comfort of room/surroundings How comfortable your room and surroundings are 25 Community life opportunities Offering opportunities for you to participate in community life 26 "Grow as person" opportunities Offering opportunities for you to grow as a person QUALITY OF STAFF DOMAIN Rate this community on Responsiveness of staff The staff s responsiveness to your requests 12 Commitment to family updates Keeping you and your family informed about you 13 Competency of staff The competency of staff 14 Care (concern) of staff The staff s care and concern for you QUALITY OF SERVICE DOMAIN Rate this facility on... 8 Sufficiency of healthcare needs Meeting your healthcare needs 9 Sufficiency of personal assistance Meeting your personal assistance needs 15 Responsiveness of management Management s responsiveness to your suggestions and concerns 27 Quality of laundry services The quality of the laundry services 29 Sufficiency of transportation Providing transportation services DINING EXPERIENCE DOMAIN Rate this community on Variety of meals Providing variety on the menu throughout the week 21 Appeal of food Providing appetizing food in terms of taste and appearance 22 Sufficiency of dietary needs Meeting special dietary needs 23 Courteousness of dining staff The courteousness of dining room staff Continued on next page

3 Assisted living resident satisfaction survey reference (continued) ITEM NUMBER/LABEL ORIGINAL SURVEY STATEMENT ENVIRONMENTAL QUALITY DOMAIN Rate this community on Home-like atmosphere Providing you with a home-like atmosphere 18 Cleanliness of room/surroundings The cleanliness of your room and surroundings 19 Control of room temperature The control you have over room temperature 28 Adequacy of storage space Providing adequate storage space 30 Quality of amenities Meeting your expectations regarding quality of amenities (décor/furnishings) BILLING/CHARGES DOMAIN Rate this community on Accuracy of bills for services How accurately the community bills for its services 32 Comparison of charges How reasonable the charges are compared to other communities DEMOGRAPHICS AND BACKGROUND INFORMATION 35 Length of stay How long have you lived at this community? 36 Person visiting most Who visits you most often? 37 How often visited How often does this person visit you? 38 Communities visited How many communities did you (or your family) visit before choosing this community? 39 Reason for choosing What is the most important reason you (or your family) chose this community? 40 Referral source How did you first learn about this community? 41 Gender of resident What is your gender? 42 Age of resident What is your age? 43 Assistance with survey How is this survey being completed? 4/17/07, My InnerView Reproduction or duplication requires written permission from My InnerView (715)

4 improve our performance in meeting your choices and preferences. IN 1 Staff make effort to learn about your personal habits, wishes, inclinations and habits. 2 Service plans are individualized and address each resident s needs, routines and way of life. 3 Staff know your preferences, routines, likes and dislikes. 4 Staff try to accommodate your preferences, routines, likes and dislikes. 5 You can decide when to sleep or wake up. 6 You can choose when and how often to bathe or shower. 7 You can choose when, where and with whom to have meals. 8 You can choose your personal care assistant. 9 Changes in community policies take your choices and preferences into account. 10 Overall, you are satisfied with the way your personal choices are met. Form DDALF/R/1- %Facility_ID% %Survey_Run_ID% %Surveyee_ID% May 2010, My InnerView ALF/R/1

5 improve the respectfulness of our staff. IN 1 Staff knock on your door before entering. 2 Staff respond with genuine concern when you seek attention. 3 Staff explain plan for caregiving to you before care begins. 4 Staff honor your confidences. 5 Staff take your complaints seriously. 6 Staff do not talk down or patronize you. 7 Staff address you by your name of choice. 8 Staff respect your personal space. 9 Staff honor your confidences and do not discuss your private information. 10 Overall, staff show genuine respect and treat you with dignity. Form DDALF/R/2- %Facility_ID% %Survey_Run_ID% %Surveyee_ID% May 2010, My InnerView ALF/R/2

6 improve our respect for privacy. IN 1 Staff do not discuss your private matters (health, financial or social condition) inappropriately or in presence of others. 2 Staff protect privacy and modesty when giving you a bath (or shower) and personal care. 3 You can visit privately with family members, friends and other residents. 4 Staff discuss personal issues only with resident or appropriate person (legal guardian or person with power of attorney). 5 You can talk privately on the phone. 6 Staff do not handle or rearrange your belongings unless requested to do so. 7 Steps are taken to prevent intrusion by other residents. 8 Staff knock or request permission before entering your room(s). 9 Staff are respectful of your personal space. 10 Overall, your need for privacy is met. Form DDALF/R/3- %Facility_ID% %Survey_Run_ID% %Surveyee_ID% May 2010, My InnerView ALF/R/3

