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Professionalism
Direct Support Professionals treat the person supported with respect and dignity. Yes     No     Not Applicable    
Direct Support Professinoals treat peers of the person supported with respect and dignity. Yes     No     Not Applicable    
Direct Support Professionals treat each other with respect and dignity. Yes     No     Not Applicable    
Direct Support Professionals know the person supported's programs and Person Centered Service Plan. Yes     No     Not Applicable    
Direct Support Professionals perform their duties. Yes     No     Not Applicable    
Direct Support Professinoals have positive attitudes. Yes     No     Not Applicable    
Direct Support Professionals give me access to reports/consents as appropriate. Yes     No     Not Applicable    
Personal Needs Met
Direct Support Professionals listen and talk with the person suppported. Yes     No     Not Applicable    
Direct Support Professionals help the person supported learn to take care of themself. Yes     No     Not Applicable    
Direct Support Profesionals help the person supported when they ask. Yes     No     Not Applicable    
Direct Support Professionals help the person supported with emergencies. Yes     No     Not Applicable    
Direct Support Professionals help the person supported call/write other when they ask. Yes     No     Not Applicable    
Direct Support Professionals help the person supported call their job when they ask. Yes     No     Not Applicable    
Direct Support Preofessionals call or visit the person supported's job when needed. Yes     No     Not Applicable    
Direct Support Preofessionals help the person supported call for appointments when they need to. Yes     No     Not Applicable    
Direct Support Professionals help the person supported get to appointments when they need to. Yes     No     Not Applicable    
Direct Support Professionals help the person supported solve their problems or concerns. Yes     No     Not Applicable    
Support Services
Direct Support Professionals explain services the person supported can use. Yes     No     Not Applicable    
I like how the Person Centered Service Plan meetings of the person supported are run. Yes     No     Not Applicable    
The Person Centered Service Plan lists all the supports the person supported needs. Yes     No     Not Applicable    
The Person Centered Service Plan lists the person supported's goals and dreams. Yes     No     Not Applicable    
Administration responds to my concerns and needs. Yes     No     Not Applicable    
The person supported gets the amount and type of food they like. Yes     No     Not Applicable    
The person supported's medical needs are met. Yes     No     Not Applicable    
The person supported's housing needs are met. Yes     No     Not Applicable    
Home and Roommate Satisfaction
Is the home clean? Yes     No     Not Applicable    
Is the furniture in good condition? Yes     No     Not Applicable    
Is the house warm enough in winter and cool enough in summer? Yes     No     Not Applicable    
IS the house easy to access, both entering and exiting? Yes     No     Notapplicable    
Does the person supported have privacy in the bathroom/bedroom when it is needed? Yes     No     Not Applicable    
Does the person supported get along with the other people liveing in the home? Yes     No     Not Applicable    
Personal Comments/Information
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Fraser Ltd.

 

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