ࡱ> QSP Cbjbj 0\I...8fL.f>>TTT///0222222$5!V/////VTTIII/dTT0I/0II|Tx"0,!!!T//I/////VVI///////!///////// : Questionnaire for Adults The questionnaire will take about 10 minutes to complete. What to do: Please tick one answer for each question. If a question is not relevant to you, then please leave that question blank. If you make a mistake or change your mind, please cross out the incorrect answer and tick your correct answer. If you want to, please add any comments in the space below the statement about your answers. Please continue on another sheet if you would like to say more about any of your answers. Thinking about your life at the moment, do you agree with the following: I live in a home that best supports my well-being. For example, it is the right home for your current needs Yes Sometimes No Don t know Please add any comments if you would like to: & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & 2. I can do the things that are important to me Yes Sometimes No Don t know Please add any comments if you would like to: & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & 3. I feel I am part of my community Yes Sometimes No Don t know Please add any comments if you would like to: & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & 4. I am happy with the support from my family, friends and neighbours Yes Sometimes No Don t know Please add any comments if you would like to: & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & 5. I feel safe For example, safe from any kind of abuse, physical harm or from falling both inside and outside your home Yes Sometimes No Don t know Please add any comments if you would like to: & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & Thinking about the care and support you have had, do you agree with the following: 6. I know who to contact about my care and support Yes Sometimes No Don t know Please add any comments if you would like to: & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & 7. I have had the right information or advice when I needed it Yes Sometimes No Don t know Please add any comments if you would like to: & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & 8. I have been actively involved in decisions about how my care and support was provided Yes Sometimes No Don t know Please add any comments if you would like to: & & & & & & & & & & & & & & & & & & & & TU`abI K   ñ҄҄҄҄ufTFhaCJOJQJ^JaJ#hxhx5CJ$OJQJ^JaJ$ha5CJOJQJ^JaJhx5CJOJQJ^JaJhM a5CJOJQJ^JaJha5CJ OJQJ^JaJ hM a5CJ OJQJ^JaJ #hxhW5CJOJQJ^JaJhW5CJOJQJ^JaJha5CJOJQJ^JaJha5CJ$OJQJ^JaJ$hM a5CJ$OJQJ^JaJ$TUabJ K   x z $ hh^h`hgdx & F5x^5gdxgdW  v x z | ~ " $ & r v teWWWhaCJOJQJ^JaJhM a6CJOJQJ^JaJhM a6CJOJQJ^JaJhaCJOJQJ^JaJhxCJ$^JaJ$hM aCJ$^JaJ$hM aCJOJQJ^JaJhaCJOJQJ^JaJhahM a6CJOJQJ^JaJhx5CJOJQJ^JaJhM a5CJOJQJ^JaJhxCJOJQJ^JaJ$ & t v ( * t x &(vxz|~vx` & ( * , . 8 : L N P R V \ ^ r t v x z $(txƸufXXXƸhaCJOJQJ^JaJhM a6CJOJQJ^JaJhM a6CJOJQJ^JaJhaCJOJQJ^JaJhM aCJOJQJ^JaJhahxCJ$^JaJ$hM aCJ$^JaJ$hM aCJOJQJ^JaJhaCJOJQJ^JaJha5CJOJQJ^JaJhM a5CJOJQJ^JaJhxCJOJQJ^JaJ"tvx̾ڑufXhaCJOJQJ^JaJhM a5CJOJQJ^JaJhxCJOJQJ^JaJhaCJOJQJ^JaJha5CJOJQJ^JaJhM a6CJOJQJ^JaJhM a6CJOJQJ^JaJhaCJOJQJ^JaJhM aCJOJQJ^JaJhahxCJ$^JaJ$hM aCJ$^JaJ$hM aCJOJQJ^JaJ"TV8:^gdx0x^`0gdx 0^`0`RTV̾ޒޒufWHڄhM a6CJOJQJ^JaJhx5CJOJQJ^JaJhx5CJOJQJ^JaJha5CJOJQJ^JaJhaCJOJQJ^JaJhaCJOJQJ^JaJha6CJOJQJ^JaJhM a6CJOJQJ^JaJhaCJOJQJ^JaJhM aCJOJQJ^JaJhahM aCJOJQJ^JaJhM aCJ$^JaJ$hxCJ$^JaJ$ "68:<68:<JL̽ڠ򠒄ufbSDha5CJOJQJ^JaJhM a5CJOJQJ^JaJhxha5CJ$OJQJ^JaJ$hM a5CJ$OJQJ^JaJ$hxCJOJQJ^JaJhaCJOJQJ^JaJhaCJOJQJ^JaJhM a6CJOJQJ^JaJhM a6CJOJQJ^JaJhaCJ OJQJ^JaJ hahM aCJ$^JaJ$hxCJ$^JaJ$hM aCJOJQJ^JaJ8:<LNHJ"$nr 0^`0LNPR\^prtvzFHJ "̾̑ufWHhM a5CJOJQJ^JaJhx5CJOJQJ^JaJha5CJOJQJ^JaJhaCJOJQJ^JaJhaCJOJQJ^JaJha5CJOJQJ^JaJhM a6CJOJQJ^JaJhM a6CJOJQJ^JaJhaCJ OJQJ^JaJ hahxCJ$^JaJ$hM aCJ$^JaJ$hM aCJOJQJ^JaJhaCJOJQJ^JaJ"$&(24FHJLPVXlnprt "npv&(*,.8:̯̾̑udUhM a5CJOJQJ^JaJ hM 56CJ^JaJmH sH haCJOJQJ^JaJhaCJOJQJ^JaJha5CJOJQJ^JaJhM a6CJOJQJ^JaJhM a6CJOJQJ^JaJhM aCJOJQJ^JaJhahxCJ$^JaJ$hM aCJ$^JaJ$hM aCJOJQJ^JaJhaCJOJQJ^JaJ! "prtv(*tv$6&6t6v6x66v7x777"8$8`gd'q0x^`0gd'q 0^`0$a$gdx:LNPRV\^rtvx6"6$6&6r6t6x666t7v7x7̽ڟrcTFhaCJOJQJ^JaJhM a6CJOJQJ^JaJh'q5CJOJQJ^JaJhM a5CJOJQJ^JaJhaCJOJQJ^JaJhaCJOJQJ^JaJUha5CJOJQJ^JaJhM a6CJOJQJ^JaJhM a6CJOJQJ^JaJhaCJ OJQJ^JaJ hahxCJ$^JaJ$hM aCJ$^JaJ$hM aCJOJQJ^JaJ& & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & 9. I was able to communicate in my preferred language For example, using English, Welsh, Polish, Bengali or any other language Yes Sometimes No Don t know Please add any comments if you would like to: & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & 10. I was treated with dignity and respect Yes Sometimes No Don t know Please add any comments if you would like to: & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & 11. I am happy with the care and support I have had Yes Sometimes No Don t know Please add any comments if you would like to: & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & 12. Please only answer this question if you live in a residential care home: It was my choice to live in a residential care home Yes Sometimes No Don t know Please add any comments if you would like to: & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & 13. Please only answer this question if you are aged 18-24 years old: I have had advice, help and support that will prepare me for adulthood Yes Sometimes No Don t know Please add any comments if you would like to: & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & A little about you& .. 14. Are you? Male Female Prefer not to say 15. How old are you? 18-24 years old 25-64 years old 65-84 years old 85+ years old Thank you for your help. 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