Department of Mental Health
Division of Developmental Disabilities
DD Evaluation of Regional Office Contact - On-Site Visit
Type of Visit
Provider Relations
Quality Enhancement
Consumer Relations:
Fiscal Review
Yes
Certification/Licensure
Yes
Other
Select
Technical Assistance
Contract Compliance
Annual Planning
Follow Up
Select
Data Report
Follow Up
QE Review
Nursing Review
SAFE
Select
TCM Monitoring
Follow Up
Inquiry
*
Name of Regional/State Staff Person:
Regional Office
Select
Albany Regional Office
Central Mo Regional Office
Hannibal Regional Office
Joplin Regional Office
Kansas City Regional Office
Kirksville Regional Office
Poplar Bluff Regional Office
Rolla Regional Office
Sikeston Regional Office
Springfield Regional Office
St Louis Regional Office
1. We had adequate information to prepare for the visit.
Strongly Agree
Agree
Uncertain/Neutral
Disagree
Strongly Disagree
2. The state staff were prompt and followed the schedule for the activity.
Strongly Agree
Agree
Uncertain/Neutral
Disagree
Strongly Disagree
3. We were given the opportunity to provide input and/or ask questions during the process.
Strongly Agree
Agree
Uncertain/Neutral
Disagree
Strongly Disagree
4. The visit was conducted in a professional and courteous manner.
Strongly Agree
Agree
Uncertain/Neutral
Disagree
Strongly Disagree
5. The state staff were well-prepared and knowledgeable about standards.
Strongly Agree
Agree
Uncertain/Neutral
Disagree
Strongly Disagree
6. We were provided a clear summary of the result of the visit.
Strongly Agree
Agree
Uncertain/Neutral
Disagree
Strongly Disagree
7. Findings were consistent with the purpose of the visit.
Strongly Agree
Agree
Uncertain/Neutral
Disagree
Strongly Disagree
8. We were given an opportunity to respond to potential issues identified.
Strongly Agree
Agree
Uncertain/Neutral
Disagree
Strongly Disagree
9. The written report was consistent with the comments of the state staff.
Strongly Agree
Agree
Uncertain/Neutral
Disagree
Strongly Disagree
10. The recommendations provided useful information and guidelines for future operations.
Strongly Agree
Agree
Uncertain/Neutral
Disagree
Strongly Disagree
11. Participation in the process assists us in serving our clients better.
Strongly Agree
Agree
Uncertain/Neutral
Disagree
Strongly Disagree
12. Overall, we were satisfied with the process.
Strongly Agree
Agree
Uncertain/Neutral
Disagree
Strongly Disagree
Comments
Provider:
Name Completing Survey