Consumer Satisfaction Questionnaire

Your voice matters.

Please take a few minutes to share your experience with FUCIS. Your honest feedback helps us continue to improve our services and ensure we are meeting the standards of person-centered care, community integration, and the rights protected under the federal Home and Community-Based Services (HCBS) Final Rule.

Participant Name

Person Completing the Survey (self / family member / authorized representative

Date

FUCIS Staff Contact

We definitely appreciate your feedback1= Excellent 2 = Good 3 = Satisfactory 4 = Poor

Staff & Communication

1|2|3|4

Comments / Suggestions

How would you rate our staff's professionalism in working with you?

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How well do FUCIS staff communicate with you on a regular and timely basis?

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How comfortable do you feel sharing feedback or concerns with FUCIS staff?

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How well does FUCIS provide language access, translation, or other communication support when needed?

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Person-Centered Planning & Choice

How well does FUCIS listen to and reflect your goals, preferences, and dreams in your service plan?

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How well are you supported in choosing the activities, schedule, and services that matter most to you?

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How well do staff respect your decisions, even when they differ from what others may recommend?

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How well does FUCIS support your ability to participate in updating your Individual Program Plan (IPP)?

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Community Integration (HCBS Final Rule)

How well does FUCIS support you in being part of your community alongside people without disabilities?

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How well are you supported in exploring personal interests, hobbies, and community activities?

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How well are you supported in using public transportation (bus, Metro, paratransit) to access community life?

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How well does FUCIS support your involvement in volunteer activities, post-secondary education, or paid internships that match your goals?

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Rights, Dignity & Autonomy (HCBS Final Rule)

How well are you treated with dignity, privacy, and respect by FUCIS staff?

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How free do you feel from coercion, pressure, or restraint while in services?

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How well do you understand your rights as a participant in services?

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How well does FUCIS support your independence in making everyday choices (what to do, where to go, who to spend time with)?

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Program Environment

How would you rate the physical accessibility of FUCIS locations and the community sites you visit?

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How would you rate the overall safety and welcoming feeling of the FUCIS program environment?

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What do you most enjoy or value about FUCIS? (Open response)

What could FUCIS do better to serve you? (Open response)

Are there any HCBS rights or person-centered planning topics you would like more information about? (Open response)

Would you recommend FUCIS to others? ☐ Yes ☐ No ☐ Not Sure

Would you be willing to share a quote about your experience for use on the FUCIS website or in our materials? (With your permission only — we will contact you before publishing anything.) ☐ Yes ☐ No

Your positive action combined with positive thinking results in success.

Email: info@fucis.net

1-323-861-8708

Mon - Fri: 8:00 - 5:00

Consumer Satisfaction Questionnaire

Your voice matters.

Your positive action combined with positive thinking results in success.

Need help? Call our intake team 24/7 at (323) 861-8708

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info@fucis.net

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