7 improve resident friendships with other residents. IN 1 The settings and environment are conducive for you to visit, socialize and dine with other residents. 2 You may choose with whom to eat. 3 Religious celebrations offer you opportunity for friendship and bonding. 4 In-house activities offer opportunity for you get to know other residents. 5 You were introduced to other residents soon after moving in. 6 You have opportunity to celebrate ethnic, cultural, national and religious events. 7 Common areas are arranged to encourage residents to socialize. 8 Outings are planned to foster friendships among residents. 9 You are encouraged to participate in activities with other residents with similar interests. 10 Overall, opportunities are offered to foster mutual friendships among residents. Form DDALF/R/4- %Facility_ID% %Survey_Run_ID% %Surveyee_ID% May 2010, My InnerView ALF/R/4

8 improve your friendships with staff. IN 1 Staff interact warmly with you. 2 Staff make an effort to understand and appreciate your history, career and achievements. 3 Staff take time to visit and chat with you. 4 Staff greet you by your name of choice. 5 Events and activities are planned to encourage residents and staff to attend together. 6 There is a sense of community among staff, residents and families. 7 On a routine basis, the same staff members care for you. 8 Staff make an effort to get to know your regular visitors and family members. 9 The community encourages friendships between you and staff. 10 Overall, residents and staff genuinely care about each other. Form DDALF/R/5- %Facility_ID% %Survey_Run_ID% %Surveyee_ID% May 2010, My InnerView ALF/R/5

9 improve our performance in providing meaningful activities. IN 1 You have opportunity to be involved in creating and scheduling activities and outings. 2 You have opportunity to participate in activities in the evening. 3 You have opportunity to participate in activities on the weekend. 4 You have opportunity to keep intellectually active (for example: library, books in large print, internet access, lectures). 5 You have opportunity to participate in outdoor activities. 6 You have opportunity for self expression (for example: cultivating a garden, cooking, painting, playing an instrument). 7 You have opportunity to participate in trips and outings. 8 You have opportunity to exercise and participate in recreational wellness programs. 9 Staff invite and escort you, if needed, to and from activities and events. 10 Overall, activities are meaningful and enjoyable. Form DDALF/R/6- %Facility_ID% %Survey_Run_ID% %Surveyee_ID% May 2010, My InnerView ALF/R/6

10 improve our performance in meeting your religious and spiritual needs. IN 1 You can participate in religious and church services of choice. 2 You have access to clergy and religious resources as needed. 3 You are offered activities that foster spiritual health. 4 Staff are sensitive to your religious preferences. 5 You have opportunity to share personal religious and spiritual beliefs. 6 You can pray or practice your religion in private. 7 You have opportunity to attend religious services outside the assisted living community. 8 Staff respect the rituals of various religions. 9 Religious services are held in an appropriate setting conducive to prayer and reflection. 10 Overall, your religious and spiritual needs are understood and met. Form DDALF/R/7- %Facility_ID% %Survey_Run_ID% %Surveyee_ID% May 2010, My InnerView ALF/R/7

11 improve our performance in meeting your healthcare needs. IN 1 Assistance with medication administration is provided to you as needed. 2 Nurses are available as needed to meet your healthcare needs. 3 Staff recognize and respond in a timely manner to changes in your health. 4 Special diets are available as required by residents. 5 Health and care needs are discussed with you and your family members as appropriate. 6 Resources (for therapy, home health, hospice care and other healthcare issues) are accessible when needed. 7 Activities to maintain your wellness are available. 8 Information on health and wellness is available. 9 Transportation to medical appointments is available. 10 Overall, staff, activities and available resources meet your healthcare needs. Form DDALF/R/8- %Facility_ID% %Survey_Run_ID% %Surveyee_ID% May 2010, My InnerView ALF/R/8

12 improve our performance in meeting your personal assistance needs. IN 1 Staff assist with administering medication as needed. 2 Staff assist with personal hygiene (for example: bathing, oral care, incontinence) as needed. 3 You get help (as needed) with mobility. 4 Staff assist with your personal appearance (for example: shaving, fixing hair, applying make-up) as needed. 5 Staff understand your personal needs and provide appropriate assistance. 6 Staff encourage your independence. 7 Staff escort you to activities and dining as needed. 8 Staff are alert to your personal needs. 9 Staff assist you with personal needs while respecting your privacy and dignity. 10 Overall, staff assist you with your personal care needs. Form DDALF/R/9- %Facility_ID% %Survey_Run_ID% %Surveyee_ID% May 2010, My InnerView ALF/R/9

