The Millings Care Home: Survey for Residents

Introduction
Thank you very much for taking part in our Enter & View Visit today!

Please fill in this survey using the notes you made and any feedback you gathered from residents during the Enter & View visit. Please submit a new response for each resident.
For example, if you spoke to 4 residents during the visit then you will need to complete this survey 4 times, once for each resident.

Don’t worry if you leave some questions blank, just fill in as much as you can based on the feedback you gathered.

Could you also ask the resident if they would like to receive our printed newsletter, and if so we would be delighted to include their care home on our distribution list.

1. We will use all of the anonymised feedback gathered during the visit and from this survey to write a report with recommendations.
The consent option indicates that:
The resident voluntarily agreed to participate and agreed to their data being anonymously used and stored by Healthwatch.
Please see our Privacy Terms & Conditions for more information).

• You have read the above information about the survey.
• You voluntarily agree to participate. *

I received consent from the resident
I do not receive consent from the resident

2. Anonymous demographic details of person who received the care:

	Male	Female
80 or older	80 or older Male	80 or older Female
65-79	65-79 Male	65-79 Female
50-64	50-64 Male	50-64 Female
25-49	25-49 Male	25-49 Female
18-24	18-24 Male	18-24 Female
17 or younger	17 or younger Male	17 or younger Female

3. Ethnicity:

	Yes
White	White Yes
White non-British, please specify	White non-British, please specify Yes
Asian or Asian British	Asian or Asian British Yes
Mixed	Mixed Yes
Black or Black British	Black or Black British Yes
Other Ethnic Group	Other Ethnic Group Yes
I do not know	I do not know Yes