Page 218 - QAP Manual 2020

NCI™ ADULT IN-PERSON SURVEY (IPS) 2020-21

50. Were you able to choose the services that you get as part of your IPP?
□ 98. Not applicable – no IPP

□ 2. Yes
□ 3. Had some input
□ 1. No
□ 99. Don’t know, no response, unclear response

51. If you want to change something about your services, do you know
whom to ask?

□ 2. Yes
□ 3. Maybe
□ 1. No
□ 99. Don’t know, no response, unclear response

PS-6 52. Do you have staff who help you? (For example, at your home, job, or
 day program?)
(Does_________________________________help you?)

□ 2. Yes
□ 1. No →Code 53-54 and CA-9 as ‘Not applicable’
□ 99. Don’t know, no response, unclear response →Code 53-54 and CA-9
as ‘Don’t know, no response, unclear response’

PS-6 53. Do your staff treat you with respect? (Do they listen and talk to you?)
 (Does_________________________________treat you with respect?)

□ 98. Not applicable – doesn’t have staff
□ 2. Yes – all staff, always
□ 3. Sometimes or some staff

□ 1. No
□ 99. Don’t know, no response, unclear response

CA-9. Do your staff support you in a way that is respectful to your culture?

□ 98. Not applicable – doesn’t have staff
□ 2. Yes – all staff, always
□ 3. Sometimes or some staff
□ 1. No
□ 99. Don’t know, no response, unclear response

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