13 improve our performance in providing a home-like atmosphere. IN 1 The community has the look and feel of a home. 2 You feel safe and secure in this community. 3 Staff accommodate your personal preferences related to daily routine, room décor, etc. 4 Staff respect your need for privacy (for example: when providing personal care, in guarding your private information, when handling your personal belongings). 5 The community provides the freedoms of living at home (for example: in matters of sleeping, waking, bathing, snacking, lounging). 6 This community makes you feel secure, wanted, comfortable and relaxed. 7 You are happy to return to this community after going out for a visit. 8 You and staff relate to each other with genuine affection. 9 You speak to visitors with pride about this community. 10 Overall, you are provided the benefits of a setting you can call home. Form DDALF/R/10- %Facility_ID% %Survey_Run_ID% %Surveyee_ID% May 2010, My InnerView ALF/R/10

14 improve the staff s responsiveness to your requests. IN 1 Adequate staff are available on all day shifts to meet your needs. 2 Adequate staff are available on weekends to meet your needs. 3 Adequate staff are available evenings and nights to meet your needs. 4 Emergency response systems (life-line systems, pull cords, etc.) are answered in a reasonable amount of time. 5 You can easily take your concerns and needs directly to the top manager (for example: the director of the community). 6 Staff convey in word and actions that staffing levels are adequate for them to do their jobs well. 7 Staff and managers respond promptly to family members concerns. 8 Phone-call queries from your family and friends are answered or returned promptly. 9 Family members can identify staff by their name tags and other means of identification. 10 Overall, staff are responsive to your requests. Form DDALF/R/11- %Facility_ID% %Survey_Run_ID% %Surveyee_ID% May 2010, My InnerView ALF/R/11

15 improve our performance in keeping you and your family informed. IN 1 Prior to moving in, you and your family members were fully informed as to what to expect from this community. 2 Family members are informed in a timely manner about things that matter to them (for example: change in your condition, an emergency or hospitalization). 3 Family members are informed about scheduled events and activities. 4 Family members calls to this community are returned in a timely manner. 5 Family members are kept informed about changes in community policy, fee schedules, etc. 6 Staff are available to answer questions from family members. 7 Nurses are available to answer questions about you. 8 Family members were invited to participate when your individual service plan was made. 9 Accurate and updated family contact information is maintained. 10 Overall, family members are kept involved in and informed about your care. Form DDALF/R/12- %Facility_ID% %Survey_Run_ID% %Surveyee_ID% May 2010, My InnerView ALF/R/12

16 improve the competency of staff. IN 1 Staff have the necessary skills to do a good job. 2 Staff are capable of handling emergency situations. 3 Staff are skilled to handle your physical needs. 4 Staff are skilled to handle your medical needs. 5 Staff know how to calm a resident who is upset. 6 Staff know how to care for a resident with dementia. 7 Staff are able to accurately respond to healthcare-related questions. 8 Staff take action when you communicate a concern. 9 Staff know your healthcare needs. 10 Overall, staff provide you with competent care. Form DDALF/R/13- %Facility_ID% %Survey_Run_ID% %Surveyee_ID% May 2010, My InnerView ALF/R/13

17 improve staff s care and concern for residents. IN 1 Staff respond to calls for help (for example: lifeline systems, pull cords) with a friendly and willing attitude. 2 Staff put care of residents as highest priority. 3 Staff are available when needed. 4 This community has devoted staff. 5 Staff spend time with you. 6 Staff show a personal concern for you. 7 Staff go out of their way to be kind to you. 8 Staff are respectful of your wisdom and life experiences. 9 Staff take the time to listen to you to understand your needs. 10 Overall, staff show genuine care and concern for you. Form DDALF/R/14- %Facility_ID% %Survey_Run_ID% %Surveyee_ID% May 2010, My InnerView ALF/R/14

