Domiciliary Care Feedback Form Domiciliary Feedback Form If you have become a client with Sustain, referred a client(s) to Sustain for Domiciliary Care or have worked in some other way with us, we would like to hear what you thought about the experience. We wish to gauge more about your experience with Sustain so that we can improve our service and would be grateful if you could complete this short survey. We aim to provide a service that is safe, effective, caring, responsive and well-led while promoting a culture of openness and fairness. The CQC Definition of Safe: “people are protected from abuse and avoidable harm”*Do you consider the service provided by Sustain UK Limited to be 'Safe?' Yes No Comments (Optional)The CQC Definition of Effective: “people’s care, treatment and support achieve good outcomes, promotes a good quality of life and is evidence-based where possible”*Do you consider the service provided by Sustain UK Limited to be 'Effective'? Yes No Comments (Optional)The CQC Definition of Caring: “staff involve people and treat people with compassion, kindness, dignity and respect”*Do you consider the service provided by Sustain UK Limited to be 'Caring'? Yes No Comments (Optional)The CQC Definition of Responsive: “services are organised so that they meet people’s needs.”*Do you consider the service provided by Sustain UK Limited to be 'Responsive'? Yes No Comments (Optional)The CQC Definition of Well-led: “the leadership, management and governance of the organisation assures the delivery of high-quality person-centred care, supports learning and innovation, and promotes an open and fair culture”*Do you consider the service provided by Sustain UK Limited to be 'Well-led'? Yes No Comments (Optional)How would you rank our overall performance in your experience?* Excellent Very Good Adequate Needs Improvement Poor Did we achieve what we promised for you?* Yes No As you answered 'No,' please provide some details below*Your comments:Would you recommend Sustain to a colleague?* Yes No As you answered 'No', please provide some details as to what you believe we would need to introduce or change, in order for you to recommend us*Your comments:Any other comments?Completed by: Organisation: HiddenDate* MM slash DD slash YYYY