18 improve the responsiveness of management. IN 1 The director/administrator is accessible to you. 2 The director/administrator shows by example that care of residents is highest priority. 3 You and your family members can voice concerns confidentially without fear of a negative reaction. 4 An appropriate person is always available to answer family members questions about you. 5 The director/administrator truly listens to family concerns. 6 The director/administrator makes an effort to address family concerns. 7 The director/administrator returns phone calls in a timely manner. 8 Staff members convey to the director/administrator issues or concerns you express. 9 The director/administrator and staff follow up on your concerns. 10 Overall, the director/administrator shows genuine concern and care for you and your family members by being responsive to your concerns. Form DDALF/R/15- %Facility_ID% %Survey_Run_ID% %Surveyee_ID% May 2010, My InnerView ALF/R/15

19 improve the safety of the community. IN 1 Interior layout and furnishings (for example: lighting, floors, furniture, doors) minimize the risk of accidents and injuries. 2 The design of exterior walkways, gardens, parking lot and entrances contribute to a safe environment. 3 The building and grounds are monitored to ensure security of the premises. 4 Equipment is properly maintained and in safe working condition. 5 You and your family members have been educated about this community s emergency and disaster plan. 6 Precautions are taken to prevent residents with dementia from wandering. 7 Staff show you how to minimize your risk of falling. 8 Needed repairs are made in a timely manner. 9 The community makes efforts to prevent mental, physical and verbal abuse. 10 Overall, this community has taken steps to ensure your safety. Form DDALF/R/16- %Facility_ID% %Survey_Run_ID% %Surveyee_ID% May 2010, My InnerView ALF/R/16

20 improve the security of personal belongings. IN 1 Locked storage is available to you. 2 Your belongings are rarely lost. 3 Staff respond in a timely manner to concerns about missing items. 4 Reports of missing items are adequately investigated. 5 Staff ask before rearranging or handling your personal belongings. 6 Steps are taken to prevent confused residents from taking what belongs to others. 7 Staff takes care to avoid losing your personal items (for example: dentures, razors, cosmetics). 8 Staff take care to avoid breaking or damaging your personal items. 9 Family members are notified when an important item is lost or damaged. 10 Overall, this community ensures that your personal items are secure. Form DDALF/R/17- %Facility_ID% %Survey_Run_ID% %Surveyee_ID% May 2010, My InnerView ALF/R/17

21 improve the cleanliness of your rooms and surroundings. IN 1 Your personal space is clean and well maintained. 2 Your bathroom is clean and well maintained. 3 Room accessories (i.e., draperies, bedspreads) are clean and in good condition. 4 The floor in your room is clean and odor free. 5 Floors in the common living areas are clean and odor free. 6 Furnishings in the common living areas are clean and well maintained. 7 Repairs to items in common use are promptly made. 8 Common living areas are free of disturbing noise. 9 The grounds are well groomed and maintained. 10 Overall, rooms and common living areas are clean, well maintained and attractive. Form DDALF/R/18- %Facility_ID% %Survey_Run_ID% %Surveyee_ID% May 2010, My InnerView ALF/R/18

22 improve the control of room temperature. IN 1 The temperature in your personal space is comfortable throughout the year. 2 The temperature is uniformly comfortable throughout your personal space. 3 The temperature in common areas is comfortable throughout the year. 4 The temperature control system is usually in working order. 5 Problems with temperature control in your personal space are addressed in a timely manner. 6 Problems with temperature control in the common living areas are addressed in a timely manner. 7 You have control over setting the temperature in your personal space. 8 You can get help (when needed) to control the temperature in your personal space. 9 Your personal spaces are free from drafts. 10 Overall, you have control over the temperature in this community. Form DDALF/R/19- %Facility_ID% %Survey_Run_ID% %Surveyee_ID% May 2010, My InnerView ALF/R/19

23 improve the variety of meals. IN 1 Menus offer a good variety in meals. 2 A variety of snacks are available upon request. 3 A variety of desserts are offered throughout the week. 4 A variety of beverages are available to meet your preferences. 5 Fresh fruits and vegetables are offered throughout the year. 6 Foods that meet residents ethnic preferences are available. 7 Other food choices are offered when the menu does not appeal to you. 8 Residents with special dietary needs have variety in their menu. 9 You can participate in selecting foods for the menu. 10 Overall, this community offers a variety of foods that meets individual, dietary and ethnic preferences. Form DDALF/R/20- %Facility_ID% %Survey_Run_ID% %Surveyee_ID% May 2010, My InnerView ALF/R/20

24 improve the appeal of food. IN 1 Food is generally tasty. 2 Menus offer a good variety in meals. 3 Food is presented in a pleasing manner. 4 Food is appropriately seasoned. 5 Snacks are appetizing. 6 Snacks are made available in an appealing manner. 7 Food is served appropriately cold, warm or hot. 8 Residents with special dietary needs are offered food that is tasty. 9 Food is presented in a pleasing manner to those with special dietary needs. 10 Overall, food is tasty and presented in a pleasing manner. Form DDALF/R/21- %Facility_ID% %Survey_Run_ID% %Surveyee_ID% May 2010, My InnerView ALF/R/21

25 improve our performance in meeting special dietary needs. IN 1 Residents with special dietary needs are offered food that is tasty. 2 Residents with special dietary needs are offered good variety in meals. 3 Food is presented in a pleasing manner to those with special dietary needs. 4 Food for a resident with special dietary needs is prepared and presented without drawing unwanted attention to the resident. 5 Residents with special dietary needs have a choice as to when and where to have their meals. 6 A sufficient amount of food is served to residents with special dietary needs. 7 Residents with special dietary needs can choose other foods when special menus are offered. 8 Tasty snacks are available to residents with special dietary needs. 9 Residents with special dietary needs are served food that is appropriately cold, warm or hot. 10 Overall, this community meets residents special dietary needs. Form DDALF/R/22- %Facility_ID% %Survey_Run_ID% %Surveyee_ID% May 2010, My InnerView ALF/R/22

26 improve the courteousness of dining room staff. IN 1 Staff contribute to a pleasant and inviting dining room atmosphere. 2 Dining room staff address you by your name of choice. 3 Dining tables are set up in a way that encourages social interaction and friendship. 4 Dining room staff are courteous when attending to your needs. 5 Dining room staff allow you enough time to enjoy your meal. 6 Dining room staff are patient when attending to your needs. 7 Dining room staff attend to your needs (with eating, opening cartons, cutting meat, etc.) without condescension and with respect. 8 Residents and dining room staff interact warmly during meal time. 9 Seating arrangements meet residents preferences (for example: sitting with friends) and special needs (for example: wheelchairs). 10 Overall, you dine in a pleasant and friendly atmosphere assisted by a respectful staff. Form DDALF/R/23- %Facility_ID% %Survey_Run_ID% %Surveyee_ID% May 2010, My InnerView ALF/R/23

27 improve the comfort of your room and surroundings. IN 1 Your room(s) and surroundings have space for their favorite things and memorabilia. 2 The design of the living area (for example: doorways, furniture, places to rest) supports your independence. 3 The temperature of this community is comfortable throughout the year. 4 Common living areas are attractively furnished. 5 Lighting is adequate for reading and other activities. 6 This community is free of sounds that you find disturbing. 7 Suitable places to entertain friends and family are provided. 8 Television and internet access are available by request. 9 Your bathroom is designed to meet your needs and preferences. 10 Overall, living areas promote residents independence, individuality and comfort. Form DDALF/R/24- %Facility_ID% %Survey_Run_ID% %Surveyee_ID% May 2010, My InnerView ALF/R/24

28 improve our performance in providing opportunities for you to participate in community life. IN 1 You can get information about events in the outside community. 2 Transportation is available to area events. 3 The outside community (for example: Girls Scouts, Rotary, church groups) makes use of the building for their functions. 4 You are encouraged to participate in volunteer activities in the outside community. 5 You have opportunity to interact with children. 6 You have opportunity to interact with outside senior groups. 7 You have opportunity to attend outside religious activities. 8 You have opportunity to participate in outside cultural activities. 9 Regular trips to restaurants or for shopping are scheduled. 10 Overall, this community encourages you to interact in the outside community. Form DDALF/R/25- %Facility_ID% %Survey_Run_ID% %Surveyee_ID% May 2010, My InnerView ALF/R/25

29 improve our performance in providing opportunities for you to grow as a person. IN 1 You have opportunity to participate in or lead discussion groups. 2 You have opportunity to participate in discussions (for example: current events, political issues, travelogues). 3 You have opportunity to volunteer in various fields. 4 You can get information on wellness (for example: education and printed materials). 5 You have opportunity to attend cultural events. 6 You are encouraged to read (for example: trips to the library, book clubs, books on tape, book collection on site). 7 You have opportunity to be actively involved in community decision-making (for example: Resident Council meetings). 8 You have opportunity to participate in activities that promote spiritual growth. 9 The internet is easily accessible to you (upon request). 10 Overall, this community promotes activities that foster personal growth (for example: learning a new skill such as crocheting, learning how to read, learning a new language). Form DDALF/R/26- %Facility_ID% %Survey_Run_ID% %Surveyee_ID% May 2010, My InnerView ALF/R/26

30 improve the quality of laundry services. IN 1 Personal laundry is rarely lost. 2 You are given choice regarding whether or not to do your personal laundry. 3 Laundry is returned in a timely fashion. 4 Your clothing is rarely damaged, shrunk, torn or stained. 5 Your clothing is returned unwrinkled and ready to be worn. 6 Staff handle your clothing and apparel with proper care. 7 Staff are sensitive in handling your personal and intimate clothing. 8 You do not get clothing and personal items belonging to another resident. 9 Family members are informed when your clothing needs to be mended or replaced. 10 Overall, the laundry service is efficient and meets your expectations. Form DDALF/R/27- %Facility_ID% %Survey_Run_ID% %Surveyee_ID% May 2010, My InnerView ALF/R/27

31 improve our performance in providing adequate storage space. IN 1 There is adequate closet space for hanging clothes. 2 There is an area to store seasonal items. 3 There is an area to store your additional items. 4 This community arranges for an outside storage unit (if requested). 5 Secure places to store valuable items are provided. 6 Your kitchen has adequate cabinet space. 7 Your personal space has adequate shelves. 8 Your personal space has adequate drawers. 9 Your bathroom has sufficient space for toiletries and other personal items. 10 Overall, this community provides adequate space to meet your storage needs. Form DDALF/R/28- %Facility_ID% %Survey_Run_ID% %Surveyee_ID% May 2010, My InnerView ALF/R/28

32 improve our performance in providing transportation services. IN 1 Transportation for medical appointments is arranged. 2 Transportation for shopping is arranged. 3 Transportation for personal appointments is arranged. 4 Transportation to area events is arranged. 5 The transportation service is reliable. 6 Staff providing transportation are courteous. 7 The transportation service is safe. 8 The transportation service is comfortable. 9 Transportation services are easy and convenient to schedule. 10 Overall, this community s transportation services meet your needs. Form DDALF/R/29- %Facility_ID% %Survey_Run_ID% %Surveyee_ID% May 2010, My InnerView ALF/R/29

33 improve our performance in meeting residents expectations regarding quality of amenities. IN 1 The premises and décor are attractive. 2 Personal items (for example: candy, cards, toiletries) are convenient to purchase. 3 Adequate recreational equipment and furnishings are provided. 4 Library and reading facilities are offered. 5 Computer and internet services are available by request. 6 Televisions are available in convenient, common living areas. 7 Adequate areas for social activities, private celebrations and parties are provided. 8 The transportation service is convenient. 9 Adequate parking is provided. 10 Overall, furnishings, amenities, conveniences and recreational services meet your needs and expectations. Form DDALF/R/30- %Facility_ID% %Survey_Run_ID% %Surveyee_ID% May 2010, My InnerView ALF/R/30

34 improve how accurately the community bills for its services. IN 1 Bills are clear and easy to understand. 2 Bills adequately itemize charges for supplies and services. 3 Charges and bills rarely contain errors. 4 The charges on your bill are as expected and agreed upon. 5 New or additional charges are discussed prior to billing. 6 Bills are submitted on a regular schedule. 7 You were informed of the appropriate person to contact for questions regarding your bill. 8 All concerns about billing are addressed in a timely manner. 9 Convenient payment options are offered. 10 Overall, charges and bills are accurate, clear and as expected. Form DDALF/R/31- %Facility_ID% %Survey_Run_ID% %Surveyee_ID% May 2010, My InnerView ALF/R/31

35 improve how reasonable charges are compared to other communities. IN 1 Charges are appropriate to the type and quality of services provided. 2 Basic charges are appropriate. 3 Food and lodging charges are appropriate. 4 Charges for ancillary services are appropriate. 5 Bills are clear and easy to understand. 6 New or additional charges are discussed prior to billing. 7 Convenient payment options are offered. 8 You were informed about ways to reduce cost. 9 Rate increases are comparable with other assisted living communities in the area. 10 Overall, charges are in line with other assisted living communities in the area. Form DDALF/R/32- %Facility_ID% %Survey_Run_ID% %Surveyee_ID% May 2010, My InnerView ALF/R/32